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.
| Rank | Diagnosis | Percentage of all outpatient visits |
|---|---|---|
| 1 | Malaria (clinical diagnosis without laboratory confirmation) | 8.3 |
| 2 | Acute upper respiratory infections | 8.1 |
| 3 | Dyspepsia (indigestion) | 5.9 |
| 4 | Other or unspecified infectious and parasitic diseases | 5.0 |
| 5 | Pneumonia | 4.8 |
| 6 | Other or unspecified diseases of the respiratory system | 4.0 |
| 7 | Malaria (confirmed with species other than Plasmodium falciparum) | 3.7 |
| 8 | Diarrhoea with blood (dysentery) | 3.7 |
| 9 | Helminthiasis (caused by worms) | 3.5 |
| 10 | Diseases of the musculoskeletal system and connective tissue (muscles, bones and joints) | 3.0 |
| Total % of all causes of outpatient visits | 47.2 | |
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.
| Rank | Diagnosis | Percentage of all inpatient deaths |
|---|---|---|
| 1 | Pneumonia | 12.4 |
| 2 | Other or unspecified effects of external causes | 7.1 |
| 3 | Tuberculosis | 7.0 |
| 4 | Human immunodeficiency virus (HIV) disease | 5.1 |
| 5 | Anaemias | 3.9 |
| 6 | Other or unspecified diseases of the circulatory system (heart, blood vessels) | 3.7 |
| 7 | Hypertension (high blood pressure) and related diseases | 3.5 |
| 8 | Malaria (clinical diagnosis without laboratory confirmation) | 3.1 |
| 9 | Malaria (confirmed with Plasmodium falciparum) | 2.5 |
| 10 | Road traffic injuries | 2.3 |
| Total % of all causes of inpatient deaths | 50.8 | |
1.1 What are communicable diseases?