Detecting P. falciparum and P. vivax

This paper reviews the sensitivity and specificity of RDTs for detecting P. falciparum and P. vivax in two different settings ¿ at health centres and in a household survey. The study includes a large number of patients (2,394 participants) and provides useful additional information about the performance of these RDTs.

Woyessa A, Deressa W, Ali A, Lindtjørn B. Evaluation of CareStartTM malaria Pf/Pv combo test for Plasmodium falciparum and Plasmodium vivax malaria diagnosis in Butajira area, south-central Ethiopia. Malaria Journal 2013, 12:218 doi:10.1186/1475-2875-12-218

Anopheles mosquitoes in three villages

This is a report on the Anopheles fauna found in three different villages located at three different altitudes ranging from 1,800 meters to 2,200 metres, showing the human/cattle blood meal preference for each species and the sporozoite rate and entomological inoculation rate for the vectors.

Animut A, Balkew M, Gebre-Michael T and Lindtjørn B. Blood meal sources and entomological inoculation rates of anophelines along a highland altitudinal transect in south-central Ethiopia. Malaria Journal 2013, 12:76 doi:10.1186/1475-2875-12-76

Background The role of anophelines in transmitting malaria depends on their distribution, preference to feed on humans and also their susceptibility to Plasmodium gametocytes, all of which are affected by local environmental conditions. Blood meal source and entomological inoculation rate of anophelines was assessed along a highland altitudinal transect in south- central Ethiopia.

Methods Monthly adult anopheline sampling was undertaken from July 2008 to June 2010 in Hobe (low altitude), Dirama (mid altitude) and Wurib (high altitude) villages located at average elevations of 1800 m, 2000 m and 2200 m, respectively. Anophelines were collected using CDC light trap, pyrethrum space spray catches (PSC) and artificial pit shelter methods. Upon collection, females were categorized according to their abdominal status and identified to species. Their human blood index, sporozoite rate and entomological inoculation rate was determined.

Results A total of 4,558 female anophelines of which Anopheles arabiensis was the most prevalent (53.3%) followed by Anopheles demeilloni (26.3%), Anopheles christyi (8.9%), Anopheles pharoensis (7.9%) and Anopheles cinereus (3.6%) were caught and tested for blood meal source or sporozoite infection depending on their abdominal status. The proportions of human fed and bovine fed An. arabiensis were generally similar. In the low altitude village, there were 0.3% (1/300) and 0.2% (1/416) Plasmodium falciparum infected An. arabiensis among the CDC trap catches and PSC respectively. The percentage of Plasmodium vivax infected An. arabiensis were 3% (9/300) and 0.7(3/416) among the CDC and PSCs respectively in the village. In addition, there were 1.4% (1/71) and 50% (1/2) P. vivax infected An. pharoensis from the CDC light trap and PSCs, respectively. In the mid altitude village, 2.5% (1/40) and 1.7% (1/58) from among the CDC and PSCs of An. arabiensis respectively carried P. vivax sporozoites. Among the CDC light trap catches; there were 3.7 and 0 P. falciparum infective bites per year per household for An. arabiensis in the years July 2008 to June 2009 and July 2009 to June 2010 respectively in the low altitude village. The corresponding numbers for P. vivax infective bites for An. arabiensis were 33 and 14.5 in the same village. Space spray catches revealed 0.32 P. vivax infective bites per household for An. pharoensis during the first year in the low altitude village.

Conclusion Anopheles arabiensis was the most prevalent vector of P. vivax and P. falciparum malaria in the low and mid altitude villages followed by An. pharoensis. Annual entomological inoculation rates showed that vivax malaria transmission was higher than that of the falciparum and both decreased with increase in altitude.

Use of bed nets to prevent malaria

The objective of this study was to characterize the pattern related to ITN use in one village in south Ethiopia. A huge discrepancy was reported between ownership versus utilization of insecticide-treated bed nets (ITNs). To acquire the benefits of ITNs, households need to use and not merely own them.

Eskindir Loha, Kebede Tefera and Bernt Lindtjørn. Freely distributed bed-net use among Chano Mille residents, south Ethiopia: a longitudinal study. Malaria Journal 2013, 12:23 doi:10.1186/1475-2875-12-23

Background:  A huge discrepancy was reported between ownership versus utilization of insecticide-treated bed nets (ITNs). To acquire the benefits of ITNs, households need to use and not merely own them. The objective of this study was to characterize the pattern of, and assess factors related to ITN use in one village in south Ethiopia.

Methods:  A prospective cohort study involving 8,121 residents (in 1,388 households) was carried out from April 2009 to April 2011 (101 weeks). Every week, individuals were asked whether they slept under an ITN the night before the interview. Descriptive statistics was used to report the availability and use of ITN. A negative, binomial, probability, distribution model was fitted to find out significant predictors of ITN use. Reasons for not using ITN were summarized.

Results:  The total number of ITNs available at the beginning of the study was 1,631 (1.68 ITNs per household). On week 48, 3,099 new ITNs (PermaNet2.0) were distributed freely (2.3 ITNs per household). The number of households who received at least one new ITN was 1,309 (98.4%). The percentage of children <5 years and pregnant women not using ITNs exceeded that of other adults. The mean (range; SD) ITN use fraction before and after mass distribution was 0.20 (0.15-0.27; 0.03) and 0.62 (0.47-0.69; 0.04), respectively. Before mass ITN distribution, the most frequent reason for not using ITN was having worn out bed nets (most complained the bed nets were torn by rats); and after mass ITN distribution, it was lack of convenient space to hang more than one ITN. Males, younger age groups (mainly 15–24 years) and those living away from the vector-breeding site were less likely to use ITN.

