Report on Training of Health Professionals on Climate and Health

The role of climate in health is currently enjoying a high profile among the international community in terms of demonstrating climate risk management and adaptation to a changing climate. The effect of climate variability and change on heath is a serious issue for most sub-Saharan African countries. Among the diseases that have public health importance in Ethiopia are malaria, meningitis and acute watery diarrhea. Understanding the relationship of climate and health in Ethiopia would be a tremendous help in early containment of these diseases. In Ethiopia, before the establishment of a Climate and Health Working Group (CHWG), which includes the Federal Ministry of Health and the National Meteorological Agency among other partners, the sharing of information among the two key players was minimal. The goal of this working group is to create a climate-informed health sector that routinely requests and uses appropriate climate information to improve the effectiveness of health interventions. In order to meet its goals, the working group, in collaboration with the International Research Institute for Climate and Society (IRI), organized a six-day training course for health professionals on climate and health. In this training, the Summer Institute course "Climate Information for Public Health" (held for the past two years at IRI in New York), was adapted and implemented. The Summer Institute has involved four Ethiopian participants, one from the National Meteorological Agency (NMA), and three from the Ministry of Health. They played a key role in facilitating some of the course lectures themselves and in identifying local professionals who could also contribute to the curriculum. The general goal of the six-day training was to build the national capacity in order to utilize climate information for decision-making in the health sector at national and regional state levels. The training was comprised of three components: core lectures, practical sessions, and short recap presentations by the participants. Sixteen participants were involved in the training. The selection of the participants was done in consultation with the Federal Ministry of Health. Participants came primarily from the Public Health Emergency Management Units of regional and federal health bureaus and were chosen for their roles in the decision-making around the prevention and control of climate-sensitive diseases. Three types of evaluation were carried out, a pre- and post-test, as well as an overall evaluation. The pre- and post-test helped to evaluate the level of knowledge about climate and health before and after the training. The latter helped in evaluating the organization of the overall training. Generally, the evaluations revealed that the training helped to increase the knowledge of the links between climate and health, as well as the use of climate information for decision-making in the public health sector. This training is the first of its kind organized in Ethiopia, especially at a national level. Most of the participants agreed on the suitability of the content, design and delivery of the course and showed their interest in organizing similar training initiatives in their respective home institutions. It is possible to recommend that this training should be extended to the regional health bureau level, with the already trained participants taking the primary responsibility of facilitating these follow-on activities with the close support of the CHWG. The collaboration of the regional branch offices of the National Meteorological Agency, with respect to using climate information, would play a crucial role in this endeavor. The most important point is to sustain this training and update its contents accordingly. The future research agenda and evidence generation efforts of the CHWG and its members should also focus on other climate sensitive diseases. Even though participants did not indicate there were always established ties to local universities in different parts of the country, these potential partnerships should be addressed in sharing the knowledge of the use of climate information for public health decision-making and in prioritizing locally important diseases. The training was held at UNECA, Addis Ababa, Ethiopia, between November 31st and December 5th, 2009. Financial and technical support was provided by IRI with funding from the Google.org sponsored project "Building Capacity to Produce and Use Climate and Environmental Information for Improving Health in East Africa.

