Uncategorized – Page 4 – International Health Research

Maternal Mortality in Ethiopia

Posted on 09/08/2010 by Bernt Lindtjørn — No Comments ↓

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?

Posted on 12/06/2010 by Bernt Lindtjørn — No Comments ↓

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

References

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

Global warming and malaria

Posted on 22/05/2010 by Bernt Lindtjørn — No Comments ↓

A recent article by Gething and colleagues in Nature (May 20^th, 2010) shows that malaria has declined the past century. The decline has been largest in areas with less malaria transmission.

What is new in this paper is that the malaria decline takes place during global warming. The reasons for decline might be non-climatic factors such as better treatment and prevention. Their research addresses malaria on large scales, and the situation might be different in local areas.

Linking changes in temperatures to variations in malaria epidemiology is justified by known biological effects on life-cycle stages of the Anopheles vector and Plasmodium parasite. For example increasing temperature to 30^oC results in shortened sporogonic period of the Plasmodium parasite, and differently for P. falciparum and P. vivax. Higher mean daily temperatures are not favourable for vector survival. Increased temperature speeds up development of the aquatic stages of the vector.

Therefore, some propose developing tools to forecast malaria epidemics. We use different terminology to describe malaria risks, and distinguish between long-term forecasts, early warning and early detection of epidemics.

Long-term epidemic forecasting is based on climate forecasting, and many use information such as the El Niño Southern Oscillation indices as added information to predict epidemic risks months in advance over large geographical areas. Such a forecast allows time for the population to prepare for a possible epidemic in the following malaria season.

Malaria epidemic early warning is based on surveying transmission risks to predict timing of an increase because of abnormal rainfall or temperature. Often, such risks are influenced by population vulnerability such as history of low malaria transmission. Such predictions can give lead times of weeks to months.

The long-term and early warning should however be distinguished from epidemic early detection. This involves noting the beginning of an unusual epidemic, and offers short lead time (days to weeks) for preparation of preventive measures.

We are studying the association between temperature, rainfall, mosquito development and malaria in both lowlands and highlands in Ethiopia. Through this research, we hope to improve our understanding of the local variations in malaria epidemiology. Our aim is to examine if the spatio-temporal distribution of surface temperature and rain can predict malaria epidemics (both long-term forecasting, and malaria epidemic early warning). We base this on an assumption the nature of the link between climate and occurrence of malaria is constant and similar for different settings.

Gething, P., Smith, D., Patil, A., Tatem, A., Snow, R., & Hay, S. (2010). Climate change and the global malaria recession Nature, 465 (7296), 342-345 DOI: 10.1038/nature09098

Corruption at health institution

Posted on 01/05/2010 by Bernt Lindtjørn — No Comments ↓

Corruption at health institution is a concern in all countries, but it is especially in developing countries where public resources are already scarce.

Countries with high indices of corruption have for example higher rates of infant mortality.

A recent World Bank report from Ethiopia (Lindelow and Serneels 2006) report on “pilfering drugs and materials, informal health care provision and illicit charging, and corruption” at health institutions in Ethiopia. The authors focus on “weak accountability mechanisms and the erosion of professional norms in the health sector” as a main causes of corruption.

Fighting corruption is important because corruption reduces the resources available for health. Corruption also lowers the quality, equity and effectiveness of health care services, and it decreases the volume and increases the cost of provided services. Corruption also discourages people to use and pay for health services.

Some examples of corruption in health care (from Vian 2002):

During construction and rehabilitation of health institutions: bribes, kickbacks and political considerations influence the contracting work, and contractors fail to perform and are not held accountable
Buying equipment, supplies, and drugs: bribes, kickbacks, and political considerations influence specifications and winners of bids, bid rigging during procurement, lack of incentives to choose low cost and high-quality suppliers. Suppliers might fail to deliver and are not held accountable
Distribution and use of drugs and supplies in service delivery: Theft (for personal use) or diversion (for resale to private institutions) of drugs and supplies at storage and distribution points. It also includes sale of drugs or supplies that were supposed to be free
Education of health professionals: bribes to gain place in medical school or other pre-service training, bribes to obtain passing grades, and political influence, nepotism in selection of candidates for training opportunities

Preventing abuse and reducing corruption is important to increase resources available for health, and thus to improve the health status of the population.

In our health work in Ethiopia we only work with institutions that focus of transparent management procedures, and have proper accounting and perform regular external financial audit. In our experience it is also important that public auditing institutions (“Office of general audit”) regularly evaluate health institutions.

