Kersa Demographic Surveillance and Health Research Center (KDS-HRC)

Kersa Demographic Surveillance and Health Research Center (KDS-HRC) is located in Kersa district of eastern Hararege, Oromia region, Eastern Ethiopia. It was established in 2007 with the vision of becoming center of excellence in health science research in Ethiopia. It conducts health and demographic surveillance. The major work on the ground are monitoring demographic altering events such as birth, death, and migration; and health related conditions such as pregnancy, immunization, and morbidity. It also conducts verbal autopsy for the deceased to identify causes of death. It is an INDPTH network member site (http://www.indepth-network.org).

KDS-HRC aims at generating up-to-date community based data including vital events; conducting studies addressing national health need; assessing trends of demographic, health and environmental changes; evaluating health intervention activities; enhancing research culture in the teaching and learning process; rendering support on research methods and analysis for students and staff; disseminate research findings to different users; and advocating utilization of research findings to improve the health and other service delivery. More explanation about KDS-HRC please visit www.haramaya.edu.et/research/projects/kds-hrc.

                                                                                                                                   Eastern Hararge

It one of the 15 Zones of Oromia regional state. It is bordered on the southwest by the Wabe Shebelle River, which separates it from Bale zone; on the west by West Hararge zone the north by Dire Dawa administration; and on the north and east by the Somali Regional state.

Based the 2007 census, the zone has an estimated total population of 2,739,390, of which 6.9% of its population is urban dwellers. The zone has an area of 24,900.21 square kilometers, and a population density of 102.64 people per square kilometer. The health coverage of the zone is 80 %. Forty four percent of the zone is malarious area.

Kersa District:

It is one of the 16 districts of Eastern Hararge zone. It is bordered on the south by Bedeno district, on the west by Meta district, on the north by Dire Dawa administrative council, on the northeast by Haramaya district, and on the southeast by Kurfa Chele district. The district capital is Kersa town which is 44 km from west of Harar city; other towns in the district include Lange and Weter.

According to a survey of the land in Kersa (released in 1995/96) showed that 28.5% is arable or cultivable, 2.3% pasture, 6.2% forest, and the remaining 56.3% is considered built-up degraded or otherwise unusable. Khat, fruits and vegetables are important cash crops. Coffee is also an important cash crop; covering 5,000 hectares. Sorghum, maize, barley, white etc are among the food crops cultivated in the district.

   Kersa field research center

The Health and Demographic Surveillance System (DSS) runs in 12 representative Kebeles out of the 38 in Kersa districts.

Out of the 12 Kebeles ten are rural and two are urban (Kersa and Weter town); whereas by altitude difference, 2 are highland two are low land the remaining 8 are mid land (Woynadega). All the 12 study Kebeles have road access during the dry season. But it is not very hard to reach to Kebeles during the rainy season also.

Lake Adele on the way to Dire Dawa is adjacent to Adele Key Key. It is one of the beauties of the site.

The way to Weter town, seen straight far

The highland majesty around GolaBelinakebele

All the Kebele administrative offices have land line telephone connection. In addition, in towns some dwellers have landline telephone connection but a significant numbers of residents in the both urban and rural study Kebeles have mobile telephone. The three towns have 24 hour electricity supply. In addition, few areas in some rural kebeles, there is electricity supply.  Residents in the study kebeles get water supply from tap water, protected springs, unprotected springs, protected and unprotected well and ponds.

There are 3 health centers and 10 health posts in the 12 kebeles of the study site. All the kebeles have 2-3 health extension workers assigned to work on the 16 health extension packages. There are 18 elementary, 2 secondary, 1 preparatory, and 2 religious schools in the study Kebeles. There are also 134 mosques, 8 churches and 6 farmers training stations.

  Student’s singing squad on typical school day. Tolla Kebele elementary school.

 The inhabitants of the study site make their living principally on farming. But small trade, government employment and daily work are also means of living. Cereals like wheat, barley, and vegetables like onion and garlic are the dominant crops produced in the highland areas. Sorghum, maize, potatoes are dominant crops in the midland and low land areas. Khat is the dominant cash crop production in most of the places.

Farming is seasonal in the study Kebeles. They make production during the rainy season. But in one of the Kebeles (HandhuraKossum), irrigation is a common practice. Residents of this kebele produce three times a year, majorly for market.

Sorghum, the dominant crop for food production in many of the mid land and low land areas of the study site

Wheat, barely, the dominant crop for food production around Tolla and GolaBelina Kebele

Vegetables are also common production around highland areas, here the farmer working in garlic farm.

Khat is the main crop produced for cash in many of the mid-land and low land areas of the study site.

Vision, Mission, Core Objectives and Values

Vision

To be a center of excellence in health science research in Ethiopia

Mission

To advance research undertaking, health science education and generating evidence for improving planning and the delivery of health service.

