SURVEILLANCE OF A CHRONIC LIVER DISEASE OF UNIDENTIFIED CAUSE IN A RURAL SETTING OF ETHIOPIA: A CASE STUDY
Published Date:Jan 2016
Source:Ethiop Med J. 54(1):27-32.
Pubmed Central ID:PMC4822084
Funding:CC999999/Intramural CDC HHS/United States
An outbreak of chronic liver disease of unidentified cause, also called “Unidentified Liver Disease” or “ULD” was first observed in a rural village in Tigray, Ethiopia in 2001. Little was known about the geographical extent, trend, and epidemiology of this disease.
We initiated a local active surveillance system to characterize and monitor trends for this emerging disease and to identify cases for treatment and follow up.
Tigray is a rural, resource-limited setting characterized by a lack of electricity, rugged terrain, limited transportation, and few healthcare facilities and trained healthcare workers.
The Ethiopian Health and Nutrition Research Institute, Centers for Disease Control and Prevention, World Health Organization, and Tigray Regional Health Bureau established the ULD surveillance system in 2009 and conducted a large-scale official training for the surveillance staff on case identification, management and reporting. In absence of a confirmatory test, the system used simple case definitions that could be applied by frontline staff with varying clinical training. To maximize resources, health extension workers already conducting household visits in affected communities identified cases and increased community awareness about the disease. A team was placed in Shire, in close proximity to the outbreak region, to provide support and collect reports from health facilities and district health offices.
Long term dedication by frontline staff, using simple case definitions to identify cases, and active collection of missing reports were critical for surveillance of this chronic non-infectious disease of unknown cause in a rural, resource-limited setting.
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