Just some information: this blog is now formatted so you can easily read the blog on your iPhone (or a similar smartphone).
Can we trust community based birth registries?
Quality check household survey on community birth registry in Bonke woreda in Gamu Gofa Zone in South-west Ethiopia.
Recently Tadesse Data from Arba Minch finished his Masters’ of public health degree at Addis Continental Institute of Public Health and University of Gondar.
In many developing countries, we lack population based and accurate, reliable and complete population data, including birth registration. Recently, we started to register births, neonatal and maternal deaths using health extension workers in south-west Ethiopia.
In his research, Tadesse Data assessed the quality of birth registries done by health extension workers. Specifically, he assessed if the existing birth registries covered the whole population.
He did a community based cross-sectional household survey in Bonke Woreda in Gamo Gofa Zone in south-west Ethiopia. He randomly selected and surveyed 15 of the 30 kebeles (peasant associations) in the woreda (province). He asked about births that had occurred during the last 12 months, and examined if these births were registered in the birth registries.
The study identified 2724 births among a population of 78782. The crude birth rate was 34.5 per 1000 population, and similar to the expected 35 per 1000 population for Ethiopia. About 71 per cent of the births were registered in kebele birth registry. Most of the non-registered births lived in remote areas, and many did not attended antenatal follow up. Eighteen mothers died, and the maternal mortality rate in Bonke Woreda rate is 661 per 100.000 live births.
The study show that health extension workers can do community based birth registration. However, the health extension workers need regular supervision, and we need to improve the coverage of the antenatal services.
Low health care coverage in south-west Ethiopia
Assessment of availabiltiy and utlization af Emergency Obstetric Care Services In Gamo Gofa Zone, SNNRP, Ethiopia
Recently Meseret Girma Abate from Arba Minch University finished her Master of public health degree at Addis Continental Institute of Public Health and University of Gondar.
This work is a part of the research done for the programme to reduce maternal mortality in south-west Ethiopia. The following is an abstract of her research:
Most maternal deaths take place during labour and within few weeks after delivery. The availability and use of emergency obstetric care facilities is important to reduce maternal deaths. However, there is limited evidence how these institutions perform, and how many people use them in Gamo Gofa zone in south-west Ethiopia.
The objective of the thesis was to assess availability and use of emergency obstetric care services in Gamo Gofa zone in south-west Ethiopia.
For this study we did a cross-sectional survey of all 63 health centres and three hospitals in Gamo Gofa. We did a retrospective review of obstetric services in Gamo Gofa zone in south-west Ethiopia. The data collectors visited each institution, observed the work, and interviewed the head nurses.
The main results show there were three basic and two comprehensive emergency obstetric care institutions per 1,740,885 population. Only 6.6% of all expected births were done by skilled attendants, and the caesarean section rate was 0.8%. Remote laying health institutions had lower number of births. The maternal mortality rate among births attending health institutions was 1900 per 100,000 live births.
The availability of basic and comprehensive emergency obstetric care facilities in south-west Ethiopia is far below the recommended health care coverage. The proportion of institutional deliveries and caesarean section rate is low.
South Sudan Medical Journal
On July 9th, 2011 South Sudan becomes an independent state. An historic day for South Sudan and for Africa. Most of the population in South Sudan have only experienced war. The country has the highest matenal mortality rates in the world (over 2.000 per 100.000 births).
During the last days I have attended “The first conference of Southern Sudan Medical Specialists”. About 70 of the existing 82 medical specialists from South Sudan attended the meeting. Many live abroad, some live in Northern Sudan and about half of them work in the south. Unfortunately, many specialists work in administrative positions. The details of an earlier survey is found here.
Although there are three medical schools in the country, none work now, mainly because of difficulties in transferring university functions from the north to the south.
The main topic discussed was to form a body to run, and to oversee medical specialist training in this new nation. I will update this page as documents are made available.
More information about the health situation in this country can is found at Southern Sudan Centre for Census, Statistics and Evaluation (SSCCSE), and from the Southern Sudan Medical Journal.
Stillbirths in Ethiopia
A stillbirth occurs when a foetus dies in the uterus and when foetal death occurs after 20 weeks gestation or the foetus weighs more than 400 grams. We use the term to distinguish it from live birth or miscarriage. Most stillbirths occur in full term pregnancies.
The Lancet recently presented a series of articles on stillbirths. We can confirm from our studies from south Ethiopia that stillbirths represent a huge problem. About 5% of all hospital births are stillbirths. And, in our birth registry data, about 1.4 per cent of registered births are labelled as stillbirths. Such figures are uncertain, and some neonatal deaths might be misclassified as stillbirths.
