Health work

In Ethiopia, I have worked we work with local, regional and national government, and with Norwegian Lutheran Mission and The Ethiopian Evangelical Church Mekane Yesus.

Reducing maternal deaths:

Deaths from maternal causes represent the leading cause of deaths among women of reproductive age in Ethiopia. Thus, in line with the Millennium Development Goal for maternal health (MDG-5), this health project aims to reduce maternal mortality among the target population by two-thirds by 2015.Experience from other countries show that two conditions are needed to reduce maternal deaths: Staff should be able to carry out comprehensive emergency obstetric care (CEOC), and these services should be available to and used by the pregnant women.

The target population are pregnant women in two zones and three special woredas in south-west Ethiopia. About 2.5 million people live here. The regional government owns this project. It shall enable nine public health institutions to provide CEOC. In accordance with WHO recommendations, this will provide the target population with an acceptable coverage of CEOC.

The project 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. We shall enable these health institutions to practice safe delivery. As most maternal deaths occur with delivery, particular attention is on intrapartum care. Thus, we equip institutions, and train health officers, and midwifes, and operating theatre staff to get the necessary skills to carry out CEOC.

Developing sustainable health institutions:

About 12 years ago we started a work to make the hospital sustainable managerially and financially. The results of this work are encouraging. Despite heavy patient loads, the hospitals have managed to become managerially and financially sustainable within a regional context. And, the model developed at Yirga Alem and Arba Minch Hospitals have now become a part of the national health system.

Antiretroviral therapy

Antiretroviral therapy started in south Ethiopia in 2003. The hospitals in Yirga Alem and Arba Minch were the among first hospitals in Ethiopia to start this important and essential service.

Dr Degu Dare’s PhD work showed that antiretroviral treatment can be carried out in district hospitals. And, recently, Asfaw Bikila showed that such treatment is cost-effective in an Ethiopian context.

Currently, about 2600 patients are followed, and about 1400 HIV patients have started treatment at the hospital. Unfortunately, some patients stop taking their drugs. We are now trying to find ways to reduce the number of patients who stop taking their drugs, and have employed community health workers to find the defaulters. Through this work we hope to learn more about the reasons they stop taking drugs, and find new ways so patients take the drugs regularly.

For more information see the [intlink id=”112″ type=”category”]ART category[/intlink] in this research blog

Malaria and Climate change

Climate warming may worsen development in Africa and may affect human health by bringing about changes in the ecology of infectious diseases. There is therefore a need to enhance the ability to adapt to future climate change. Malaria is a major public health problem in Ethiopia. Unfortunately, there are no practical tools to predict malaria epidemics based on climate forecasts. Such tools would be useful in making efficient use of the limited resources for malaria control.

In this project, scientists from Ethiopia and Norway collaborated to incorporate climate variability and forecast information for malaria epidemics. The collaboration also aimed to strengthen PhD and masters programmes in Ethiopia.

From 2007 – 2012, this project combined new population-based malaria transmission information with climate and land use variability data to develop an early warning to predict malaria epidemics in Ethiopia.

Summary of Ethiopian Malaria Prediction System (EMAPS) project

While the generation of precipitation depends on local ascent and cooling of the air, our research has provided new data on the transport of moisture into the country that may improve weather and climate change forecasting. We developed a new classification of climate zones, have mapped drought episodes in all parts of Ethiopia during the last decades, and have improved seasonal weather forecasting. Our hydrology studies show the effect of potential climate change differs among the Ethiopian river basins. Our analysis shows the annual river flows are sensitive to variations in rainfall, but only moderately sensitive to temperature changes.

We integrated hydrological, meteorological and malaria studies using a mathematical model. We use rainfall, temperature and other environmental data from a regional climate model (the Weather Research and Forecasting Model), and we also include human and cattle densities to describe the dynamics of the malaria mosquitoes, and this influences malaria transmission.

The computer model, Open Malaria Warning, incorporates hydrological, meteorological, mosquito-breeding and land-use data to find out when and where outbreaks are likely to occur. The model made direct use of the limited real-time information available in typical rural areas. To have confidence the model describes observed malaria epidemics, there is a need for several years of active monitoring of malaria cases and mosquito densities. Such data is rare in Africa. This model is not only a tool for predicting malaria, but can also be used to understand malaria transmission.

Our research aimed to improve our understanding of malaria in the Ethiopian Highlands. We selected the highland areas because global warming would make its impact here, and would increase malaria transmission. Both through epidemiological and entomological studies, we show that malaria transmission takes place above 2000 m altitude. In another study, we show the ideal temperature for malaria transmission is about 25 degrees, underlining that global warming may lead to more malaria in highland areas, and less in the lowlands with already high average temperatures.

