Pertussis outbreak in Southern Ethiopia: challenges of detection, management and response

Abstract Background: Despite the availability of effective vaccines, pertussis remains endemic with high fatality rates in low and middle-income countries (LMIC).This study aims to describe an outbreak of pertussis in a health district of Ethiopia. The study highlights the challenges faced by the health system in identifying pertussis cases and appropriately responding to the outbreak at the district level. Methods: a descriptive cross-sectional study was conducted using data sourced from the District Public Health Emergency and Management (PHEM) surveillance service and outbreak management field reports. Stratified attack rates and fatality rates for pertussis are described. Systemic problems leading to the outbreak are explored and narrated. A modified CDC pertussis case definition was employed with a polymerase chain reaction used to confirm cases. Results: From September 2018 to January 2019, 1840 suspected, probable, and confirmed pertussis cases and six deaths were identified. Pertussis cases ranged from 1 month to 51 years in age and an outbreak occurred in 14 out of the 24 villages of Dara Malo district. The overall attack rate was 1708 per 100,000 population with a fatality rate of 3.3 per 1,000 pertussis cases. The highest attack rate of 12,689/100,000 was seen in infants. Among confirmed, probable and suspected pertussis cases, only 41.1% had completed the three-dose pertussis vaccine's primary schedule. The household survey revealed the population coverage of 73.4% and 40.8% for Pentavalent vaccine dose one and three respectively. Investigations suggested the existence of a poor cold chain management system in the study area. Conclusions: There is an urgent need to build capacity to strengthen routine vaccination services and improving the maintenance of the vaccine cold chain. Other Low-and Middle -Income Countries (LMICs), are urged to take lessons learned from this outbreak and strengthen their own vaccination programs and capacitate health workers to manage local outbreaks.

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Pertussis outbreak in Southern Ethiopia: challenges of detection, management and response

10.21203/rs.2.17809/v3 ◽

2020 ◽

Author(s):

Aychiluhim Damtew Mitiku ◽

Mesele Damte Argaw ◽

Binyam Fekadu Desta ◽

Zergu Taffesse Tsegaye ◽

Afework Ayele Atsa ◽

...

Keyword(s):

Attack Rate ◽

Health Workers ◽

Vaccine Dose ◽

Lessons Learned ◽

Cold Chain ◽

Southern Ethiopia ◽

Cross Sectional ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

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Pertussis outbreak in Southern Ethiopia: challenges of detection, management and response

10.21203/rs.2.17809/v2 ◽

2020 ◽

Author(s):

Aychiluhim Damtew Mitiku ◽

Mesele Damte Argaw ◽

Binyam Fekadu Desta ◽

Zergu Taffesse Tsegaye ◽

Afework Ayele Atsa ◽

...

Keyword(s):

Attack Rate ◽

Health Workers ◽

Case Definition ◽

Cold Chain ◽

Southern Ethiopia ◽

Cross Sectional ◽

Middle Income ◽

Outbreak Management ◽

Middle Income Countries ◽

Low And Middle Income

Abstract Background: Despite the availability of effective vaccines, pertussis remains endemic with high fatality rates in low and middle-income countries (LMIC).This study aims to describe an outbreak of pertussis in a health district of Ethiopia. The study highlights the challenges faced by the health system in identifying pertussis cases and appropriately responding to the outbreak at district level. Method: a descriptive cross-sectional study was conducted using data sourced from the district Public Health Emergency and Management (PHEM) surveillance service and outbreak management field reports. Stratified attack rates and fatality rates for pertussis are described. Systemic problems leading to the outbreak are explored and narrated. A modified CDC pertussis case definition was employed with polymerase chain reaction used to confirm cases. Results: From September 2018 to January 2019, 1840 suspected, probable and confirmed pertussis cases and six deaths were identified. Pertussis cases ranged from 1 month to 51 years in age and outbreak occurred in 14 out of the 24 villages of Dara Malo district. The overall attack rate was 1708 per 100,000 population with a fatality rate of 3.3 per 1,000 pertussis cases. The highest attack rate of 12,689/100,000 was seen in infants. Only 41.1% had completed the three-dose pertussis vaccine primary schedule. Investigations suggested the existence of poor cold chain management system in the study area. Conclusion: There is an urgent need to build capacity to strengthen routine vaccination services and improving the maintenance of vaccine cold chain. Other Low-and Middle -Income Countries (LMICs), are urged to take lessons learnt from this outbreak and strengthen their own vaccination programs and capacitate health workers to manage local outbreaks.

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Pertussis outbreak in Southern Ethiopia: challenges of detection, management and response

10.21203/rs.2.17809/v5 ◽

2020 ◽

Author(s):

Aychiluhim Damtew Mitiku ◽

Mesele Damte Argaw ◽

Binyam Fekadu Desta ◽

Zergu Taffesse Tsegaye ◽

Afework Ayele Atsa ◽

...

