Reanalysis of the Maltrials study

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Our malaria prevention trial in Zeway was recently reanalysed. When analysing the trial results, we particularly questioned why the entomological data showed an effect of our interventions while the randomised cluster trial was negative.

In the last year, we have tried several new reanalysis methods, and we believe we had a negative trial because we needed to account for unequal community levels. In the future, we should pay much more attention to multi-level data structures.

As you may read from the paper, we postulate that visible and hidden layers could affect the analysis of such community studies. Thus, we are currently working with people familiar with remote sensing to evaluate if the distribution of, for example, maise fields plays an essential role in the variation of malaria in communities. In addition, we are trying to map the distribution of small and temporary ponds often seen as breeding sites for Anopheles arabiensis. We’re trying to use remote sensing by downloading high-resolution satellite data for our Hawassa and Arba Minch studies.

Is it time to recruit new students, master’s or PhD, with a keen interest and relevant educational background to do work on the interdisciplinary aspects of epidemiology, remote sensing and GIS?

You can read our paper by following this link,  where you will find related research papers.

South Ethiopia Network of Universities in Public Health II (SENUPH II)

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The SENUPH II project represents a network of three universities in southern Ethiopia as well as the University of Bergen. The focus is on public health. Based on history of 20-year collaboration, we aim to strengthen the existing collaboration so to enhance efforts to improve capacity building, research, building independent senior researchers, and collaborate with the Ministry of Health with the relevant health information to improve the health of peoples in southern Ethiopia.

Project’s particular importance

Even if there has been a substantial economic growth in Ethiopia, the country remains among the 20 poorest countries. The population is in a transition with declining fertility, increasing life expectancy, heavy burdens of poverty-related diseases and increasing load of non-communicable diseases. Thus, the country needs evidence-based healthcare to improve health policy and improve the health of the population.

This project focuses on health challenges and priority setting. We believe universities in southern Ethiopia, can produce relevant information for policymakers to enhance public health work. By focusing on infectious diseases, malnutrition and the emerging burden of non-communicable diseases, we aim to build capacity in higher education both at universities and at the Ministry of health.

By the end of the project and through building strong research groups, we expect to have nine independent researchers capable of research leadership, supervising future PhD students, mentoring post docs, that further can develop their institutions when this project ends. Furthermore, we expect to have strengthened two PhD programs that would be sustainable in an Ethiopian context.

Building on a previous joint PhD degree programme between Hawassa University and the University of Bergen, and strengthening research at Dilla and Arba Minch University, we plan through PhD and post doc research, linked to training at the master’s level, strengthen the ownership, capability, and sustainability of the universities and of the Ministry of health to carry out evidence-based healthcare. The teaching, research, and implementation work will be interdisciplinary and integrated and involve disciplines such as epidemiology, medicine, priority setting and health economics, household economy, essential laboratory disciplines for emerging and existing epidemics.

Project goals

Through this six-year project, we aim to strengthen the institutional capacity for teaching, supervision and research by developing teams of researchers consisting of both senior (post docs) and junior researchers (PhD students and PhD holders) and thereby obtaining a critical mass needed for future sustainability of the institution. This will also focus on enhancing leadership capability of researchers so that they become independent researchers.

We shall strengthen research groups on thematic areas such as communicable diseases (malaria, emerging and re-emerging infections, and tuberculosis), nutrition, and priority setting on non-communicable diseases and health economics.

Relevant SDGs in the project

This project will deal with several of the sustainable development goals. The main goal is good health and well-being (SDG3). However, a large proportion of the efforts will be to reduce hunger in an area where chronic malnutrition is highly prevalent (SDG2). Our program will be based on quality teaching (DG4), and gender equality (SDG5).

Partner institutions

In Ethiopia, Hawassa University, Arba Minch University, and Dilla University, and the University of Bergen

History of Yirga Alem Hospital in Southern Ethiopia

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Lindtjørn B. The role of a mission organization in building a sustainable government hospital in Southern Ethiopia. Christian Journal for Global Health.7(2):133-46.

This study details the intriguing history of Yirga Alem Hospital in Southern Ethiopia under the aegis of the Norwegian Lutheran Mission since the middle of the last century.