We also compared malaria transmission in the highlands with that of the lowlands, characterising malaria transmission over some years in both highlands and lowlands. This provided us with new knowledge on how malaria is transmitted in Ethiopia, how intense the seasonal transmission is, and how malaria occurs in different populations.

A retrospective review of 10 years of malaria from south-east Ethiopia showed the association between whether and malaria is complex. Although our statistical model showed that we could predict malaria for large areas, malaria transmission varies from place to place, and depends on local environmental conditions. Thus, to make a good malaria prediction for specific locations, we need to have good and local knowledge about each area, and our computer model must adapt for local scale prediction. However we note that weather variability currently is the main driver of malaria in Ethiopia.

 

EMAPS Publications

Tuberculosis Control

Even if 36 million patients with tuberculosis were successfully treated and up to 6 million lives were saved during the past 15 years, tuberculosis remains a major public health problem. Still, more than 9 million cases occur every year. Unfortunately, only about half of the expected cases are identified yearly and receive proper care.

Our research group works to develop novel interventions to diagnose, treat, and thus stop transmission of tuberculosis (see list of publications). Through operational research we aim to improve public health interventions and treatment of diseases in real-life situations.

Most recently we asked: Is active case finding necessary to control tuberculosis in developing countries? In a series of papers, Daniel Datiko Gemetchu documented that involving of health extension workers (HEWs) in sputum collection and treatment improved smear-positive case detection and treatment success rate, possibly because of an improved service access. This finding has policy implications and could be applied in settings with low health service coverage and a shortage of health workers.

Recently, National TB Control Programme in Ethiopia started to decentralize case finding and treatment to local communities (in Ethiopia called kebeles) using community based-treatment by health extension workers.

We now plan to follow up our earlier studies and develop a model for community DOTS in rural Ethiopia. We will try to develop community-based tuberculosis registries, and registries of patients with symptoms suggestive of tuberculosis.  Through this work we aim to see if active case finding and treatment outcomes can be improved on a larger scale and involving larger populations

Publications on tuberculosis:

PhD work:

Hamusse SD. Tuberculosis Control in Arsi in Ethiopia: Programme Performance and Disease Burden.  PhD. University of Bergen, 2017. Bergen

Dangisso MH. Tuberculosis control in Sidama in Ethiopia. Programme performance and spatial epidemiology [PhD]. Bergen: University of Bergen; 2016.

Datiko DG. Improving Tuberculosis Control in Ethiopia: performance of TB control programme, community DOTS and its cost-effectiveness [PhD]. Bergen: University of Bergen; 2011.

Shargie E. Trends, challenges and opportunities in tuberculosis control in rural Ethiopia : Epidemiological and operational studies in a resource-constrained setting [PhD]. Bergen: University of Bergen; 2007.

Jerene D. HIV antiretroviral therapy in Ethiopia. Overcoming implementation challenges [PhD]. Bergen: University of Bergen; 2007.

Demissie M. Challenges of Tuberculosis Control in Ethiopia [PhD]. Bergen: University of Bergen; 2002.

Madebo T. Clinical and operational challenges in the control of tuberculosis in south Ethiopia [PhD]. Bergen: University of Bergen; 2002.

 

Scientific articles:

Hamusse S, Demissie M, Teshome D, Hassen MS, Lindtjorn B. Prevalence and Incidence of Smear-Positive Pulmonary Tuberculosis in the Hetosa District of Arsi Zone, Oromia Regional State of Central Ethiopia. BMC infectious diseases. 2017;17(1):214.

Uppada DR, Selvam S, Jesuraj N, Lau EL, Doherty TM, Grewal HMS, Vaz M, Lindtjørn B: Incidence of tuberculosis among school-going adolescents in South India. BMC Public Health 2016, 16:1-11.

Hamusse S, Teshome D, Hussen M, Demissie M, Lindtjorn B. Primary and secondary anti-tuberculosis drug resistance in Hitossa District of Arsi Zone, Oromia Regional State, Central Ethiopia. BMC Public Health 2016; 16(1):

Dangisso MH, Gemechu Datiko D, Lindtjørn B. Accessibility to tuberculosis control services and tuberculosis programme performance in southern Ethiopia. Global health action 2015; 8(0).

Dangisso MH, Datiko DG, Lindtjørn B (2015) Spatio-Temporal Analysis of Smear-Positive Tuberculosis in the Sidama Zone, Southern Ethiopia. PLoS One 2015; 10(6): e0126369.

Dangisso, MH, Datiko DG and Lindtjørn B. (2015). Low case notification rates of childhood tuberculosis in southern Ethiopia. BMC Pediatr 15(1): 1-10.