Keyword(s):

Attack Rate ◽

Health Workers ◽

Vaccine Dose ◽

Case Definition ◽

Lessons Learned ◽

Cold Chain ◽

Southern Ethiopia ◽

Cross Sectional ◽

Outbreak Management ◽

Vaccination Programs

Abstract Background: Despite the availability of effective vaccines, pertussis remains endemic with high fatality rates in low and middle-income countries (LMIC).This study aims to describe an outbreak of pertussis in a health district of Ethiopia. The study highlights the challenges faced by the health system in identifying pertussis cases and appropriately responding to the outbreak at the district level.Methods: A descriptive cross-sectional study was conducted using data sourced from the District Public Health Emergency and Management (PHEM) surveillance service and outbreak management field reports. Stratified attack rates and fatality rates for pertussis are described. Systemic problems leading to the outbreak are explored and narrated. A modified CDC pertussis case definition was employed with a polymerase chain reaction used to confirm cases.Results: From September 2018 to January 2019, 1840 suspected, probable, and confirmed pertussis cases and six deaths were identified. Pertussis cases ranged from 1 month to 51 years in age. An outbreak occurred in 14 out of the 24 villages of Dara Malo district. The overall attack rate was 1708 per 100,000 population with a fatality rate of 3.3 per 1,000 pertussis cases. The highest attack rate of 12,689/100,000 was seen in infants. Among confirmed, probable and suspected pertussis cases, only 41.1% had completed the three-dose pertussis vaccine's primary schedule. The household survey revealed a population coverage of 73.4% and 40.8% for Pentavalent vaccine dose one and three respectively. Investigations suggested the existence of a poor cold chain management system in the study area.Conclusions: There is an urgent need to build capacity to strengthen routine vaccination services and improve the maintenance of the vaccine cold chain. Other LMICs are urged to take lessons learned from this outbreak to strengthen their own vaccination programs and capacitate health workers to manage local outbreaks.

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Pertussis outbreak in Southern Ethiopia: challenges of detection, management and response

10.21203/rs.2.17809/v6 ◽

2020 ◽

Author(s):

Aychiluhim Damtew Mitiku ◽

Mesele Damte Argaw ◽

Binyam Fekadu Desta ◽

Zergu Taffesse Tsegaye ◽

Afework Ayele Atsa ◽

...

Keyword(s):

Attack Rate ◽

Health Workers ◽

Vaccine Dose ◽

Case Definition ◽

Lessons Learned ◽

Cold Chain ◽

Southern Ethiopia ◽

Cross Sectional ◽

Outbreak Management ◽

Vaccination Programs

Abstract Background: Despite the availability of effective vaccines, pertussis remains endemic with high fatality rates in low and middle-income countries (LMIC).This study aims to describe an outbreak of pertussis in a health district of Ethiopia. The study highlights the challenges faced by the health system in identifying pertussis cases and appropriately responding to the outbreak at the district level.Methods: A descriptive cross-sectional study was conducted using data sourced from the District Public Health Emergency and Management (PHEM) surveillance service and outbreak management field reports. Stratified attack rates and fatality rates for pertussis are described. Systemic problems leading to the outbreak are explored and narrated. A modified CDC pertussis case definition was employed with a polymerase chain reaction used to confirm cases.Results: From September 2018 to January 2019, 1840 suspected, probable, and confirmed pertussis cases and six deaths were identified. Pertussis cases ranged from 1 month to 51 years in age. An outbreak occurred in 14 out of the 24 villages of Dara Malo district. The overall attack rate was 1708 per 100,000 population with a fatality rate of 3.3 per 1,000 pertussis cases. The highest attack rate of 12,689/100,000 was seen in infants. Among confirmed, probable and suspected pertussis cases, only 41.1% had completed the three-dose pertussis vaccine's primary schedule. The household survey revealed a population coverage of 73.4% and 40.8% for Pentavalent vaccine dose one and three respectively. Investigations suggested the existence of a poor cold chain management system in the study area.Conclusions: There is an urgent need to build capacity to strengthen routine vaccination services and improve the maintenance of the vaccine cold chain. Other LMICs are urged to take lessons learned from this outbreak to strengthen their own vaccination programs and capacitate health workers to manage local outbreaks.

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Pertussis outbreak investigation of Dara Malo district, Gamo Administrative Zone, Southern Nations, Nationalities and Peoples Region, Southern Ethiopia

10.21203/rs.2.17809/v1 ◽

2019 ◽

Author(s):

Aychiluhim Damtew Mitiku ◽

Mesele Damte Argaw ◽

Binyam Fekadu Desta ◽

Zergu Taffesse Tsegaye ◽

Afework Ayele Atsa ◽

...