Conclusions:  The ITN use fraction reached to a maximum of 69% despite near universal coverage (98.4%) was achieved. Gender, age differences and distance from vector breeding site were associated with ITN use. Strategies may need to be designed addressing disproportions in ITN use, lack of convenient space to hang more than one ITN (for those receiving more than one), and measures to prolong usable life of ITNs.

Reducing maternal mortality in south Ethiopia

In line with the Millennium Development Goal for maternal health (MDG-4 and 5), I take part in a project to support regional and local government in their work to cut maternal and neonatal deaths. The Reducing Maternal Mortality programme, which started in 2008, is today viewed as a pilot programme for Ethiopia, and efforts are under way to scale up these efforts for the whole country. It is funded by NORAD and Norwegian Lutheran Mission.

The overall development goal of this collaboration with three Regional Health Bureaus is to improve maternal health and make large decline in neonatal and maternal mortality among the target population.

The target population for this project are pregnant women in remote areas in south-west Ethiopia (Gamu Gofa Zone, Basketo Special Woreda, Saggan Zone (previous Dirashe and Konso Special Woreda), and in south-east Ethiopia (Bale Zone and the southern part of Somali Region). See Map.

The project’s aims to strengthen the antenatal services so the health extension workers can help normal deliveries, and identify and refer women in need of help during delivery to health institutions. The project shall enable health centres and hospitals to practise safe delivery. Particular attention is on intrapartum care.


“Every fallen is a brother and a friend”

Norway is a peaceful and harmonious society, and is very open. On July 22, this was shattered by a massacre at a youth camp at Utøya, and a bombing in the capital, Oslo. At least 76 people were killed in the attacks, many were injured and some are still missing.

On May 17th, 1940, after the start of war in Norway, the famous Norwegian poet Nordahl Grieg wrote: “Vi er så få her i landet, Hver fallen er bror og venn” My English translation is: “We are so few in this country, Every fallen is a brother and a friend”.

The worst atrocity in Norway since World War II was done by a 32 year old Norwegian.

Norway after July 22 will be different from what is was before this national tragedy. In the days after this national tragedy, many hundred thousand people in Norway have in public expressed their deep sorrow. All are defiant, and are determined that this national tragedy won’t undermine the values our country stands for: peace, democracy, solidarity, openness and tolerance.

200 Countries, 200 Years, 4 Minutes

I have for many years known Hans Rosling. He is a professor in Stockholm. He started working in rural Africa, described the Konzo nutritional disorder, and is now a not only an excellent teacher, but also global educator.

Please visit his homepage and download some of the very good software that he has developed. This software is free, and the teaching materials are useful tools to learn both students and professionals.

Now, please watch the film from YouTube (BBC Four):

Statistics come to life when Swedish academic superstar Hans Rosling graphically illustrates global development over the last 200 years.

Maternal Mortality in Ethiopia

In a special issue of the Ethiopian Journal of Health Development, eight papers discuss important topics such as maternal mortality trends, infrastructure and resources available for maternal health, and maternal health care use.

The articles show there have been improvements in antenatal care coverage and Tetanus Toxoid immunization. Unfortunately, delivery by skilled attendants and post-natal care coverage remain low. Ethiopia is making little progress in the indicator (skilled attendance at birth) that is considered to be the most important predictor of maternal mortality.

One of the papers discusses how to interpret trend data on maternal mortality ratio. Comparing the results of 2000 and 2005 Ethiopian Demographic Health Survey show there appears to be a decline in maternal mortality. However, as the overlaps in the 95% confidence intervals overlap, we cannot be certain about the decline.

What happens to tuberculosis patients after treatment?

Mortality in successfully treated TB patients is an important measure of the efficacy of treatment. However, there is no routine monitoring of TB patients after treatment completion to understand what happens to them after successful treatment for tuberculosis. We recently did a study in rural south Ethiopia to measure mortality in TB patients after they completed treatment.

From south Ethiopia, we showed (Datiko and Lindtjørn 2010) that deaths rates after successful TB treatment was higher in TB patients than in the general population. It was especially high in populations with increased risk of HIV infection.

In a study from China, He and colleagues (2010) show that TB patients with multi-drug resistance had high recurrence and death rates four years after treatment with standardized first line drug regimens. They also show that it is not sufficient to document cure only based on conventional smear microscopy at the end of treatment.

Therefore, TB patients, and especially high- risk groups, should be followed for some years after completing the TB treatment


Datiko DG and Lindtjørn B (2010). Mortality in successfully treated tuberculosis patients in southern Ethiopia: retrospective follow-up study Int J Tuberc Lung Dis, 14 (7), 1-6

He, G., Xie, Y., Wang, L., Borgdorff, M., van der Werf, M., Fan, J., Yan, X., Li, F., Zhang, X., Zhao, Y., & van den Hof, S. (2010). Follow-Up of Patients with Multidrug Resistant Tuberculosis Four Years after Standardized First-Line Drug Treatment PLoS ONE, 5 (5) DOI: 10.1371/journal.pone.0010799