In 1950, the Norwegian Lutheran Mission (NLM) began holistic mission work, including health work in Yirga Alem in Sidama in Southern Ethiopia. The hospital, which had served as a military hospital during the Italian war (1936-41), became a mission hospital. This paper presents some historical developments of a government hospital managed by a mission organization, the story of its medical work, and how the NLM functioned under varying political regimes and societal environments in Southern Ethiopia. At the same time, societal changes occurring in Norway with the weakening of mission organizations and the Norwegian governments policy that influenced external financial support for the hospital are presented and discussed. The key message of the paper is that it is possible under challenging external politics for a mission organization to collaborate with government entities even with difficult regimes. In the area of Yirga Alem Hospital, this was done without compromising the basics of mission, but rather readjusting comparative strategies while ensuring sustainability and local ownership. The uniqueness of this work is that it explores a mission, i.e., the NLM, which developed health work within the context of a nationally owned health service. Moreover, this fruitful collaboration persists until this day and previous missionaries still work to strengthen public health programs that target such major areas as tuberculosis and HIV control, maternal health, childcare, and nutrition.

The paper can be downloaded here: http://bernt.w.uib.no/files/2020/07/351-Article-Text-5479-3-10-20200628.pdf

New and important research from Arba Minch University

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Arba Minch University has recently published three important papers. This work comes from the resaearch group on malaria and leishmaniasis. You will find the references with links to fulltext papers below:

Mekuriaw W, Balkew M, Messenger LA, Yewhalaw D, Woyessa A, Massebo F. The effect of ivermectin® on fertility, fecundity and mortality of Anopheles arabiensis fed on treated men in Ethiopia. Malaria Journal. 2019;18(1).

Pareyn M, Van den Bosch E, Girma N, van Houtte N, Van Dongen S, Van der Auwera G, et al. Ecology and seasonality of sandflies and potential reservoirs of cutaneous leishmaniasis in Ochollo, a hotspot in southern Ethiopia. PLoS Negl Trop Dis. 2019;13(8):e0007667

Pareyn M, Kochora A, Van Rooy L, Eligo N, Vanden Broecke B, Girma N, et al. Feeding behavior and activity of Phlebotomus pedifer and potential reservoir hosts of Leishmania aethiopica in southwestern Ethiopia. PLoS Negl Trop Dis. 2020;14(3):e0007947.

New article: Few pregnant women seek health care in Gedeo in southern Ethiopia

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Borde MT, Loha E, Johansson KA, Lindtjorn B (2019) Utilisation of health services fails to meet the needs of pregnancy-related illnesses in rural southern Ethiopia: A prospective cohort study. PLoS ONE 14(12): e0215195. https://doi.org/10.1371/journal.pone.0215195

Although maternal survival has improved in the last decades, evidence on illnesses and the use of health services during pregnancy remains scarce. Therefore, we aimed to assess the incidence and risk factors for illnesses among pregnant women and measure the use of health services. A prospective cohort study was conducted in three kebeles in rural southern Ethiopia among 794 pregnant women from May 2017 to July 2018. Each woman was followed every two weeks at home. Poisson and survival regression models were used for analysis. The incidence rate of episodes of illnesses was 93 per 100 pregnant-woman-weeks (95%CI: 90.6, 94.2), with an average of eight episodes of illnesses per woman. Anaemia accounted for 22% (177 of 794 women), and hypertension 3% (21 women of 794 women). However, utilization of health services for any illness episodes was only 8% (95%CI: 7.6%, 8.9%). The main reasons for not using health services were that the women thought the illness would heal by itself, women thought the illness was not serious, women could not afford to visit the health institutions, or women lacked confidence in the health institutions. The risk factors for illnesses are having many previous pregnancies in life time (ARR = 1.42; 95%CI = 1.02, 1.96), having history of stillbirth (ARR = 1.30; 95%CI = 1.03, 1.64), having history of abortion (AHR = 1.06; 95%CI = 1.02, 1.11), and walking more than 60 minutes to access the nearest hospital (AHR = 1.08; 95%CI = 1.03, 1.14). The risk factors for low use of health services are also having history of abortion (AHR = 2.50; 95%CI = 1.00, 6.01) and walking more than 60 minutes to access the nearest hospital (AHR = 1.91; 95%CI = 1.00, 3.63). Rural Ethiopian pregnant women experience a high burden of illness during pregnancy. Unfortunately, very few of these women utilize health services.

New paper: Reversal of Choroquine resistance in Zambia

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Sitali L, Mwenda MC, Miller JM, Bridges DJ, Hawela MB, Chizema-Kawesha E, Chipeta J &  Lindtjørn B. En-route to the ‘elimination’ of genotypic chloroquine resistance in Western and Southern Zambia, 14 years after chloroquine withdrawal. Malar J. 2019;18(1):391. Epub 2019/12/05.