Report on Training of Health Professionals on Climate and Health

The role of climate in health is currently enjoying a high profile among the international community in terms of demonstrating climate risk management and adaptation to a changing climate. The effect of climate variability and change on heath is a serious issue for most sub-Saharan African countries. Among the diseases that have public health importance in Ethiopia are malaria, meningitis and acute watery diarrhea. Understanding the relationship of climate and health in Ethiopia would be a tremendous help in early containment of these diseases. In Ethiopia, before the establishment of a Climate and Health Working Group (CHWG), which includes the Federal Ministry of Health and the National Meteorological Agency among other partners, the sharing of information among the two key players was minimal. The goal of this working group is to create a climate-informed health sector that routinely requests and uses appropriate climate information to improve the effectiveness of health interventions. In order to meet its goals, the working group, in collaboration with the International Research Institute for Climate and Society (IRI), organized a six-day training course for health professionals on climate and health. In this training, the Summer Institute course "Climate Information for Public Health" (held for the past two years at IRI in New York), was adapted and implemented. The Summer Institute has involved four Ethiopian participants, one from the National Meteorological Agency (NMA), and three from the Ministry of Health. They played a key role in facilitating some of the course lectures themselves and in identifying local professionals who could also contribute to the curriculum. The general goal of the six-day training was to build the national capacity in order to utilize climate information for decision-making in the health sector at national and regional state levels. The training was comprised of three components: core lectures, practical sessions, and short recap presentations by the participants. Sixteen participants were involved in the training. The selection of the participants was done in consultation with the Federal Ministry of Health. Participants came primarily from the Public Health Emergency Management Units of regional and federal health bureaus and were chosen for their roles in the decision-making around the prevention and control of climate-sensitive diseases. Three types of evaluation were carried out, a pre- and post-test, as well as an overall evaluation. The pre- and post-test helped to evaluate the level of knowledge about climate and health before and after the training. The latter helped in evaluating the organization of the overall training. Generally, the evaluations revealed that the training helped to increase the knowledge of the links between climate and health, as well as the use of climate information for decision-making in the public health sector. This training is the first of its kind organized in Ethiopia, especially at a national level. Most of the participants agreed on the suitability of the content, design and delivery of the course and showed their interest in organizing similar training initiatives in their respective home institutions. It is possible to recommend that this training should be extended to the regional health bureau level, with the already trained participants taking the primary responsibility of facilitating these follow-on activities with the close support of the CHWG. The collaboration of the regional branch offices of the National Meteorological Agency, with respect to using climate information, would play a crucial role in this endeavor. The most important point is to sustain this training and update its contents accordingly. The future research agenda and evidence generation efforts of the CHWG and its members should also focus on other climate sensitive diseases. Even though participants did not indicate there were always established ties to local universities in different parts of the country, these potential partnerships should be addressed in sharing the knowledge of the use of climate information for public health decision-making and in prioritizing locally important diseases. The training was held at UNECA, Addis Ababa, Ethiopia, between November 31st and December 5th, 2009. Financial and technical support was provided by IRI with funding from the Google.org sponsored project "Building Capacity to Produce and Use Climate and Environmental Information for Improving Health in East Africa.

Baseline survey for the implementation of insecticide treated mosquito nets in Malaria control in Ethiopia

No Abstract Available Ethiop.J.Health Dev. Vol.19 (1) 2005: 16-2

The Ethiopian Field Epidemiology and Laboratory Training Program: strengthening public health systems and building human resource capacity

The Ethiopian Field Epidemiology and Laboratory Training Program (EFELTP) is a comprehensive two-year competency-based training and service program designed to build sustainable public health expertise and capacity. Established in 2009, the program is a partnership between the Ethiopian Federal Ministry of Health, the Ethiopian Health and Nutrition Research Institute, Addis Ababa University School of Public Health, the Ethiopian Public Health Association and the US Centers of Disease Control and Prevention. Residents of the program spend about 25% of their time undergoing didactic training and the 75% in the field working at program field bases established with the MOH and Regional Health Bureaus investigating disease outbreaks, improving disease surveillance, responding to public health emergencies, using health data to make recommendations and undertaking other field Epidemiology related activities on setting health policy. Residents from the first 2 cohorts of the program have conducted more than 42 outbreaks investigations, 27analyses of surveillance data, evaluations of 11 surveillance systems, had28oral and poster presentation abstracts accepted at 10 scientific conferences and submitted 8 manuscripts of which 2are already published. The EFELTP has provided valuable opportunities to improve epidemiology and laboratory capacity building in Ethiopia. While the program is relatively young, positive and significant impacts are assisting the country better detect and respond to epidemics and address diseases of major public health significance

