optimizing trachoma control with gis mapping of safe in ethiopia · 2006. 11. 10. · zwho...

ITI, SAFE Analysis Q1 2006 1

Optimizing Trachoma Control with Optimizing Trachoma Control with GIS Mapping of SAFE in EthiopiaGIS Mapping of SAFE in Ethiopia

Dr. Amir Bedri Kello, MD, MSc (CEH), Country Representative Ethiopia International Trachoma Initiative

Kirsten Axelsen, MS, Director Market Analytics Pfizer Dr. Jacob Kumaresan, MD, PhD, President International Trachoma

Initiative

ITI, SAFE Analysis Q1 2006

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Mapping SAFE to Control Trachoma Mapping SAFE to Control Trachoma In EthiopiaIn Ethiopia

Trachoma 101

The International Trachoma Initiative

The ITI Mission in Ethiopia

Trachoma Burden and Control in Ethiopia

Access to Water and Sanitation in Ethiopia

Organizations Supporting S.A.F.E.

Upcoming Events in Water and Sanitation

Resources for ITI Ethiopia


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TrachomaTrachoma

Leading cause of preventable blindness worldwide – disease of povertyRepeated Infection with Chlamydia trachomatis causes scarring of the eyelash follicles, turning the eyelid inwardEyelashes abrade the cornea, causing blindnessChildren are carriers of the disease, highest incidence of blinding trachoma in womenControlled by regular face-washing with clean water, antibiotics for active infection and surgery to repair damage

Inflamed follicles

Very Inflamed follicles

Scarring

turned eyelashes

Clouded cornea

Source: Implementing the SAFE Strategy for Trachoma Control, Carter Center Jan. 2006


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International Trachoma Initiative (ITI)International Trachoma Initiative (ITI)

Created in 1998 by Pfizer and the Edna McConnell Clark FoundationPfizer provides antibiotic azithromycin ITI supports research, communication and advocacyITI works with partner organizations and governments in country to distribute azithromycin– Prior to distribution baseline survey and census must be

undertaken

In 2003 azithromycin available through ITI in Ethiopia– WHO supported SAFE strategy with azithromycin

http://www.trachoma.org/history.php


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Trachoma In EthiopiaTrachoma In EthiopiaDisease Burden

1 Million cases of trichiasis in EthiopiaPrevalence of active trichiasis 2%-11% in adults aged 15+Prevalence of active trachoma in children 50%-88%

Access to Water and Sanitation 85% of the population in Ethiopia in rural areas11%-25% of rural population has access to clean water6% of rural population has access to sanitary facilityAmong the lowest rates of access to water and sanitation in the worldGDP/capita $780 USD

Dec 2003, EVALUATION OF TRACHOMA CONTROL ACTIVITIES IN ETHIOPIA, Federal Ministry of Health of Ethiopia;; International Trachoma Initiative; University of Nairobi; And London School of Hygiene & Tropical Medicine, UNICEF-WHO joint monitoring programme (2004) citing 202 data, and Ethiopian Central Statistics Authority, Statistical Abstract 2003, UNDP, Human Development Index


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Mapping SAFE in EthiopiaMapping SAFE in EthiopiaObjective

Collect information to facilitate synergy among the organizations providing SAFE Suggest ways to optimize coordination with partner and related organizations to ensure full SAFE coverage

– Expand access to antibioticsTactics

Develop Comprehensive Database of Organizations Providing Surgery, Face-washing & Environmental Improvement

– Focus on three regions– Collect location of major water and sanitation improvements in the

next five years– Create maps for data visualization and coordination

Develop presentations to facilitate discussions with partners


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Information Collected in EthiopiaInformation Collected in Ethiopia

All Collected at the District LevelSurgery– Presence of clinics, surgical outreach, or hospital

Antibiotics– Current and future districts for azithromycin distribution

Facewashing and Environment– Sites of ongoing water projects, areas of expansion– Districts and cities targeted in World Bank expansion project– Existing rates of water coverage

Other infrastructure– Roads, hospitals (from WHO mapping software)


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Methodology for Developing SAFE Methodology for Developing SAFE MapsMaps

Interviews, Site Visits, Review of Secondary DataGovernment (Federal and local Health and Water)NGOs (International, national and local)Community Health Workers and Health Extension AgentsHouseholds

MapsData and information synthesized into database, aligned to Ethiopian DistrictsWHO Healthmapper Application Used to display informationOpportunity areas (with SFE) identified

Supported by Getachew Alem, international Water and Sanitation consultant


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Site Visit Zithromax Distribution 2005

Areas StudiedAreas Studied

TigrayAfar

SNNPAddis Ababa


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Building SAFE MapsBuilding SAFE Maps

Primary and Secondary Data collected into Excel datasheetMost Recent Boundary Alignments Obtained from Ethiopian Ministry of Water ResourcesWHO Healthmapper application utilized to create mapsSAFE components mapped separately and together to identify areas of opportunity for azithromycin expansion


