1.1.1  The burden of communicable diseases in Ethiopia

Outpatient refers to someone who comes to a health facility seeking treatment, but does not stay overnight. An inpatient is someone admitted to a health facility, who has at least one overnight stay.

Communicable diseases are the main cause of health problems in Ethiopia. According to the Ethiopian Federal Ministry of Health, communicable diseases accounted for most of the top ten causes of illness and death in 2008/09. As you can see in Table 1.1, most causes of outpatient visits are due to communicable diseases.

  • Can you identify the communicable diseases in Table 1.1?

  • You may not recognise them all (you will learn about them in later study sessions), but you probably mentioned malaria, respiratory infections, parasitic diseases, pneumonia and diarrhoea.

Table 1.1  Top 10 leading causes of outpatient visits in most regions of Ethiopia, September 2008–August 2009. (From: Federal Ministry of Health (2010) Health and Health Related Indicators: 2008/9, Addis Ababa, Ethiopia)

RankDiagnosisPercentage of all outpatient visits
1Malaria (clinical diagnosis without laboratory confirmation)8.3
2Acute upper respiratory infections8.1
3Dyspepsia (indigestion)5.9
4Other or unspecified infectious and parasitic diseases5.0
5Pneumonia4.8
6Other or unspecified diseases of the respiratory system4.0
7Malaria (confirmed with species other than Plasmodium falciparum)3.7
8Diarrhoea with blood (dysentery)3.7
9Helminthiasis (caused by worms)3.5
10Diseases of the musculoskeletal system and connective tissue (muscles, bones and joints)3.0
Total % of all causes of outpatient visits47.2

A clinical diagnosis is based on the typical signs and symptoms of the disease, without confirmation from diagnostic tests, e.g. in a laboratory.

The naming of infectious agents is discussed in Section 1.2.1.

Table 1.2 shows that most causes of inpatient deaths are due to communicable diseases, including pneumonia, tuberculosis, HIV/AIDS and malaria. These and other communicable diseases will be discussed in detail in later study sessions of this module.

Table 1.2  Top 10 leading causes of inpatient deaths in most regions of Ethiopia, September 2008–August 2009. (Source as Table 1.1)

RankDiagnosisPercentage of all inpatient deaths
1Pneumonia12.4
2Other or unspecified effects of external causes7.1
3Tuberculosis7.0
4Human immunodeficiency virus (HIV) disease5.1
5Anaemias3.9
6Other or unspecified diseases of the circulatory system (heart, blood vessels)3.7
7Hypertension (high blood pressure) and related diseases3.5
8Malaria (clinical diagnosis without laboratory confirmation)3.1
9Malaria (confirmed with Plasmodium falciparum)2.5
10Road traffic injuries2.3
Total % of all causes of inpatient deaths50.8

1.1  What are communicable diseases?

1.1.2  Endemic and epidemic diseases