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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
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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)
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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