Malaria indicator survey 2007, Ethiopia: coverage and use of major malaria prevention and control interventions

<p>Abstract</p> <p>Background</p> <p>In 2005, a nationwide survey estimated that 6.5% of households in Ethiopia owned an insecticide-treated net (ITN), 17% of households had been sprayed with insecticide, and 4% of children under five years of age with a fever were taking an anti-malarial drug. Similar to other sub-Saharan African countries scaling-up malaria interventions, the Government of Ethiopia set an ambitious national goal in 2005 to (i) provide 100% ITN coverage in malarious areas, with a mean of two ITNs per household; (ii) to scale-up indoor residual spraying of households with insecticide (IRS) to cover 30% of households targeted for IRS; and (iii) scale-up the provision of case management with rapid diagnostic tests (RDTs) and artemisinin-based combination therapy (ACT), particularly at the peripheral level.</p> <p>Methods</p> <p>A nationally representative malaria indicator survey (MIS) was conducted in Ethiopia between September and December 2007 to determine parasite and anaemia prevalence in the population at risk and to assess coverage, use and access to scaled-up malaria prevention and control interventions. The survey used a two-stage random cluster sample of 7,621 households in 319 census enumeration areas. A total of 32,380 people participated in the survey. Data was collected using standardized Roll Back Malaria Monitoring and Evaluation Reference Group MIS household and women's questionnaires, which were adapted to the local context.</p> <p>Results</p> <p>Data presented is for households in malarious areas, which according to the Ethiopian Federal Ministry of Health are defined as being located <2,000 m altitude. Of 5,083 surveyed households, 3,282 (65.6%) owned at least one ITN. In ITN-owning households, 53.2% of all persons had slept under an ITN the prior night, including 1,564/2,496 (60.1%) children <5 years of age, 1,891/3,009 (60.9%) of women 15 - 49 years of age, and 166/266 (65.7%) of pregnant women. Overall, 906 (20.0%) households reported to have had IRS in the past 12 months. Of 747 children with reported fever in the two weeks preceding the survey, 131 (16.3%) sought medical attention within 24 hours. Of those with fever, 86 (11.9%) took an anti-malarial drug and 41 (4.7%) took it within 24 hours of fever onset. Among 7,167 surveyed individuals of all ages, parasitaemia as estimated by microscopy was 1.0% (95% CI 0.5 - 1.5), with 0.7% and 0.3% due to <it>Plasmodium falciparum </it>and <it>Plasmodium vivax</it>, respectively. Moderate-severe anaemia (haemoglobin <8 g/dl) was observed in 239/3,366 (6.6%, 95% CI 4.9-8.3) children <5 years of age.</p> <p>Conclusions</p> <p>Since mid-2005, the Ethiopian National Malaria Control Programme has considerably scaled-up its malaria prevention and control interventions, demonstrating the impact of strong political will and a committed partnership. The MIS showed, however, that besides sustaining and expanding malaria intervention coverage, efforts will have to be made to increase intervention access and use. With ongoing efforts to sustain and expand malaria intervention coverage, to increase intervention access and use, and with strong involvement of the community, Ethiopia expects to achieve its targets in terms of coverage and uptake of interventions in the coming years and move towards eliminating malaria.</p

Elimination of Guinea Worm Disease in Ethiopia; current status of the diseases, eradication strategies and challenges to the endgame

