Ethiop Med J

ProblemAn outbreak of chronic liver disease of unidentified cause, also called \u201cUnidentified Liver Disease\u201d or \u201cULD\u201d 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.ApproachWe 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 settingTigray 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 changesThe 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 learnedLong 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.20162017-01-01T00:00:00ZCC999999/Intramural CDC HHS/United States27069276PMC4822084691