Core objectives

The Demographic Surveillance and Health Research Center focus is to:
1.generate up-to-date community based data including vital events;
2.conduct studies in addressing national health issue ;
3.assess trends of demographic, health and environmental changes;
4.evaluate health intervention activities;
5.enhance research culture in the learning and teaching process;
6.render support on research method and analysis for students and staff;
7.disseminate research findings to different users;
8.advocate utilization of research findings in improving health and other service delivery.

Values
Engagement: research undertaking within the community in existence
Excellence: best and innovative way of looking at things
Collaboration: working together with other stakeholders
Banding: team approach to research undertaking
Respect: upholding public norms, culture, ethics and moral issues

Focus areas of research:

KDS-HRC undertakes researches in major health and health related public health problems. Some of the focus areas of research’s areas are:
• Child health
• Maternal health
• Demographic changes
• Reproductive health
• HIV/AIDS and other STIs
• Malaria and other acute infectious diseases
• Tuberculosis and other chronic infectious diseases
• Gender related issues
• Nutrition
• Water and sanitation
• Vector borne diseases
• Pollution
• Occupational health
• Mental health
• Chronic non-infectious diseases (hypertension, diabetes and etc…)
• Other communicable diseases
• Health service utilization

Services KDS-HRC Provides:

• Availing any type of sample frame for community based study
• Consultation
• Supporting on data management and data analysis
• Sharing software
• Providing list of individuals within the study site on request for specific purpose
• Trainings on data analysis, research methodology, qualitative study, GIS, the use of internet
• Conducting health and demographic studies
• Providing technical support on research for departments, regional health office and health institutions

Kersa District

Location:

Kersa is one of the 180 districts in the Oromia Region. It is part of east Hararghe. It is bordered on the south by Bedeno district, on the west by Meta district, on the north by Dire Dawa administrative council, on the northeast by Haramaya woreda, and on the southeast by Kurfa Chele district. The woreda capital is Kersa, which is 44 km from Harar west wards.

Topography:

The district ranges from 1400 to 3200 meters above sea level. According to a survey of the land in Kersa 28.5% is arable or cultivable, 2.3% pasture, 6.2% forest, and the remaining 56.3% is considered built-up degraded or otherwise unusable. Chat, fruits and vegetables are important cash crops. Coffee is also an important cash crop, covering 5,000 hectares.

In the woreda, there are 35 rural Kebeles and 3 small towns. According to the information obtained from the woreda administration, out of the 38 Kebeles, 2 are lowland, 22 are temperate, 7 are a mix of lowland and temperate and the remaining 7 are highland, containing 2.8 %, 60.2, %, 17 % and 20 % of the district population, respectively. All the Kebeles have road access.

Population:

According to the 2007 census, the district has a total population of 172,626; out of which, 6.87 are urban dwellers. With an estimated area of 463.75 square kilometers, Kersa has an estimated population density of 372.24 people per square kilometer. The district has six health centers, 28 health posts and eight private pharmacies. The health service coverage of the woreda is 80 %.

The Need for Demographic and Health Surveillance: 

 Demographic and Health Surveillance is the continuous tracking of demographic and health data from a particular place for a continuous period of time. Such a program gives valid and reliable health information to health planners and facilitates evidence-based action unlike the traditional health system oriented generation of data.

 Traditional sources of health information collected from health facilities such as health centers and hospitals often serve as the basis for health-services planning and allocation of resources in Ethiopia. Yet, healthfacility-based data often provide fragmentary and biased information. Not all population groups have geographic or socio-economic access to health facilities. Those who do have such access are usually selfselected and are often those who visit health-care facilities when they suffer from a serious illness.

Great majorities of poor people have less access to health-care facilities than those who are better off, and they often treat themselves or use traditional health care remedies. Women may suffer from gender disparities as well, with time and cultural constraints on the use of health-care facilities, particularly in rural settings. Services for children are also severely constrained. Thus, health-facility-based data are not representative of the health problems of all rural and urban communities and do not therefore reflect the health status of the population.

 This void of valid health information for a large segment of the Ethiopia’s population makes it difficult for policymakers to depend on valid information on the health situation of these people. The need to establish a reliable information base to support health development has never been given due attention.

 Ideally, reliable health information should be community based, inclusive of all groups, and collected prospectively and continuously. Such an ideal is best met through demographic and health surveillance systems collecting demographic, environment and health data on selected population samples. Such a continuous generation of data is indispensable in providing the necessary health services and advancing health science research and promoting quality education. Moreover, it plays a significant role in health planning strengthening staff research capacity and institutional development.

What we do in the field?  

At the KDS-HRC field site, we do a continuous tracking of vital events and health information. Demographic events that changes population characteristics such as births, deaths, immigration and outmigration are of particular interest.

While deaths and out-migration reduces population size, immigration and birth increases population size, this dynamism is called open cohort.

Other events like marital status change, immunization, morbidity and birth outcomes are also under follow-up. For deceased we fill verbal autopsy to identify the cause of death.