Results from our studies in Ethiopia demand that we need to address this issue. What are the causes? Can we do anything to reduce stillbirths in settings such as rural south-west Ethiopia? We now plan to recruit a new PhD student to investigate how stillbirths can be reduced in southwest Ethiopia.
PhD Reviews
Global Health Action (GHA) is an international, peer-reviewed Open Access journal, which was launched in 2008. It is affiliated with the Umeå Centre for Global Health Research (CGH) in Sweden.
The Journal is registered in PubMed, and reaches a global audience in 190 countries.
The journal has recently started a new area of editorial content called PhD Reviews.
They invite young researchers that have recently defended their PhDs within the field of global health to write a paper based on their cover stories. One background reason for this is that Scandinavian PhDs are usually based on a set of articles synthesized into a “cover story” of some 30-50 pages. Some of these syntheses provide excellent reviews of the research area but they seldom reach beyond the host institution or the close collaborators and examiners. Condensing them into a PhD Review may also serve as incentive for the young researcher to publish their first post doc paper as a sole author.
You may find a few examples at their website, www.globalhealthaction.net, or by clicking here to find the section ‘PhD Reviews.
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 http://www.gapminder.org/ 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.
Some links to blogs on global health
Here are some links to blogs on Global Health or International Health:
http://internationalhealthpolicies.blogspot.com
http://blog.tropika.net/tropika/
http://globalhealth.unc.edu/blog/
http://blogs.cgdev.org/globalhealth/
Improving tuberculosis control in Ethiopia
Ethiopia, with over 80 million people, is heavily affected by tuberculosis, complicated by poverty and HIV infection, limited access to the health service and shortage of health workers.
We recently reviewed tuberculosis control programme in South Ethiopia. Although treatment success rates have improved during the last decade, low case notification rate, mainly because of inability to access the health service, remains a challenge.
Using community health workers, we enrolled health extension workers (HEWs) in providing health education, sputum collection and providing treatment. This improved case detection, and more significantly for women, because the community-based sputum collection increased access to the diagnostic services. Similarly, community-based treatment improved the treatment success of smear-positive patients (90%) compared with to health facility-based treatment (83%). This approach also reduced the total costs by 63%. Thus, such interventions are economically attractive to the health service and patients, caregivers and the community.
Community based intervention improve access for the poor and for women to have better access to the health service. It is effective and an economically attractive alternative to the traditional health services.
By improving health service delivery to the affected community living in high burden countries, this is an example of how operational research in developing countries provide evidence for policy change. Recently, this approach was endorsed by the Ministry of Health Ethiopia. Health Extension Workers shall now be involved in tuberculosis control in Ethiopia.
This research has been carried out by Daniel Gemechu Datiko. This week he defends his PhD at the University of Bergen. You can read his thesis at: Improving Tuberculosis Control in Ethiopia: Performance of TB control programme, community DOTS and its cost-effectiveness.
The two most important papers in his thesis are:
Datiko, D., & Lindtjørn, B. (2009). Health Extension Workers Improve Tuberculosis Case Detection and Treatment Success in Southern Ethiopia: A Community Randomized Trial PLoS ONE, 4 (5) DOI: 10.1371/journal.pone.0005443
Datiko, D., & Lindtjørn, B. (2010). Cost and Cost-Effectiveness of Treating Smear-Positive Tuberculosis by Health Extension Workers in Ethiopia: An Ancillary Cost-Effectiveness Analysis of Community Randomized Trial PLoS ONE, 5 (2) DOI: 10.1371/journal.pone.0009158
Science blogging and peer-review
Should science bloggers play a role in discussing peer-reviewed publications? That is the question an interesting Editorial in Nature raise on December 16, 2010.
The background for was a paper about the discovery a bacterium can replace the phosphorus in its DNA with arsenic paper (F. Wolfe-Simon et al. Science doi:10.1126/science.1197258; 2010). The researchers had widely publicised their findings on the web, but when bloggers and researchers raised thoughtful reservations about the paper’s method and findings, the authors refused to comment because the blog was not peer-reviewed.
Unfortunately, few papers get substantive comments. Nature states that bloggers have an important part to play in assessing research findings, especially when the criticism is from the researchers’ peers (a person of the same age, status, or ability as another named person).
It is encouraging that journals now encourage post-publication discussion on blogs and online commenting facilities. This is a complement to, and not a substitute for conventional peer review. However, it is equally true that online commenting and blogs contribute little and few authors bother to respond to online criticisms of their papers (P. C. Gøtzsche et al. Br. Med. J. 341, c3926; 2010).