Background: Dracunculiasis, also named Guinea Worm Disease (GWD), is one of the diseases listed under Neglected Tropical Diseases caused by a parasitic nematode known as Dracunculus medinensis. Given, its feasibility for eradication, the Guinea Worm Eradication Program (GWEP) was launched in 1980 with the aim of eradicating the disease. This paper reviews the current status of the global Guinea worm eradication in Ethiopia and intervention strategies. Methods: Published papers related to infectious diseases elimination, particularly of GWD were extracted from PubMed, WHO, CDC, and Google Scholar. Of these, the CDC website, WHO online atlas (GW data store) and recent data from EDEP were extensively used. Results: In Ethiopia, the Ethiopian EDEP which was established in 1993 has made remarkable move towards interruption of disease transmission and now the endgame is fast approaching. The EDEP with support mainly from partners has reduced GWD by more than 99% from 1994 to 2015. In 2016, 3 human cases, 14 dogs and 2 baboon infections were reported. Refugee influx from the Republic of South Sudan, increased animal infections with unknown role in transmission of Dracunculiasis, the presence of hard to reach communities and lack of safe water sources in remote non-village areas remain among important challenges at this final stage of GWD eradication in Ethiopia. Conclusion: Eradication strategies encompassing community education for behavioral change including raising awareness towards cash reward for reporting Guniea Worm Disease (GWD) and animal infection, case containment, surveillance systems, provision of safe water supply, and ABATE chemical application are discussed

Epidemiology of rubella virus cases in the pre-vaccination era of Ethiopia, 2009–2015

Abstract Background Rubella is a common mild rash illness caused by rubella virus. The majority of infections occur in children and young adults. The infection is the cause of a serious birth defect known as Congenital Rubella Syndrome (CRS) when a woman acquires infection early in pregnancy. Ethiopia has not yet established rubella virus surveillance and has not yet introduced rubella vaccine into the routine immunization program. We characterize the epidemiology of laboratory confirmed rubella virus cases collected through measles surveillance from 2009 to 2015 to better understand the burden of the disease in the country. Methods A descriptive analysis was made to characterize rubella cases reported through the national measles case based surveillance system. The measles case definition was used to capture potential rubella cases. A suspected measles case was a person with generalized rash and fever with cough, or coryza or conjunctivitis. Those cases whose sera were negative for measles IgM antibodies were tested for rubella IgM antibody. A confirmed rubella case was a person who tested positive for rubella IgM. Only laboratory confirmed rubella cases were analyzed in this article. Results Between 2009 and 2015, a total of 28,284 serum/plasma samples were collected and tested for measles IgM antibody and 11,151 (39.4%) were found positive. A total of 17,066 measles IgM negative or indeterminate samples were tested for rubella virus IgM and 2615 (15.3%) were found positive during the same period. Of 2615 confirmed rubella cases, 52.2% were females. The age of confirmed cases ranged from one month to 42 years with a mean age of 7.3 years. Three-fourth of all confirmed rubella cases were aged less than 10 years. The number of laboratory confirmed rubella cases linearly increased from 83 in 2009 to 856 in 2013 but dropped to 222 and 319 in 2014 and 2015 respectively. Higher number of cases occurred in the hot dry season (January through June) and in the central and western part of Ethiopia with 127 lab-confirmed outbreaks in the study period. Conclusions Based on our analysis, rubella was found to be endemic throughout Ethiopia. Children below the age of 10 years were the most affected. The burden of rubella cases varied from year to year but had a seasonal peak in March. To better understand the magnitude of rubella prior to vaccine introduction, establishing rubella surveillance system, conducting sero-prevalence studies among child bearing age females and establishing CRS sentinel surveillance among young infants are critical

Rapid Increase in Ownership and Use of Long-Lasting Insecticidal Nets and Decrease in Prevalence of Malaria in Three Regional States of Ethiopia (2006-2007)

Following recent large scale-up of malaria control interventions in Ethiopia, this study aimed to compare ownership and use of long-lasting insecticidal nets (LLIN), and the change in malaria prevalence using two population-based household surveys in three regions of the country. Each survey used multistage cluster random sampling with 25 households per cluster. Household net ownership tripled from 19.6% in 2006 to 68.4% in 2007, with mean LLIN per household increasing from 0.3 to 1.2. Net use overall more than doubled from 15.3% to 34.5%, but in households owning LLIN, use declined from 71.7% to 48.3%. Parasitemia declined from 4.1% to 0.4%. Large scale-up of net ownership over a short period of time was possible. However, a large increase in net ownership was not necessarily mirrored directly by increased net use. Better targeting of nets to malaria-risk areas and sustained behavioural change communication are needed to increase and maintain net use

