Physico-chemical investigation of consumables and environmental samples to determine the causative agent of liver disease outbreak in Tahitay Koraro Woreda, Tigray
The occurrence of liver disease out break of unknown origin and of a significant morbidity and mortality with a major symptom of abdominal dropsy was reported among the inhabitants of Tsaeda--Emba village, Tahtay Koraro woreda, Tigray during mid December, 2005. The aim of this study was to assess if chemical intoxicants were the responsible agents for the outbreak in the affected locality. The experimental approach towards the identification of the possible causative agent from the consumables and environmental samples collected from the affected village were determination of physico-chemical quality parameters and chemical analysis using instrumental and chromatographic techniques. The intoxicant was found to stem from the consumption of the water from the unprotected well in which pyrrolizidine containing plant, Ageratum sp, abundantly thrives. The water source was intimately linked to the outbreak of disease and, therefore, immediate intervention and preventive measures are called for.
[Show abstract] [Hide abstract] ABSTRACT: Problem: An outbreak of chronic liver disease of unidentified cause, also called "Unidentified Liver Disease" or "ULD" was first observed in a rural village in Tigray, Ethiopia in 2001. Little was known about the geographical extent, trend, and epidemiology of this disease. Approach: We initiated a local active surveillance system to characterize and monitor trends for this emerging disease and to identify cases for treatment and follow up. Local setting: Tigray is a rural, resource-limited setting characterized by a lack of electricity, rugged terrain, limited transportation, and few healthcare facilities and trained healthcare workers. Relevant changes: The Ethiopian Health and Nutrition Research Institute, Centers for Disease Control and Prevention, World Health Organization, and Tigray Regional Health Bureau established the ULD surveillance system in 2009 and conducted a large-scale official training for the surveillance staff on case identification, management and reporting. In absence of a confirmatory test, the system used simple case definitions that could be applied by frontline staff with varying clinical training. To maximize resources, health extension workers already conducting household visits in affected communities identified cases and increased community awareness about the disease. A team was placed in Shire, in close proximity to the outbreak region, to provide support and collect reports from health facilities and district health offices. Lessons learned: Long term dedication by frontline staff, using simple case definitions to identify cases, and active collection of missing reports were critical for surveillance of this chronic non-infectious disease of unknown cause in a rural, resource-limited setting.0Comments 0Citations
- "ULD was characterized by epigastric pain, abdominal distention, as cites, and hepatosplenomegaly, with case fatality rates estimated at 30% to 40%.(1-3) Having ruled out infectious causes with initial investigations patients were investigated for potential toxic etiologies.123456 Basic epidemiological questions considered to characterize the disease included geographic, temporal, and seasonal trends, case demographics, clinical characteristics , and incidence and mortality rates. "