|Cerebrospinal Meningitis Epidemics and Surveillance Systems in the Sudan, Ethiopia and Chad (Centre for Research on the Epidemiology of Disasters, 1990, 40 p.)|
|II. COUNTRY REPORTS|
|B. People's Democratic Republic of Ethiopia|
The surveillance system for meningitis epidemics is rather weak. The lack of communication is responsible for a slow flow of information. The serious underreporting, the misclassifications due to a clinically based diagnosis, the lacks of resources for compilation within the Ministry of Health handicap the monitoring of the situation in the country.
CSM is one of the diseases reported through the weekly radio-telephone system. The weaknesses of the system have been pointed out.
Active and Passive case detection
In case of an epidemic, passive and active surveillance systems should be implemented.
Health workers and motivated persons from the community at large will be responsible for the active case detection.
Specific forms have been developed for daily reports on cases and deaths stating age, sex and origin. These must be sent every week to the Regional Health Department and to the MOH.
- The Epidemic Control Team (ECT):
This division works in close collaboration with the surveillance unit. The main objectives of the ECT are:
- to provide the regions with technical assistance in case of a suspected or confirmed epidemic
- to send additional drugs if needed
- training on epidemics with the collaboration of NGOs.
When there is suspicion of a CSM epidemic, the Department of Epidemiology is informed and one member of the Epidemic Control Team is sent out to the area where the epidemic has been declared. This person will evaluate the situation and take the necessary laboratory samples to confirm the diagnosis and the risk of epidemic.
The definition advised for an epidemic is a many-fold increase in the number of cases compared to the normal endemic rate, or an attack rate higher than 10/100000 per week.
- Crisis Committee:
If the epidemic or risk is confirmed, an Emergency Committee is called in. These committees exist at the national, regional, and district (Awaja) levels. They are responsible for the evaluation, monitoring and management of the emergency. These committees were established during the 1988-1989 epidemic.
At the central level, the chairman of this committee is the head of the Department of Epidemiology. Besides the different divisions of the Department of Epidemiology, other Ministries (e.g. Education, Agriculture), NGOs, are also represented in these committees according to the type of emergency.
In November 1989, the Department of Epidemiology developed a guideline on prevention and control of meningococcal meningitis epidemic.
Before the 1987 and 1988 epidemics there was no specific action plan nor any specific surveillance procedure for meningitis epidemic control. It was during these epidemics that all the following measures were taken and implemented.
- Guidelines for diagnosis and treatment:
The guideline recommends confirming all suspected cases of meningitis by a lumbar puncture.
Chemoprophylactic treatment of close household contacts is recommended by MOH. Rifampicine (RMP) is used for this prophylaxis.
Treatment of cases:
First therapeutic choice: Crystalline Penicilline
Second therapeutic choice: Chloramphenicol IV
- Serogroup and sensitivity monitoring
There is not any systematic monitoring of sensitivity or serogroup.
The MOH recommends testing of samples from cases not responding to antibiotherapy in order to determine whether sulfadiazin is effective for prophylactic treatment.
Mass vaccination is not recommended. High risk groups eligible for vaccination are, the day-care centre children, students, prisoners, and close household contacts of an index case.
- Other measures:
- Treatment facilities:
Temporary shelters will be installed. This measure allows treatment of the cases near the place they come from, and encourages an early treatment.
- Health Education:
This consists of, during an epidemic, informing the population about the disease in order to avoid any panic in the community.
- Operational Plan
This following operational plan has been developed during the 1988 epidemic.