Woldesemayat EM, Datiko DG, Lindtjørn B. Follow-Up of Chronic Coughers Improves Tuberculosis Case Finding: Results from a Community-Based Cohort Study in Southern EthiopiaPLoS ONE 2015; 10(2): e0116324.

Dangisso MH, Datiko DG, Lindtjorn B. Trends of tuberculosis case notification and treatment outcomes in the Sidama Zone, southern Ethiopia: ten-year retrospective trend analysis in urban-rural settings. PloS ONE 2014; 9(12): e114225.

Westerlund E, Jerene D, Mulissa Z, Hallstrom I, Lindtjorn B. Pre-ART retention in care and prevalence of tuberculosis among HIV-infected children at a district hospital in southern Ethiopia. BMC pediatrics 2014; 14(1): 250.

Hamusse SD, Demissie M, Teshome D, Lindtjorn B. Fifteen-year trend in treatment outcomes among patients with pulmonary smear-positive tuberculosis and its determinants in Arsi Zone, Central Ethiopia. Global health action 2014; 7: 25382.

Hamusse SD, Demissie M, Lindtjorn B. Trends in TB case notification over fifteen years: the case notification of 25 Districts of Arsi Zone of Oromia Regional State, Central Ethiopia. BMC public health 2014; 14: 304.

Woldesemayat EM, Datiko DG, Lindtjorn B. Use of biomass fuel in households is not a risk factor for pulmonary tuberculosis in South Ethiopia. The international journal of tuberculosis and lung disease : 2014; 18(1): 67-72.

Mulissa Z, Jerene D, and Lindtjørn B. Patients Present Earlier and Survival Has Improved, but Pre-ART Attrition Is High in a Six-Year HIV Cohort Data from Ethiopia. PLoS ONE 5(10): e13268. doi:10.1371/journal.pone.0013268

Datiko, D. G. (2011). Improving Tuberculosis Control in Ethiopia: Performance of TB control programme, community DOTS and its cost-effectiveness. Centre for International Health. Bergen, University of Bergen. PhD: 162.

Datiko DG, Lindtjørn B. Mortality in successfully treated TB patients in southern Ethiopia: retrospective post-treatment follow up study. The International Journal of Tuberculosis and Lung Disease, 2010, 14 (7): 866-871

Datiko DG, Lindtjørn B. Cost and cost-effectiveness of smear-positive tuberculosis treatment by health extension workers in southern ethiopia: a community randomized trial. PLoS One. 2010;5(2):e9158. (ClinicalTrials.gov ID: NCT00913172)

Datiko DG, Lindtjørn B. Tuberculosis recurrence in smear-positive patients cured under DOTS in southern Ethiopia: retrospective cohort study. BMC Public Health 2009, 9:348

Datiko DG, Lindtjørn B. Health Extension Workers Improve Tuberculosis Case Notification and Treatment Success in Southern Ethiopia: A Community-Randomized Trial PLoS ONE 2009; 4(5): e5443. doi:10.1371/journal.pone.0005443. ClinicalTrials.gov NCT00803322.

Datiko DG, Yassin MA, Chekol LT, Kabeto LE, Lindtjørn B. The rate of TB-HIV co-infection depends on the prevalence of HIV infection in a community. BMC Public Health. 2008;8:266.

Shargie EB, Lindtjørn B. Determinants of treatment adherence among smear-positive pulmonary tuberculosis patients in Southern Ethiopia. PLoS Med. 2007;4:e37.

Demissie M, Omer OA, Lindtjørn B, Hombergh J. 2006  “Tuberculosis” in Berhane Y, Hailemariam D and Kloos (Eds) The Epidemiology and Ecology of Health and Disease in Ethiopia.  Page  409-434. Addis Ababa: Shama Books

Jerene D, Naess A, Lindtjørn B. Antiretroviral therapy at a district hospital in Ethiopia prevents death and tuberculosis in a cohort of HIV patients. AIDS Res Ther. 2006;3:10.

Shargie EB, Mørkve O, Lindtjørn B. Tuberculosis case-finding through a village outreach programme in a rural setting in southern Ethiopia: community randomized trial. Bull World Health Organ. 2006;84:112-9.

Shargie EB, Yassin MA, Lindtjørn B. Prevalence of smear-positive pulmonary tuberculosis in a rural district of Ethiopia. Int J Tuberc Lung Dis. 2006;10:87-92.

Shargie EB, Lindtjørn B. DOTS improves treatment outcomes and service coverage for tuberculosis in South Ethiopia: a retrospective trend analysis. BMC Public Health. 2005;5:62.

