Building Capacity for Noncommunicable Disease Surveillance and Prevention in Ethiopia

As noncommunicable disease (NCD) prevalence continues to increase worldwide, complex global health challenges have emerged. The burden of NCDs on individuals, communities, health systems, and countries disproportionately impacts those in low- and middle-income countries–including Ethiopia, where nearly 25% of adults have hypertension. To address the challenges of NCDs, particularly the growing burden of cardiovascular disease (CVD) in Ethiopia, the Field Epidemiology and Laboratory Training Program (FELTP) established an Advanced-level FELTP NCD track in 2019 to build field epidemiologists' technical capacity in CVD epidemiology and surveillance. The program is the first NCD-focused FELTP on the African continent, joining similar programs in China, India and Thailand. These programs are supported by the Bloomberg Philanthropies and Resolve to Save Lives through a grant to the National Foundation for the Centers for Disease Control and Prevention (CDC Foundation).

In December 2022, EFELTP graduated its first advanced-level NCD cohort. This is not only EFELTP's first, but also the first NCD cohort to graduate in Africa. 

EFELTP fellows in the NCD track pose for a photo after a training workshop in September 2021 (Photo courtesy of EFELTP).

The new NCD track aims to build capacity and strengthen the public health workforce trained to respond to both infectious and noncommunicable diseases. The first cohort consisted of eight trainees from across universities representing seven regions of Ethiopia. Graduates are equipped with skills and tools to address the leading health threats and challenges and serve as advocates for NCDs and associated risk factors such as high blood pressure and high salt consumption.

Dinka Kebede poses at his graduation ceremony in September 2022 (Photo courtesy of EFELTP).

Dinka Kebede is one of the graduates in the first cohort of the EFELTP NCD track. After graduation, he plans to continue contributing to NCD prevention, surveillance and control efforts in Ethiopia, both locally and nationally. He stated, "In this country, as the war against communicable diseases is still not over, particular attention is still being given to these diseases. Therefore, the EFELTP NCD track can have an impact on bringing attention to these deadly [NCDs] to the Ministry of Health." 

Another EFELTP NCD track graduate, Dagmawi Abebe, echoed Kebede's sentiments about the impact of the NCD FETP, saying, "Nowadays, NCDs are a leading cause of death. We need epidemiological evidence and expertise to understand this disease burden, design and monitor effective interventions, and inform the improvement of programs and policies."

Zemene Woreket, another cohort one graduate, emphasized how their cohort can increase awareness of NCDs at the community level as well, stating, "Well-trained health professionals can increase community awareness on NCD prevention, facilitate community involvement in NCD prevention, and conduct studies to identify factors that hamper implementation of NCD prevention programs''. Zemene plans to do just that after graduation, utilizing his skills to train other NCD workers, provide health education, and strengthen NCD prevention activities at the community level.

Mandefro Kebede poses after his graduation in August 2022 (Photo courtesy of EFELTP).

On top of being advocates for NCD surveillance and response, all graduates intend to continue their professional careers working to address NCDs in Ethiopia. Three graduates reported a specific interest in conducting NCD research to inform evidence-based strategies for prevention and control at local and national levels. One of these graduates, Bortola Abdisa Ayana, said, "NCD track residents and graduates generate evidence and conduct research mostly focusing on NCDs. Based on the recommendations from their findings, the governmental and non-governmental organizations, political leaders, policy makers, health professionals, and the whole community can use the evidence to inform their respective actions in preventing NCDs." Trained field epidemiologists play an essential role in strengthening these processes. 

EFELTP Program Director, Dr. Zegeye Hailemariam, shared that the EFELTP has already made considerable strides in developing NCD-focused surveillance, response and research. The program plans to continue providing key training for health professionals as EFELTP and Ethiopia continue to make progress in reducing NCD burden. "Having NCD-trained field epidemiologists at each level of governmental administration will help the Ethiopian Health system to achieve their strategic targets for reducing morbidity and mortality of CVD and their risk factors. We hope that the graduates and trainees will bring down the current NCD national prevalence from 54% to 20-30% by implementing strong surveillance systems and advocating for CVD prevention methods," said Dr. Hailemariam.

As part of their FELTP NCD training, trainees completed the following theses related to NCDs in Ethiopia: 

  • Abiye Demelash, Mekele University:  Time to achieve blood pressure control among hypertensive patients treated at public hospitals in Afar Region, north eastern Ethiopia: A retrospective cohort study
  • Bortola Abdisa Ayana, St. Paul's Hospital Millenium Medical College: Effects of noncommunicable diseases on severity and mortality of COVID-19 at Field Hospital, Addis Ababa, Ethiopia, 2022: Retrospective Cohort Study
  • Dagmawi Abebe, Haramaya University: Factors associated with mortality among hospitalized COVID-19 adult patients with chronic noncommunicable diseases in Dire Dawa, Eastern Ethiopian: A hospital based case-control study
  • Dinka Kebede Dibisa, Jimma University: Determinants of hypertensive heart diseases among adult hypertensive patients attending Adama hospital medical college and Bishoftu General Hospital
  • Lemma Lankamo, Lale Hawassa University: Magnitude and factors associated with uncontrolled hypertension among hypertensive patients on follow-up care in public health facilities of Bensa District, Sidama Region, Ethiopia, 2022
  • Mandefro Kebebe, Addis Ababa University: An Assessment of Chronic Disease among COVID-19 Patients-, Somali Region, Ethiopia
  • Mekonnen Yimer Sisay, Bahir Dar University: Salt intake reduction practice and associated factors among adults in Bahir Dar city
  • Zemene Woreket, University of Gondar:  Magnitude and factors associated with loss to follow up among hypertensive patients on treatment at public health facilities in Bahirdar town, 2022