In Vivo Efficacy of Artemether-Lumefantrine and Chloroquine against Plasmodium vivax: A Randomized Open Label Trial in Central Ethiopia

Background In vivo efficacy assessments of antimalarials are essential for ensuring effective case management. In Ethiopia, chloroquine (CQ) without primaquine is the first-line treatment for Plasmodium vivax in malarious areas, but artemether-lumefantrine (AL) is also commonly used. Methods and Findings In 2009, we conducted a 42-day efficacy study of AL or CQ for P. vivax in Oromia Regional State, Ethiopia. Individuals with P. vivax monoinfection were enrolled. Primary endpoint was day 28 cure rate. In patients with recurrent parasitemia, drug level and genotyping using microsatellite markers were assessed. Using survival analysis, uncorrected patient cure rates at day 28 were 75.7% (95% confidence interval (CI) 66.8–82.5) for AL and 90.8% (95% CI 83.6–94.9) for CQ. During the 42 days of follow-up, 41.6% (47/113) of patients in the AL arm and 31.8% (34/107) in the CQ arm presented with recurrent P. vivax infection, with the median number of days to recurrence of 28 compared to 35 days in the AL and CQ arm, respectively. Using microsatellite markers to reclassify recurrent parasitemias with a different genotype as non-treatment failures, day 28 cure rates were genotype adjusted to 91.1% (95% CI 84.1–95.1) for AL and to 97.2% (91.6–99.1) for CQ. Three patients (2.8%) with recurrent parasitemia by day 28 in the CQ arm were noted to have drug levels above 100 ng/ml. Conclusions In the short term, both AL and CQ were effective and well-tolerated for P. vivax malaria, but high rates of recurrent parasitemia were noted with both drugs. CQ provided longer post-treatment prophylaxis than AL, resulting in delayed recurrence of parasitemia. Although the current policy of species-specific treatment can be maintained for Ethiopia, the co-administration of primaquine for treatment of P. vivax malaria needs to be urgently considered to prevent relapse infections. Trial Registration ClinicalTrials.gov NCT0105258

Initial evidence of reduction of malaria cases and deaths in Rwanda and Ethiopia due to rapid scale-up of malaria prevention and treatment

<p>Abstract</p> <p>Background</p> <p>An increasing number of malaria-endemic African countries are rapidly scaling up malaria prevention and treatment. To have an initial estimate of the impact of these efforts, time trends in health facility records were evaluated in selected districts in Ethiopia and Rwanda, where long-lasting insecticidal nets (LLIN) and artemisinin-based combination therapy (ACT) had been distributed nationwide by 2007.</p> <p>Methods</p> <p>In Ethiopia, a stratified convenience sample covered four major regions where (moderately) endemic malaria occurs. In Rwanda, two districts were sampled in all five provinces, with one rural health centre and one rural hospital selected in each district. The main impact indicator was percentage change in number of in-patient malaria cases and deaths in children < 5 years old prior to (2001–2005/6) and after (2007) nationwide implementation of LLIN and ACT.</p> <p>Results</p> <p>In-patient malaria cases and deaths in children < 5 years old in Rwanda fell by 55% and 67%, respectively, and in Ethiopia by 73% and 62%. Over this same time period, non-malaria cases and deaths generally remained stable or increased.</p> <p>Conclusion</p> <p>Initial evidence indicated that the combination of mass distribution of LLIN to all children < 5 years or all households and nationwide distribution of ACT in the public sector was associated with substantial declines of in-patient malaria cases and deaths in Rwanda and Ethiopia. Clinic-based data was a useful tool for local monitoring of the impact of malaria programmes.</p