Introduction Measles is a vaccine-preventable viral infection of humans, primarily affecting children <5 years. During early 2019, outbreak of measles occurred in Ginnir district of Bale zone, Southeast Ethiopia. We investigated to describe the outbreak and identify risk factors. Methods We conducted a descriptive and 1:2 unmatched case-control study in Ginnir district from March 18 to April 29, 2019. Fifty-six cases and 112 controls were recruited. For descriptive study, we identified 1043 cases recorded on the line-list and for case-control study, cases were identified using national standard case-definition. Mothers of case-patients and controls were interviewed using structured questionnaire. We estimated vaccine efficacy (VE) from case-control study. We conducted bivariate and multivariable logistic regression. Results In four-months period, a total of 1,043 suspected measles cases epidemiologically linked to five laboratory confirmed cases reported. Of which, 555 (53.2%) were males and 714 (68.5%) were <5 years. The median age of cases was 36 months (IQR=12-60 months). The overall attack rate (AR) was 63/10,000 population with case fatality ratio of 0.5% (5 deaths/1043). Infant <9 months were the most affected age groups (AR=31/1000). Majority (79%) of measles cases were not vaccinated against measles. Last-year (2017/18) administrative measle vaccine coverage of the district was 76.7%. Being unvaccinated against measles (AOR=5.4, 95%CI=2.2-13.4), travel history (AOR=4.02, 95%CI=1.2-13.6), contact with measles case-patient (AOR=5.6, 95%CI=2.12-14.4) and mothers knowledge of measles transmission (AOR=0.36, 95%CI=0.15-0.87) were associated with measles infection. VE in children aged 9-59 months was 90% (95%CI=69-97%). Conclusion This confirmed measles outbreak was caused by failure to vaccinate, as indicated by the high VE, low administrative coverage, and 79% unvaccinated cases. Strengthening routine and supplementary immunization are required.

Background: Nutritional status affects effectiveness and adherence to antiretroviral therapy, survival status, and quality-of-life in people living with human immunodeficiency virus. Prevalence of undernutrition among HIV infected people in Ethiopia ranges from 12.3% to 55.6%. Objective: To identify determinants of undernutrition among adult people on antiretroviral therapy in Goba Hospital, Southeast Ethiopia. Methods: A facility-based case-control study was conducted on 276 study participants from March 16 to May 26, 2019. Nutritional status was determined by body mass index (BMI), where BMI<18.5 kg/m 2 was defined as malnutrition. A pretested structured questionnaire was used to collect data by face-to-face interview. Data were entered into Epi-data version 4.4 and then exported to SPSS version 23 for analyses. Bivariable and multiple binary logistic regression were fitted. Multicollinearity was checked among candidate variables using variance inflation factor. P-value<0.05 was considered statistically significant and AORs at 95% CIs was used to assess the strength of association. Results: The response rate of participants was 97% among cases and 95% among controls. Nearly two-thirds (65%) of cases and 54.3% of controls were females. Factors significantly associated with undernutrition were household food insecurity (AOR=3.24, 95% CI=1.72-6.08), depression (AOR=2.07, 95% CI=1.16-3.72), current alcohol consumption (AOR=3.80, 95% CI=1.71-8.43), and non-adherence to antiretroviral therapy (AOR=2.61, 95% CI=1.28-5.30). Conclusion: Household food insecurity, depression, current alcohol consumption, and nonadherence to ART were associated with undernutrition. Strengthening the strategies and programs that target food assistance besides therapeutic interventions, addressing problems related to adherence of ART, incorporating psychosocial information about depression and substance use during counseling provided by healthcare providers for PLHIV and further longitudinal study were recommended.

Background: Scabies is neglected parasitic disease and major public health problem worldwide, particularly in resource-poor regions including Ethiopia. It has been estimated about 300 million cases reported yearly and causes more than 1.5 million Disability Adjusted Life Years for all age. The study conducted in Ethiopia, among ‘Yekolo-Temari’ revealed 22.5% scabies prevalence. On March 9, 2019, the Sinana district surveillance office reported a scabies outbreak in five madrasahs. We investigate to determine its magnitude, identify risk factors and provide intervention and recommendation.Methods: We conducted a (1:2) unmatched case-control study. The scabies case-patient was any student of madrasahs in Sinana district with signs and symptoms consistent with scabies (superficial burrows, intense itching especially at night, generalized rash and secondary infection) from March 11 to April 30, 2019. We reviewed the line list and conducted active case finding. Participants were recruited from all madrasahs (five) proportional to the number of students in each madrasah (56 cases-patients and 111 controls) and interviewed with structured questionnaires. We use OR, P-value and 95% CI to measure the strength of association in multivariable logistic regression. Result: We identified 815 (6 crusted) scabies cases-patients (100% male) with the attack rate 143 per 1000 population (815/5,689) and no death and the mean age was 14 years (range 8-28 years). Sharing bed with scabies case (AOR=3.9, [95% CI=1.5-10.3], travel history to scabies area (AOR=3.87, [95% CI=1.19-12.56], showering more than a week interval (AOR= 2.74, [95% CI=1.04-7.21] were statistically associated with illness.Conclusion: Sharing bed with scabies case, travel history to scabies area and showering more than a week interval was associated with a high frequency of scabies infestation. All patients and contacts treated, additionally, at two madrasahs mass drug administration conducted with permethrin, and cloxacillin for secondary infection. We recommend health education about the transmission, prevention and control of scabies disease to the students.