Background  Anti-malarial resistance is, and continues to be a significant challenge in the fight against malaria and a threat to achieving malaria elimination. In Zambia, chloroquine (CQ), a safe, affordable and well-tolerated drug, was removed from use in 2003 due to high levels of resistance evidenced with treatment failure. This study sought to investigate the prevalence of chloroquine resistance markers in Southern and Western Provinces of Zambia 14 years after the withdrawal of CQ.

Methods  Data from a cross-sectional, all-age household survey, conducted during the peak malaria transmission season (April–May 2017) was analysed. During the all-age survey, socio-demographic information and coverage of malaria interventions were collected. Consenting individuals were tested for malaria with a rapid diagnostic test and a spot of blood collected on filter paper to create a dried blood spot (DBS). Photo-induced electronic transfer–polymerase chain reaction (PET–PCR) was used to analyse the DBS for the presence of all four malaria species. Plasmodium falciparum positive samples were analysed by high resolution melt (HRM) PCR to detect the presence of genotypic markers of drug resistance in the P. falciparum chloroquine resistance transporter (Pfcrt) and P. falciparum multi-drug resistance (Pfmdr) genes.

Results  A total of 181 P. falciparum positive samples were examined for pfcrt K76T and MDR N86. Of the 181 samples 155 successfully amplified for Pfcrt and 145 for Pfmdr N86. The overall prevalence of CQ drug-resistant parasites was 1.9% (3/155), with no significant difference between the two provinces. No N86Y/F mutations in the Pfmdr gene were observed in any of the sample.

Conclusion  This study reveals the return of CQ sensitive parasites in Southern and Western Provinces of Zambia 14 years after its withdrawal. Surveillance of molecular resistant markers for anti-malarials should be included in the Malaria Elimination Programme so that resistance is monitored country wide.

New article: Can we measure household Food Insecurity?

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Kabalo, Bereket Yohannes, Seifu Hagos Gebreyesus, Eskindir Loha, and Bernt Lindtjørn. “Performance of an Adapted Household Food Insecurity Access Scale in Measuring Seasonality in Household Food Insecurity in Rural Ethiopia: A Cohort Analysis.” BMC Nutrition 5, no. 1 (2019/11/20 2019): 54. https://doi.org/10.1186/s40795-019-0323-6

Background  Seasonality poses a considerable food security challenge in Ethiopia. Yet, measuring seasonal variations in food insecurity, particularly the dimension of food access, lacks an adequately validated tool. We therefore evaluated the performance of an adapted Household Food Insecurity Access Scale (HFIAS) to estimate seasonal variations in food insecurity (FI) among subsistence villagers in Ethiopia.

Methods  We employed a cohort study design using a panel of four repeated measurements taken in June, September, and December in the year 2017, and in March 2018. The study recruited 473 villagers from the drought-affected Wolaita area in southwest Ethiopia. The performance of the HFIAS was evaluated via internal consistency (Chronbach’s alpha values) and criterion validation techniques. The set of criteria include: parallelism between affirmative responses to FI questions and wealth strata; dose-response relationship between FI and dietary intake; and also FI severity and household wealth status.

Results  This study revealed that the HFIAS had satisfactory performance in four repeated measurements. The likelihood of affirmative responses to questions about FI decreased with ascending wealth quintiles. We observed an inverse dose-response relationship between FI and wealth status, and between FI and household dietary diversity.

Conclusions  The HFIAS showed an acceptable potential for measuring seasonal variations in FI in the study area. Our findings complement efforts to evaluate the scale’s applicability in various settings, in order to promote cross-culture monitoring and comparisons. However, it required a careful adaption for contextual and cultural sensitivities.

Book Chapter: Developing a sustainable PhD programme: Experiences from southern Ethiiopia

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We recently published a chapter about the ideas behind the development of our SENUPH programme in southern Ethiopia:

Lindtjørn, Bernt, Moges Tadesse, and Eskindir Loha. “Developing a Sustainable Phd Programme: Experiences from Southern Ethiopia “ Chap. 18 In Sharing Knowledge Transforming Societies. The Norhed Programme 2013 – 2020, edited by Tor Halvorsen, KS Orgeret and R Krøvel, 442-56. Cape Town, Bergen: African Minds and University of Bergen, 2019.

See book chapter here Lindtjorn-NORHED chapter 18