Shargie, Estifanos Biru; Yassin, Mohammed Ahmed; Lindtjørn, Bernt. Quality control of sputum microscopic examinations for acid fast bacilli in southern Ethiopia. Ethiopian Journal of Health Development 2005;19(2):104-108.

Madebo T, Lindtjørn B, Aukrust P, Berge RK. Circulating antioxidants and lipid peroxidation products in untreated tuberculosis patients in Ethiopia. Am J Clin Nutr. 2003;78:117-22.

Demissie M, Getahun H, Lindtjørn B. Community tuberculosis care through “TB clubs” in rural North Ethiopia. Soc Sci Med. 2003;56:2009-18.

Demissie M and Lindtjørn B. Gender perspective in health: does it matter in tuberculosis control? Ethiop J Hlth Dev 2003; 17: 239-243Demissie M, Zenebre B, Berhane Y and Lindtjørn B. Rapid survey to determine the prevalence of smear positive pulmonary tuberculosis in Addis Ababa. Int J Tuberc Lung Dis, 2002,6(7): 1-5.

Demissie M, Berhane Y and Lindtjørn B. Patient and Health Service delay in the diagnosis of pulmonary tuberculosis patients in Addis Ababa. BMC Public Health 2002 2:23. http://www.biomedcentral.com/1471-2458/2/23

Lindtjørn B, Madebo T. The outcome of tuberculosis treatment at a rural hospital in south Ethiopia. Tropical Doctor 2001; 31(3): 132-5

Demissie M, Lemma E, Gebeyehu M and Lindtjørn B. Sensitivity to anti TB drugs in HIV positive and negative TB patients. Scan J Infect Dis 2001; 33: 914-919.

Demissie M, Lindtjørn B and Tegbaru B. Human Immunodeficiency Virus infection in tuberculosis patients in Ethiopia. Ethiop J Hlth Dev 2000; 14(3): 277-282.

About myself

I am a Professor in International health and have broad working experience in research and public institutions, international organisations and NGOs.

By training, I am a medical doctor with long and extensive experience in hospital work, research, disease control, management, research management, and teaching and work in developing countries. My professional profile includes surgery in developing countries, population studies, maternal and child health, and control of tuberculosis, HIV and AIDS, malaria and malnutrition.

In Norway, I have also worked as a surgeon at Haukeland University Hospital, focusing on Breast and Endocrine surgery.

Scientific Publications and Book Chapters  

Current position:

Adjunct Professor, Hawassa University, Ethiopia

Adjunct Professor, Arba Minch University, Ethiopia

Adjunct Professor, Addis Ababa University, Ethiopia

Professor emeritus at Centre for International Health, University of Bergen

Previous positions

Professor at Centre for International Health, University of Bergen (up to August 2019)

Senior Consultant (Endocrine and Breast Surgery) at Haukeland University Hospital.

E-mail: bernt.lindtjorn@cih.uib.no

Current research projects

Previous research projects:

Work Experience

  • Centre for International Health, University of Bergen: Professor, 1998 to date (http://www.uib.no/persons/Bernt.Lindtjorn#profil)
  • Centre for International Health, University of Bergen: Director, 1998 – 2000 and 2004 – 2007
  • European and Developing Countries Clinical Trials Partnership: Interim Executive Director (December 20, 2004 to June 20, 2005)
  • European Malaria Vaccine Initiative:  Contact Holder (EMVI); 2003 to 2007
  • Health work in Ethiopia: Gidole Hospital (1980 – 1982, 1985; 2008 – 2014), Arba Minch Hospital (1984, 2000 – 2014); Yirga Alem Hospital (1978-1980; 1985-1987; 1992-1993; 2000 – 2006); Coordinator famine relief work in Ethiopia 1984-1985
  • Haukeland University Hospital: Consultant Specialist in Endocrine Surgery; 1996- date
  • Consultancy work in China, Mongolia, India, Angola, Ethiopia, Tanzania, South Sudan and Bangladesh.

Education

  • Dr, Med.  University of Bergen, 1992. Thesis: Child health and nutrition. A study from drought-prone areas in southern Ethiopia.
  • Medical specialist – General Surgery (Norway, 1996)
  • Cand Med (Medical Degree) – Faculty of Medicine, University of Oslo. 1976

Supervisor for PhD students

Completed:

  • 43 PhD students
  • Mentored postdoctoral fellows: 7

On-going

Supervisor Master Thesis

Completed: 16

About this blog

My name is Bernt Lindtjørn. I am a professor in International Health at the University of Bergen.

I combine practical public health and clinical medicine, mostly in Ethiopia, with research and teaching.

It is important for me to see the disease control, research efforts, teaching and organizational work result in sustainable health programmes in countries with limited resources.