No abstract

Background Malnutrition is a serious disease and remains an important public health problem in many developing countries including Ethiopia. Malnutrition is one of the diseases under the surveillance system which is reported weekly and monthly. In the Bale zone, malnutrition is one of the major public health problems. Therefore, this trend analysis of severe acute malnutrition was to describe the magnitude, trends, disease outcome and geographical distribution of the severe acute malnutrition in Bale Zone from 2014-2017.Methods A descriptive cross-sectional study was conducted on April 2018. Data was extracted from Bale zone monthly malnutrition report database and checked for completeness and consistency then four years’ trends of severe acute malnutrition were analyzed. The prevalence and trend of severe acute malnutrition by Woreda, year and age were analyzed using Microsoft office excel and SPSS version 20 then summarized using text, table, and figure.Result A total of 37,678 severe acute malnutrition cases registered over four years (2014-2017). Of these, 31,642(84%) cured, 52(0.14%) died, 641(1.7%) defaulters, 66(0.18%) non-respondents. Among registered cases, 98.2% are 6-59months age groups. The average annual prevalence of severe acute malnutrition high among under-five children was 3.3%. Prevalence rate per 1000 population of severe acute malnutrition in 2014, 2015,2016 and 2017 are 3.6, 4.5, 7.5 and 4.7 respectively and death rate are 0.21%, 0.26%, 0.1% and 0.08% respectively. Among the Woreda, the highest prevalence at Delomena (2.45%) and lowest at Sinana woreda (0.1%). The death rate is high among 6-59months age groups (0.13%) and followed by less than 6months age group (0.008%).Conclusion Cases of severe acute malnutrition increased during the year 2014 to 2016 then decreased during 2017. The prevalence of severe acute malnutrition high in under-five age groups children at Bale zone during the study period and Delomena Woreda has the highest average annual prevalence of severe acute malnutrition. We recommend further research on why some district has a high prevalence of severe acute malnutrition.

Background: Public health surveillance systems should be evaluated periodically to ensure the problems of public health importance are being monitored efficiently and effectively. Despite the widespread measles outbreak in Ginnir district of Ethiopia in 2019, an evaluation of measles surveillance systems has not been conducted. Therefore, we evaluated the performance of measles surveillance systems and key attributes in Ginnir district, Southeast Ethiopia. Methods: We conducted a concurrent embedded mixed quantitative/qualitative study in August 2019 among 15 health facilities/study units in Ginnir district. The qualitative study involved a purposively selected 15 key-informants. Data were collected using updated guidelines for evaluating surveillance systems based on CDC's Framework. Results: Records of 15 study units were reviewed and 15 key informants participated. The structure of surveillance data flow was from the community to the respective upper level. Emergency preparedness and a response plan was available only at the district level. Weekly report completeness and timeliness were 95% and 87% respectively. We found weak supportive supervision and feedback, and no regular analysis and interpretations of surveillance data. The participation of surveillance stakeholders in implementation of the system was good. The surveillance system was found to be useful, easy to implement, representative, and can accommodate and adapt to changing operating conditions. Report documentation and quality of data was poor at lower level health facilities. The stability of the system has been challenged by a shortage of budget, logistics, staff turnover and lack of update trainings. Conclusion: The surveillance system was acceptable, useful, simple, flexible, and representative. Quality of data, timeliness, and the stability of the system were attributes that require improvement. The overall performance of measles surveillance systems in prevention and control of measles was weak. Hence, regular analysis of data, preparation, and dissemination of epidemiological bulletin, capacity building, and regular supervision and feedback are recommended to enhance performance of the system.

Purpose Multidrug-resistant tuberculosis threatens global tuberculosis care and prevention and remains a major public health concern in many countries. In 2016, there were an estimated 490,000 cases of MDR and 110,000 more cases resistant to rifampicin (RR TB). Ethiopia is among the highest MDR TB burden countries according to the WHO. This study aims to describe the magnitude, trends, and geographical distribution of the drug-resistant TB in Bale Zone during study period. Materials and Methods A descriptive study was conducted. We reviewed secondary data of MDR and RR TB cases from July 2014 to June 2018. Data were extracted from the Bale zone health management information system database, checked for completeness, and then analyzed for trends over time. Results A total of 43 cases (67.4% female) of drug-resistant TB were reviewed, with 30.2% MDR and 69.8% RR TB. The prevalence of drug-resistant tuberculosis cases declined from 0.81% to 0.62% (trend χ 2 =2.18; P=0.14) during study period. Among drug-resistant TB cases, RR TB increased from 52.6% to 81% (trend χ 2 =6.5; P=0.01). Conclusion Drug-resistant TB decreased over the period studied, although the trend did not reach statistical significance. These trends may reflect the efficacy of TB control programs to reduce drug-resistant TB transmission, as well as improved RR TB detection due to increased use of molecular diagnostic platforms like GeneXpert MTB/RIF.

Purpose Measles is still an important cause of childhood morbidity and mortality even in developed countries. It is a leading cause of vaccine-preventable deaths among young children. The Bale zone reported a measle outbreak on 1/15/2019. This study was conducted to describe the magnitude of the measle outbreak in the Bale Zone. Methods We conducted a descriptive cross-sectional study from September 20 to November 15, 2019, by reviewing the line lists of the cases. We checked the data for completeness and analyzed using epi-info version 7 and Microsoft Office Excel 2016. Results A total of 2753 measle cases with attack rate (AR) 201per 100,000 population and 7 death (0.25% case fatality rate) were reported during this confirmed outbreak (all five samples positive for measle IgM test). Males (0.21%) and females (0.19%) were almost equally affected. The AR was 736 per 100,000 population among 9months-4years age groups followed by an age group less than 9months (682 per 100,000 population). Most of the cases were unvaccinated (74.9%). Conclusion The majority of the cases were unvaccinated and 9months to 4years followed by less than 9months of age groups. We recommend strengthening the routine immunization and surveillance to prevent the occurrence of the measle outbreak.