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Surgical Outreach or Standing Facilities in 16 WoredasAround 50% of Population Has Surgical Outreach in Same District

– Govt = Quiha Hospital Outreach– S/L = St. Louis Clinic Outreach

Surgical Clinic or Outreach

Quiha Eye Hospital

Surgery in TigraySurgery in Tigray

Healthmapper 4.1 S

Interview Regional Health Bureau, Quiha Hospital, St. Louis Clinic Q1, 2006


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SurgerySurgery

She is Already Blind in One Eye from Trachoma, She Will Leave with Surgery to Preserve Remaining Sight

(Quiha Hospital)

S


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Antibiotic Intervention in 6 Districts– Reached 20% of population

azithromycin distribution

AntibioticsAntibiotics

Source: ITI Ethiopia, *Projected with Ethiopian Central Statistics Authority Data 2003 assuming 90% coverage

Healthmapper 4.1 A


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Environment/Water and Sanitation In Environment/Water and Sanitation In TigrayTigray

Rural Water Coverage 30%8 districts have less than 15% coverageOrganizations supporting water and Sanitation– Relief Society of Tigray – World Vision Ethiopia– Catholic Relief Services – Ethiopian Orthodox Church– UNICEF– Rural Water Supply Project (World Bank/Ministry of Water)

Source: Tigray Water Resources Mines and Energy Bureau, Rural Water Supply Coverage of Tigray by Woreda, June 2005 and Interview with Bureau of Water Resources

FE


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No info

15-34%

45-54%

55% +

< 15%

8% of Population

21% of Population

45% of Population

6% of Population

% of Population

Western Zone Characterized by Very Low Access to Water

Rural Water SupplyRural Water Supply

Number Indicates Water Coverage Estimate

Source: Tigray Water Resources Mines and Energy Bureau, Rural Water Supply

Coverage of Tigray by Woreda, June 2005 (adjusted for displacement)

Healthmapper 4.1 FE


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Organizations Supporting Water and Organizations Supporting Water and SanitationSanitation

FE

Higher NGO presence in east

Organization Supporting Water and/or Sanitation


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EnvironmentEnvironment

Latrines and Handwashing Help Reduce Spread of Disease(Ethiopian Orthodox Church Community Water Project: Hintalo-Wajerat Woreda, Tigray

Region)


18Selected Regions Likely to Have Increased Capacity in the next 5 yearsMinistry of Water Resources Jan 2006 and ITI Zithromax Distribution Schedule 2006,

FE

Water Supply and Sanitation Project Water Supply and Sanitation Project (World Bank/Ministry of Water)(World Bank/Ministry of Water)

Phase 1 Water Supply and Sanitation Project:

Districts


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SAFESAFEBringing it all Together

Observations: All regions studied had some districts with S.F.E. but no A

– Opportunity? In many areas partners were operating in these districts already

Recommendations:Share S.A.F.E. mapping with partner organizations, encourage use of this information in planning for future distributionFollow developments and update as appropriateConsider future capacity of Water and Sanitation (World Bank WSSP, UNICEF WASH acceleration) when planning for azithromycin distribution


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F&E

S.A.F&E

S

A.F.E.

S.A.

S.F&E

Many with water and sanitation projects only

1 Districts w/out S for S.A.F.E., but clinic nearby

3 Districts with Surgical Outreach Only

1 District with S.A. and no NGO supporting F &E

8 districts lacking A for full SAFE

4 districts with full S.A.F.E coverage(~28% population)

Note: It could be considered that all districts have S, with patients traveling to clinics for S

S.A.F.E.S.A.F.E.

SAFEColor indicates organization present and focusing on this area of trachoma control

Interviews with NGOs and Health & Water Bureaus Q1, 2006


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How is This Information Being UsedHow is This Information Being Used

Surveys are now being conducted in northern Tigray districts (with S.F.E), map was used as a discussion tool with the Regional Health BureauMaps and presentations used in discussions with partner organizations in other regions


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Resources for ITI EthiopiaResources for ITI EthiopiaPresentations

– Region Focus (1 per region)S. A. F. E., WSSP, UNICEF

– Focus on Water Supply and SanitationOverview and maps

– Focus on Major OrganizationUNICEF, regular programs in all 5 regions

Mapping Tools– Software Healthmapper 4.1 – Database with S.A.F.E.updated for 3 regions studied– Database with S.A.F.E. for 2 regions studied in prior years– Healthmapper Manual– Instructions for ITI

Interview Notes– Typed with Key Findings Highlighted


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Questions?Questions?

Interviews with Community Health WorkersDerka Kebele, Lelay Maychew Woreda, Tigray Region

optimizing trachoma control with gis mapping of safe in ethiopia · 2006. 11. 10. · zwho...

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