References:

Lindelow, M., & Serneels, P. (2006). The performance of health workers in Ethiopia: Results from qualitative research Social Science & Medicine, 62 (9), 2225-2235 DOI: 10.1016/j.socscimed.2005.10.015

Vian T. 2002. Corruption and the Health Sector. http://www.usaid.gov/our_work/democracy_and_governance/publications/ac/sector/health.doc

Smear negative pulmonary tuberculosis in HIV infected patient

Posted on 02/04/2010 by Bernt Lindtjørn — No Comments ↓

Clinicians working with HIV patients know how difficult it is to make a certain tuberculosis diagnosis in the smear negative pulmonary tuberculosis. Often the diagnosis is made on clinical and radiological criteria, and is based on national guidelines and international recommendations.

In a recent paper in PLoSONE, Davies and colleagues show that Clinical and radiographic criteria did not help diagnose smear-negative pulmonary tuberculosis among HIV-infected patients with unexplained cough in a low-income setting.

In their paper they evaluated if commonly used clinical and radiological signs could predict if the patient had tuberculosis, and they used culture as their god standard for diagnosing a definite tuberculosis diagnosis. However, their paper does not discuss the limits in doing cultures, and their samples might not have been representative.

In a recently research from south Ethiopia we found that patients receiving antituberculosis drugs had better survival than patients without tuberculosis. This unexpected finding may be because many patients remain undiagnosed with tuberculosis. In the Arba Minch Hospital Cohort Study we evaluated the survival of 1428 patients receiving antiretroviral treatment over a six-year period.

It further underlines Davis’s recommendation that we need improved tools to diagnose smear-negative tuberculosis in developing countries.

Davis, J., Worodria, W., Kisembo, H., Metcalfe, J., Cattamanchi, A., Kawooya, M., Kyeyune, R., den Boon, S., Powell, K., Okello, R., Yoo, S., & Huang, L. (2010). Clinical and Radiographic Factors Do Not Accurately Diagnose Smear-Negative Tuberculosis in HIV-infected Inpatients in Uganda: A Cross-Sectional Study PLoS ONE, 5 (3) DOI: 10.1371/journal.pone.0009859

Article-level metric

Posted on 01/11/2009 by Bernt Lindtjørn — No Comments ↓

A citation index allows the user to establish which later documents cite which earlier documents. The impact factor is a measure reflecting the average number of citations to articles published in science journals. It is frequently used as a proxy for the relative importance of a journal within its field.

Both the Citation index and Impact factors are used to measure how good an article is. This is a misunderstood and a misleading way of using such measures. Unfortunately institutions and governments use citation index to fund researchers.

Recently, the PLoS and BioMedCentral journals give authors some information on citations, but also tell you how many times the article has been downloaded. This is called article-level metrics, and measures individual papers.

However, it is important to recognize that also such metrics are prone to errors. An article that is mentioned in a newspaper, is likely to be downloaded more often that articles that do not receive such media attention.

Although these new metrics provide us with more information, it is not yet clear how best to use these measures. Currently, both PLoS and BioMedCentral simply present the data.

But, there is only one way of deciding whether a paper is important and to you, and that is to read it, critically analyse it, and come to your own conclusions.

Bibliography on the Konso

This Bibliography on the Konso aims to include literature on a wide range of topics on the Konso people and Konso area of south Ethiopia.

It will regularly be updated.

October 25, 2009:

Agriculture (3)

1. Amborn H. Agricultural intensification in the Burji-Konso cluster of south-western Ethiopia. Azania. 1989 Jan 1.

2. Asfaw T. Understanding Farmers. Explaining Soil and Water conservation in Konso, Wolaita and Wello …. librarywurnl. 2003 Jan 1.

3. Kelly V, Jayne TS, Ababa A, Demeke M, Said A, Valle JCL, et al. Grain Market Research Project. 1999 Feb 2.

Anthropology (4)

1. Amborn H. Wandlungen im sozio-okonomischen gefuge der bevolkerungsgruppen im Gardulla-Dobase-Horst in Sudaethiopien. Paideuma. 1976;22:151-61.

2. Amborn H. Concepts in wood and stone: Socio-religious monuments of the Konso of Southern Ethiopia. Zeitschrift für Ethnologie. 2002 Jan 1.

3. Hallpike R, Christopher. The Konso of Ethiopia: a study of the values of a Cushitic people‎. 1972.

4. Hallpike R, C. The Konso of Ethiopia: A Study of the Values of an East Cushitic People‎; 2008.

Evolution (3)

1. Brown F, Fuller C. Stratigraphy and tephra of the Kibish Formation, southwestern Ethiopia. J Hum Evol. 2008 Sep 1;55(3):366-403.

