Bernt Lindtjørn Research Blog
During the last decade there has been a great increase in the number of Ethiopian Universities.
There are several methods of ranking universities. This is a ranking system with many pitfalls, but it gives an impression about the quality of work done at the institutions.
The top 10 ranking Ethiopian Universities are seen from the table.
For more information see the following web page: http://www.webometrics.info/en/Africa/Ethiopia
The overall objective of the PhD thesis is to measure and compare maternal and neonatal mortality and obstetric services through community- and facility-based methods in southern Ethiopia. Yaliso Yaya used four different methods to measure maternal mortality:
Neonatal mortality was measured with the second method, and emergency obstetric services were assessed through the facility-based review.
The thesis is based on a thorough and systematic registration of adverse events during several years, using multiple methods. This allows validation of estimates, and it presents detailed and precise information about maternal mortality rates from rural south Ethiopia.
A special focus of the work is on the finding that community based health workers (Health Extension Workers) can be used to generate maternal mortality data, thus alleviating the chronic problem of unavailability of valid and timely mortality data.
The PhD thesis can be downloaded here.
Dangisso MH, Datiko DG, Lindtjorn B. Spatio-temporal analysis of smear-positive tuberculosis in the sidama zone, southern Ethiopia. PLoS One 2015; 10(6): e0126369.
BACKGROUND: Tuberculosis (TB) is a disease of public health concern, with a varying distribution across settings depending on socio-economic status, HIV burden, availability and performance of the health system. Ethiopia is a country with a high burden of TB, with regional variations in TB case notification rates (CNRs). However, TB program reports are often compiled and reported at higher administrative units that do not show the burden at lower units, so there is limited information about the spatial distribution of the disease. We therefore aim to assess the spatial distribution and presence of the spatio-temporal clustering of the disease in different geographic settings over 10 years in the Sidama Zone in southern Ethiopia.
METHODS: A retrospective space-time and spatial analysis were carried out at the kebele level (the lowest administrative unit within a district) to identify spatial and space-time clusters of smear-positive pulmonary TB (PTB). Scan statistics, Global Moran’s I, and Getis and Ordi (Gi*) statistics were all used to help analyze the spatial distribution and clusters of the disease across settings.
RESULTS: A total of 22,545 smear-positive PTB cases notified over 10 years were used for spatial analysis. In a purely spatial analysis, we identified the most likely cluster of smear-positive PTB in 192 kebeles in eight districts (RR= 2, p<0.001), with 12,155 observed and 8,668 expected cases. The Gi* statistic also identified the clusters in the same areas, and the spatial clusters showed stability in most areas in each year during the study period. The space-time analysis also detected the most likely cluster in 193 kebeles in the same eight districts (RR= 1.92, p<0.001), with 7,584 observed and 4,738 expected cases in 2003-2012.
CONCLUSION: The study found variations in CNRs and significant spatio-temporal clusters of smear-positive PTB in the Sidama Zone. The findings can be used to guide TB control programs to devise effective TB control strategies for the geographic areas characterized by the highest CNRs. Further studies are required to understand the factors associated with clustering based on individual level locations and investigation of cases.
On the malaria blog you can read about two presentations at the 2015 GLOBVAC conference:
Yaya Y, Data T, Lindtjørn B (2015) Maternal Mortality in Rural South Ethiopia: Outcomes of Community-Based Birth Registration by Health Extension Workers.PLoS ONE 10(3): e0119321. doi: 10.1371/journal.pone.0119321
Methods
In 2010, health extension workers (HEWs) registered births and maternal deaths among 421,639 people in three districts (Derashe, Bonke, and Arba Minch Zuria). One nurse-supervisor per district provided administrative and technical support to HEWs. The primary outcomes were the feasibility of registration of a high proportion of births and measuring MMR. The secondary outcome was the proportion of skilled birth attendance. We validated the completeness of the registry and the MMR by conducting a house-to-house survey in 15 randomly selected villages in Bonke.
Results
We registered 10,987 births (81·4% of expected 13,492 births) with annual crude birth rate of 32 per 1,000 population. The validation study showed that, of 2,401 births occurred in the surveyed households within eight months of the initiation of the registry, 71·6% (1,718) were registered with similar MMRs (474 vs. 439) between the registered and unregistered births. Overall, we recorded 53 maternal deaths; MMR was 489 per 100,000 live births and 83% (44 of 53 maternal deaths) occurred at home. Ninety percent (9,863 births) were at home, 4% (430) at health posts, 2·5% (282) at health centres, and 3·5% (412) in hospitals. MMR increased if: the male partners were illiterate (609 vs. 346; p= 0·051) and the villages had no road access (946 vs. 410; p= 0·039). The validation helped to increase the registration coverage by 10% through feedback discussions.