Keyword(s):

Attack Rate ◽

Health Workers ◽

Vaccine Coverage ◽

Case Definition ◽

Outbreak Investigation ◽

Cold Chain ◽

Southern Ethiopia ◽

Health Seeking ◽

Cross Sectional ◽

Outbreak Management

Abstract Background: The aim of this outbreak investigation was to verify and describe a pertussis outbreak in the Dara Malo district of Ethiopia. Method: a descriptive cross-sectional study was conducted using district Public Health Emergency and Management (PHEM) surveillance data and outbreak management field reports. Stratified attack rates and fatality for pertussis are described. Systemic problems leading to the outbreak are explored and narrated. A modified CDC pertussis case definition was employed with polymerase chain reaction used to confirm cases. Results: From September 2018 to January 2019, 1840 suspected, probable and confirmed pertussis cases and six deaths were identified. Pertussis cases ranged from 1 month to 51 years in age and outbreak occurred in 14 out of the 24 villages of Dara Malo district. The overall attack rate was 1708 per 100,000 population with a fatality rate of 3.3 per 1,000 pertussis cases. The highest attack rate of 12,689/100,000 was seen in infants. Investigations suggest low vaccine coverage and cold chain management system leading to low vaccine potency as the most likely reason for the outbreak. in these community were: low pentavalent three vaccination coverage and non- functional. In addition, poor implementation of surveillance programs, poor health seeking behavior of the community may have led to delayed and suboptimal responses to the outbreak. Conclusion: There is an urgent need to build capacity to strengthen routine vaccination services capacitate health workers to manage outbreaks. In addition, improving the maintenance of cold chain must be prioritised. Other LMICs, are urged to take lessons learnt from this outbreak and strengthen their own vaccination programs.

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Non-communicable disease training for public health workers in low- and middle-income countries: lessons learned from a pilot training in Tanzania

International Health ◽

10.1093/inthealth/ihu090 ◽

2014 ◽

Vol 7 (5) ◽

pp. 339-347 ◽

Cited By ~ 6

Author(s):

Evelyn P. Davila ◽

Zubeda Suleiman ◽

Janneth Mghamba ◽

Italia Rolle ◽

Indu Ahluwalia ◽

...

Keyword(s):

Public Health ◽

Health Workers ◽

Communicable Disease ◽

Lessons Learned ◽

Pilot Training ◽

Middle Income ◽

Middle Income Countries ◽

Public Health Workers ◽

Non Communicable Disease ◽

Low And Middle Income

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Hierarchical disentanglement of contextual from compositional risk factors of diarrhoea among under-five children in low- and middle-income countries

Scientific Reports ◽

10.1038/s41598-021-87889-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Adeniyi Francis Fagbamigbe ◽

A. Olalekan Uthman ◽

Latifat Ibisomi

Keyword(s):

Risk Factors ◽

National Level ◽

Cross Sectional ◽

Middle Income ◽

Contextual Risk ◽

Under Five ◽

Factors Associated ◽

Under Five Children ◽

Middle Income Countries ◽

Low And Middle Income

AbstractSeveral studies have documented the burden and risk factors associated with diarrhoea in low and middle-income countries (LMIC). To the best of our knowledge, the contextual and compositional factors associated with diarrhoea across LMIC were poorly operationalized, explored and understood in these studies. We investigated multilevel risk factors associated with diarrhoea among under-five children in LMIC. We analysed diarrhoea-related information of 796,150 under-five children (Level 1) nested within 63,378 neighbourhoods (Level 2) from 57 LMIC (Level 3) using the latest data from cross-sectional and nationally representative Demographic Health Survey conducted between 2010 and 2018. We used multivariable hierarchical Bayesian logistic regression models for data analysis. The overall prevalence of diarrhoea was 14.4% (95% confidence interval 14.2–14.7) ranging from 3.8% in Armenia to 31.4% in Yemen. The odds of diarrhoea was highest among male children, infants, having small birth weights, households in poorer wealth quintiles, children whose mothers had only primary education, and children who had no access to media. Children from neighbourhoods with high illiteracy [adjusted odds ratio (aOR) = 1.07, 95% credible interval (CrI) 1.04–1.10] rates were more likely to have diarrhoea. At the country-level, the odds of diarrhoea nearly doubled (aOR = 1.88, 95% CrI 1.23–2.83) and tripled (aOR = 2.66, 95% CrI 1.65–3.89) among children from countries with middle and lowest human development index respectively. Diarrhoea remains a major health challenge among under-five children in most LMIC. We identified diverse individual-level, community-level and national-level factors associated with the development of diarrhoea among under-five children in these countries and disentangled the associated contextual risk factors from the compositional risk factors. Our findings underscore the need to revitalize existing policies on child and maternal health and implement interventions to prevent diarrhoea at the individual-, community- and societal-levels. The current study showed how the drive to the attainment of SDGs 1, 2, 4, 6 and 10 will enhance the attainment of SDG 3.

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