Epidemiology of intussusception among infants in Ethiopia, 2013-2016.

INTRODUCTION: intussusception is a condition in which one segment of the bowel prolapses into another causing obstruction. Information on the epidemiology of intussusception in sub-Saharan Africa is limited. We describe the sociodemographic and clinical characteristics of children with intussusception in Ethiopia. METHODS: active surveillance for children < 12 months of age with intussusception was conducted at six sentinel hospitals in Ethiopia. Limited socio-economic and clinical data were collected from enrolled children. Characteristics among children who died and children who survived were compared using the Wilcoxon rank sum test for continuous variables and Chi-square tests for categorical variables. RESULTS: total of 164 children < 12 months of age with intussusception were enrolled; 62% were male. The median age at symptom onset was 6 months with only 12 (7%) of cases occurring in the first 3 months of life. Intussusception was reduced by surgery in 90% of cases and 10% were reduced by enema; 13% of cases died. Compared to survivors, children who died had a significantly longer time to presentation to the first health care facility and to the treating health care facility (median 3 days versus 2 days, p = 0.02, respectively). CONCLUSION: the high mortality rate, late presentation of intussusception cases, and lack of modalities for non-surgical management at some facilities highlight the need for better management of intussusception cases in Ethiopia.

Status of surveillance and routine immunization performances in Amhara Region, Ethiopia: findings from in-depth peer review.

INTRODUCTION: Trend analyses of non-polio AFP and stool adequacy rates in Amhara Region showed optimal performance over the years. However, sub regional gaps continue to persist in certain zones where the reasons for low performance were not well documented. The objective of this study was to assess the performance of the disease surveillance and immunization system in Amhara Region, Ethiopia with emphasis on low performing woredas and zones. METHODS: A descriptive cross-sectional study was conducted from July 2-10, 2015 to assess the structure, core and support surveillance functions in five zones and two town administrations that were purposively sampled based on differing performances, geographic location, and history of vaccine preventable disease outbreaks among others. RESULTS: Of the 82 sites reviewed, 71 (87%) have a designated surveillance focal person. Less than half 36(44%) of these focal persons have written terms of reference. Twenty-six (93%) of the health offices had a written surveillance work plan for the fiscal year. Only 17 (81%) of woreda health offices and town administrations had prioritized active surveillance sites into high, medium and low during the last 12 months. Only 4(17%) had independent active case search visits to these sites as per the priority. Seventy-eight (95%) and seventy-seven (94%) sites have a designated immunization focal person and updated EPI performance monitoring charts, respectively. There had been vaccine stock out in the 3 months before assessment in 28 (34%) of the sites. CONCLUSION: Though there is an existence of well-organized surveillance network with adoption of the integrated disease surveillance and response, gaps exist in following the standard guidelines and operation procedures. Improvements needed in reporting site priority setting and regular visiting for active case search, outbreak investigation and management, vaccine supply and overall documentations.

Assessment of reporting sites for acute flaccid paralysis surveillance in Ethiopia: implications for planning of active case search visits.

INTRODUCTION: The World Health Organization acute flaccid paralysis (AFP) surveillance standards recommend documentation of the role of each potentially reporting site for evidence -based planning and tailoring support for active surveillance visits. This study assessed the contribution of various sites as source and quality of AFP cases reported over a five -year period in Ethiopia. METHODS: We conducted a retrospective analysis of AFP surveillance data collected from 2010-2014 in Ethiopia. Analyses were done using EPI-INFO version 7 for calculating frequencies and proportions, and testing possible associations between reporting sites and key dependent variables. RESULTS: Of the 5,274 AFP cases reported, hospitals and health centers reported 4627 (88%) of the cases. Hospitals in Addis Ababa (53%) and health posts in Benishangul Gumuz (48%) regions have contributed majority of the cases reported. Only 3% of cases were reported by private clinics nationally. The stool adequacy rate for health posts (81%) was lower than the overall national rate of 88% .Cases from health posts are more likely to be reported after 14 days of onset of paralysis, and 62% less likely to be investigated within two days of notification(OR: 1.82, 95% CI OR : 1.41-2.36, p-value <0.0001). Greater proportion (2.4%) of cases reported from health posts were either compatible, VDPV or WPV compared to cases reported by health centers (1.14%) or hospitals (1.4%). CONCLUSION: Though majority of the cases were reported by health centers followed by hospitals ,our findings suggest that all potentially reporting sites should be exhaustively identified, prioritized and regularly supported for quality case detection, investigation and reporting.