KDS-HRC National Projects

Title of the Project 

A phase IV multi-site observational epidemiology study to assess potential risk for adverse events following immunization that may be associated with misuse of a twodose vial of 10-valent Pneumococcal Conjugate Vaccine (Synflorix) in Ethiopia.

Short Title: The Ethiopian Vaccine Adverse Events Study [EVAES].

Investigators and Institutional Affiliations 

Status:       completed 

 Investigators

• Yemane Berhane (MD, MPH, PhD, Principal)
• Alemayehu Worku (PhD)
• Meaza Demissie (MD, MPH, PhD)
• Neghist Tesfaye (MD, MsC IH)

Co-Investigators

 Abstract  

The Government of Ethiopia is about to introduce a new 10-valent Pneumococcal Conjugate Vaccine (PCV10) for infants in Ethiopia. The vaccine is highly efficacious against diseases caused by Streptococcus pneumoniae. The selected vaccine, Synflorix™, is presented as a 2-dose vial without preservative. The two-dose vial will have significant advantages in limiting new cold-chain requirements. Multi-dose vaccines used in resource-limited settings have traditionally contained a preservative to minimize risk of microbial contamination. This allows one vial of the vaccine to be used for up to 28 days after the vial is opened provided stringent safety criteria, outlined in the multidose vial policy, are met. Given general public concerns about the use of preservatives, two-dose presentations of some new vaccines have been developed as preservative-free vials. Such vials should be discarded if not used within 6 hours of opening.

In Ethiopia, although specific training will be conducted to familiarize immunization staff with the necessary procedures of how to use Synflorix as a two-dose preservative-free vaccine, there remains a risk that in routine clinical settings, improper immunization practice (i.e. not discarding vials within 6 hours of opening) could result in microbial contamination, non-sterile injections, and adverse events following immunization (AEFI) such as injection -site abscesses, shock or death.

The Ethiopian society is well organized in geographic units and provides a suitable platform for conducting population based evaluation of potential AEFIs. In addition, Health and demographic surveillance systems (HDSS) routinely collect records of births, deaths, and other health related events that provide a feasible venue for a longitudinal, population-based evaluation of potential AEFIs as they can provide retrospective mortality

information. Clinic- and household-based surveillance can identify and analyze suspected injection-site abscesses, the primary endpoint. In addition, secondary endpoints of shock and all-cause mortality can be investigated through hospital-based and demographic surveillance, respectively. Because surveillance is already established, data can be collated after introduction of Synflorix ™ to compare with existing data in the admission registers from the prevaccine era. Although the HDSS sites can provide adequate sample size for the mortality component of the study they cannot provide the necessary sample size for monitoring abscess formation; thus all kebeles in the selected woredas will be included in the study to obtain the required sample size for the latter study objective.  Pharmacovigilance is important for evaluating new vaccines globally, and extended health and demographic surveillance systems in the selected woredas provide an important opportunity to evaluate the safety of current and new EPI vaccines.

Assuming that this study shows no evidence of significant adverse event outcomes, these rigorous safety assessments following Synflorix ™ introduction will add confidence in the use of a formulation that could enhance the

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Published Articles:

 1.Nega A. Yemane B., Alemayehu W., Amy T., The hazard of pregnancy loss and stillbirth among women in Kersa, East Ethiopia: A follow up study(2012), http://dx.doi.org/10.1016/j.srhc.2012.06.002

2. Nega A., Yemane B., Alemayehu W., Wealth Status, Mid Upper Arm Circumference (MUAC) and Antenatal Care (ANC) Are Determinants for Low Birth Weight in Kersa, Ethiopia. PLoS ONE 7(6): e39957. doi:10.1371/journal.pone.0039957. http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0039957

3. Wondimu S., Nega A., Mengistu W., Arja R., Female genital mutilation: prevalence, perceptions and effect on women’s health in Kersa district of Ethiopia. International Journal of Women’s Health 2012:4 45–54. http://www.dovepress.com/female-genital-mutilation-prevalence-perceptions-and-effect-on-women39-peer-reviewed-article-IJWH-recommendation1

4. Nega K., Yemane B., Alemayehu W.,Predictors of unintended pregnancy in Kersa, Eastern Ethiopia, 2010., Reproductive Health 2012, 9:1. http://www.reproductive-health-journal.com/content/9/1/1

5. Gobena T, Berhane Y, Worku A. Low long-lasting insecticide nets (LLINs) use among household members for protection against mosquito bite in kersa, Eastern Ethiopia. BMC Public Health. 2012 Oct 29;12(1):914. http://www.ncbi.nlm.nih.gov/pubmed/23107071

6. Bezatu Mengistie, Yemane Berhane and Alemayehu Worku. Predictors of Oral Rehydration Therapy use among under -five children with diarrhea in Eastern Ethiopia: a community based case control study. BMC Public Health 2012, 12:1029 doi:10.1186/1471-2458-12-1029. Published: 24 November 2012. http://www.biomedcentral.com/1471-2458/12/1029

KDS-HRC PROJECT COLLABORATORS