Introduction to Public Health Emergency

Management (PHEM) and

Maternal and Perinatal Death Definitions
 Outline
• Background on surveillance activities in Ethiopia
• Introduction to PHEM
• Goal and objectives of PHEM
• Mandate of the PHEM Center
– Capacity Building
– Early Warning and Communication
– Response
– Recovery and Rehabilitation
• Maternal and Perinatal Death Definition
 Back ground:
Diseases Surveillance In Ethiopia Between 1998-2009

Diseases Surveillance In Ethiopia

Since 2009
 Public Health
before 2009
 It includes: Emergency
• Integrated diseases Management (PHEM)
surveillance  Designed by business process
• Response re-engineering( BPR)
• Containment of an outbreaks
 It is one of the nine Eight/
 Focused on epidemic diseases
only core processes of
• No nutritional surveillance ORHB/MOH
• Weak laboratory surveillance  Located in Ethiopian Public
Health Institute/ORHB
 Lack of appropriate
preparedness
 No recovery activities after
disaster
 Introduction:
IDSR PHEM
 Mainly focuses on Epidemic  Multi hazard approach
disease  Surveillance Data comes
 Surveillance data comes
weekly
monthly  Smallest reporting unit is
 Smallest reporting unit is Health
Health post
Center  Robust/strong early warning system
 Weak early warning system  Prompt response
 Delayed response  Recovery activities included
 No recovery  Event based surveillance
 No event based surveillance
 Goal and objective of PHEM:

Goal of PHEM:
 To markedly reduce mortality and morbidity due to epidemics and
other Public Health Emergencies and minimize associated social
and economic crisis

General Objective

 To prepare for, detect early, and contain epidemics locally ;

respond timely to other public health emergencies and recover
quickly from their impacts.
 Capacity Building:
Types of Reporting Formats
Reporting formats for all reportable
events
Capacity Building:
1. Community case definitions
 Sensitive
 Used at the community level
 Capacity Building:
2. Standard case
Definitions
Customized from WHO case

definitions
Printed and distributed to all

health facilities
Used at health center and above
 Capacity Building:
3. Guidelines already printed and
distributed
 PHEM guideline
 Cholera guideline
 Measles guideline
 Malaria guideline
 Influenza Surveillance
implementation guideline
 Meningitis Guideline
 AFP Guideline
 NNT Guideline
 MPDSR Technical Guidance
 Guideline under Preparation
 Yellow Fever
 Rabies
 Anthrax
 Dengue fever
 Indicator based surveillance:
Immediately Reportable Weekly Reportable
1. Acute Flaccid Paralysis 1. Dysentery
2. Anthrax
2. Malaria
3. Avian Human Influenza
4. Cholera 3. Meningitis
5. Dracunculiasis/Guinea worm 4. Relapsing
6. Measles 5. Typhoid Fever
7. Neonatal tetanus
6. Typhus
8. Pandemic Influenza A(H1N1)
9. Rabies 7. Severe Acute Malnutrition
10. Small pox
11. SARS Criteria for identification
1. Diseases under eradication and
12. Viral Hemorrhagic Fever(VHF) elimination
13. Yellow Fever 2. Disease of public health importance
14. Maternal Death 3. Diseases of international concern
15. Perinatal Death
Timeline for immediately Reportable Diseases:

Health Woreda Zone Region EPHI

Facility

Within 30 Within 30
Within 30 Within 30
Minutes Minutes
Minutes Minutes

Even
t
0:30 1:00 1:30 2:00
Time
Timeline for Weekly Reportable Diseases:

HF to Woreda Zone to Region to

woreda to zone Region EPHI

Event Monday Tuesday Wednesday Thursday

The following Week

Reporting Channel:
EPHI

E-mail
Fax
Rumor-Phone
Region

Telephone
E-mail
Zone Fax

Telephone
Fax
Woreda

Health Facility • Paper

• Telephone

Papers Telephone E-mail

 CASE DEFINITION

 Classification of case definitions:

1. COMMUNITY CASE DEFINITION

1.a. Probable death:

• Broad, sensitive, needs further screening, used by the
general community

1.b. Possible (suspected) death:

• Filtered after screening verbally

• Gets coded and used for investigation

2. STANDARD (CONFIRMED) CASE DEFINITION
 COMMUNITY CASE DEFINITION

PROBABLE MATERNAL DEATHS PROBABLE PERINATAL DEATHS

• Death of a woman of
• The birth of a dead
reproductive age
foetus or death of a
group: (15-49 years of
new born
age)
 COMMUNITY CASE DEFINITION

Suspected maternal death Suspected perinatal death

“Probable maternal death” plus at

least one of the following (Screen): “Probable perinatal death” plus (screen):
– Birth after 7 month of pregnancy
 Died while pregnant,
and
 Died within 42 days of
– New born dead at the time of birth
termination of pregnancy
OR
or
– Death within 28 days of delivery
 missed her menses before

she died
 1. Any one who knows her

Screen if there duration of pregnancy or

was seven
months of 2. GA of 28 weeks or 196 days

pregnancy using: starting from the first date of

the last normal menstrual

period (LNMP)
 STANDARD CASE DEFINITION
Confirmed maternal death Confirmed Perinatal death

“The death of a woman while

pregnant or within 42 days of the end “Death of a fetus born after 28

completed weeks of gestation or
of pregnancy (irrespective of duration
neonatal deaths through the first 28
and site of pregnancy), from any cause
completed days after birth”
related to or aggravated by the

pregnancy or its management but not

from accidental or incidental causes “

(Source: ICD-10)
 By Using :
1. last normal menstrual period (LNMP) :
GA of 28 weeks or 196 days starting from
the first date of the last menstrual
period (LNMP) or

Gestational age 2. Fundal height of 28 cm

of 28 weeks is
3. Early or First trimester(™) Ultrasound:
confirmed
• Crown lump length (CRL) (9-11 weeks)
or
• Gestational sac(GS) diameter at 5-6 GA
weeks.
*GS-is first sign of early pregnancy
 Explanation of Crown-lump length (CRL) :
Crown-lump length (CLL) is the measurement of the
length of human embryos and fetuses from the top of the
head (crown) to the bottom of the buttocks (lump). It is
typically determined from ultrasound imagery and can be
used to estimate gestational age.