2. Suwa G, Asfaw B, Beyene Y, White TD, Katoh S, Nagaoka S, et al. The first skull of Australopithecus boisei. Nature. 1997 Oct 2;389(6650):489-92.

3. Wood B, Lieberman D. Craniodental variation in Paranthropus boisei: a developmental and functional perspective. Am J Phys Anthropol. 2001 Sep 1;116(1):13-25.

Health (17)

1. Ali A, Ashford R. Visceral leishmaniasis in Ethiopia. I. Cross-sectional leishmanin skin test in an endemic locality. Ann Trop Med Parasitol. 1993 Apr 1;87(2):157-61.

2. Ali A, Ashford R. Visceral leishmaniasis in Ethiopia. II. Annual leishmanin transformation in a population. Is positive leishmanin reaction a life-long phenomenon? Ann Trop Med Parasitol. 1993 Apr 1;87(2):163-7.

3. Ali A, Ashford R. Visceral leishmaniasis in Ethiopia. III. The magnitude and annual incidence of infection, as measured by serology in an endemic area. Ann Trop Med Parasitol. 1994 Feb 1;88(1):43-7.

4. Ali A, Ashford R. Visceral leishmaniasis in Ethiopia. IV. Prevalence, incidence and relation of infection to disease in an endemic area. Ann Trop Med Parasitol. 1994 Jun 1;88(3):289-93.

5. Anderson TF. Kala Azar in the East African Forces. The East African Medical Journal. 1945;20:172-5.

6. Berhe N, Abraham Y, Hailu A, Ali A, Mengistu G, Tsige K, et al. Electrocardiographic findings in Ethiopians on pentavalent antimony therapy for visceral leishmaniasis. East Afr Med J. 2001 Nov 1;78(11):608-10.

7. Gebre-Michael T, Lane RP, Frame IA, Miles MA. Leishmania donovani infections in phlebotomine sandflies from the kala-azar focus at Aba Roba in Ethiopia: DNA probe compared with conventional detection methods. Med Vet Entomol. 1993 Jul;7(3):294-6.

8. Gebre-Michael T, Pratlong F, Lane RP. Phlebotomus (Phlebotomus) duboscqi (Diptera: Phlebotominae), naturally infected with Leishmania major in southern Ethiopia. Trans R Soc Trop Med Hyg. 1993 Jan-Feb;87(1):10-1.

9. Hailu A, Berhe N, Ali A, Gemetchu T. Use of Leishmania major derived leishmanin for skin test surveys of visceral leishmaniasis in Ethiopia. East Afr Med J. 1997 Jan 1;74(1):41-5.

10. Konso Community Health P. Nutrition survey in Bedinggelto. Nutrition survey in Bedinggelto; 1990.

11. Lindtjørn B. Severe measles in the Gardulla area of southwest Ethiopia. J Trop Pediatr. 1986 Oct;32(5):234-9.

12. Lindtjørn B. Famine in Ethiopia 1983-85: kwashiorkor and marasmus in four regions. Annals of Tropical Paediatrics. 1987;7:1-5.

13. Lindtjørn B. The usefulness of the mid upper arm circumference in measuring acute malnutrition. The Lancet. 1987;1985.

14. Lindtjørn B. Famine in southern Ethiopia 1985-6: population structure, nutritional state, and incidence of death \ldots. BMJ. 1990 Jan 1;301(1):1123-7.

15. Lindtjørn B, Olafsson J. Kala-azar in the Seggen and Woyto Valleys, South-west Ethiopia. EthiopMedJ. 1983;21:35-41.

16. Mikru F, Molla T, Ersumo M, Henriksen T, Klungseyr P, Hudson P, et al. Community-wide outbreak of Neisseria gonorrhoeae conjunctivitis in Konso district, North Omo administrative region. Ethiop Med J. 1991 Jan 1;29(1):27-35.

17. Tirados I, Costantini C, Gibson G, Torr SJ. Blood-feeding behaviour of the malarial mosquito Anopheles arabiensis: implications for vector control. Med Vet Entomol. 2006;20(4):425-37.

Sociology (1)

1. Kloos H, Abate T, Hailu A, Ayele T. Social and ecological aspects of resettlement and villagization among the Konso of Southwestern Ethiopia. Disasters. 1990;14(4):309-21.