Conclusion
It is possible to obtain a high-coverage birth registration and measure MMR in rural communities where a functional system of community health workers exists. The MMR was high in rural south Ethiopia and most births and maternal deaths occurred at home.
Gebreyesus S, Lunde T, Mariam D, Woldehanna T, Lindtjorn B. Is the adapted Household Food Insecurity Access Scale (HFIAS) developed internationally to measure food insecurity valid in urban and rural households of Ethiopia? BMC Nutrition 2015; 1(1): 2.
Abstract
Background
The concept of food insecurity encompasses three dimensions. One of these dimensions, the access component of household food insecurity is measured through the use of the Household Food Insecurity Access Scale (HFIAS). Despite its application in Ethiopia and other similar developing countries, its performance is still poorly explored. Our study aims to evaluate the validity of the HFIAS in Ethiopia.
Methods
We conducted repeated cross-sectional studies in urban and rural villages of the Butajera District in southern Ethiopia. The validation was conducted on a pooled sample of 1,516 households, which were selected using a simple random sampling method. The HFIAS was translated into the local Amharic language and tested for face validity. We also evaluated the tool’s internal consistency using Cronbach’s alpha and factor analysis. We tested for parallelism on HFIAS item response curves across wealth status and further evaluated the presence of a dose-response relationship between the food insecurity level and the consumption of food items, as well as between household wealth status and food insecurity. Additionally, we evaluated the reproducibility of the tool through the first and second round of HFIAS scores.
Results
The HFIAS exhibited a good internal consistency (Cronbach’s alpha for the values of rounds 1 and 2 were 0.76 and 0.73, respectively). A factor analysis (varimax rotation) resulted in two main factors: the first factor described a level of mild to moderate food insecurity, while the second factor described severe food insecurity. HFIAS item response curves were parallel across wealth status in the sample households, with a dose-response trend between food insecurity levels and the likelihood of previous day food consumption being observed. The overall HFIAS score did not change over the two rounds of data collection.
Conclusions
The HFIAS is a simple and valid tool to measure the access component of household food insecurity. However, we recommend the adaptation of questions and wordings and adding examples before application, as we found a discrepancy in understanding of some of the nine HFIAS questions.
Woldesemayat EM, Datiko DG, Lindtjørn B. Follow-Up of Chronic Coughers Improves Tuberculosis Case Finding: Results from a Community-Based Cohort Study in Southern Ethiopia. PLoS ONE 2015; 10(2): e0116324.
Abstract
Background
Untreated smear-positive tuberculosis (TB) patients are the primary source of infection; however, a large number of TB cases have not been identified and are untreated in many sub-Saharan African countries, including Ethiopia. This study determined whether or not a community-based follow-up of chronic coughers improves detection of TB cases and the risk factors for death among such cases.
Methods
We conducted a census in six rural communities in Sidama, southern Ethiopia. Based on interview and sputum investigation, we identified 724 TB smear-negative chronic coughers, and did a cohort study of these chronic coughers and 1448 neighbourhood controls. For both chronic coughers and neighbourhood controls, we conducted a TB screening interview and performed sputum microscopy, as required, at 4, 7 and 10 months. Between September 2011 and June 2012, we followed chronic coughers and neighbourhood controls for 588 and 1,204 person-years of observation, respectively.
Results
Of the chronic coughers, 23 developed smear-positive TB (incidence rate = 3912/105 person-years) compared to three neighbourhood controls who developed smear-positive TB (incidence rate = 249/105 person-years). The male-to-female ratio of smear-positive TB was 1:1. We demonstrated that chronic coughers (adjusted hazards ratio [aHR], 13.5; 95% CI, 4.0–45.7) and the poor (aHR, 2.6; 95% CI, 1.1–5.8) were at high-risk for smear-positive TB. Among the study cohort, 15 chronic coughers and two neighbourhood controls died (aHR, 14.0; 95% CI, 3.2–62.4).
Conclusion
A community-based follow-up of chronic coughers is helpful in improving smear-positive TB case detection, it benefits socioeconomically disadvantaged people in particular; in rural settings, chronic coughers had a higher risk of death.
Recently, Yaliso Yaya, PhD candidate at The Centre for International Health wrote the following post as part of the The Maternal Health Task Force series Translating Research into Practice Series.
Motorcycle ambulances have been useful for transporting mothers with complications to health facilities. The message in Amharic reads “A mother should not die while giving life.” (Photo: Demissew Mitiku).
Unfortunately, there is still limited information to oversee maternal and newborn mortality interventions in low-income countries. Developing countries lack vital registrations that are present in high-income countries. Because of the shortage of such essential information, translating policy into action and monitoring programmes to reduce maternal and neonatal deaths is difficult.
The new Sustainable Development Goals divide countries into three groups where the maternal mortality ratio (MMR) is greater than 400, between 100 and 400, and less than 100 based on the ratio in 2010. Such a grouping is necessary because different ratios may determine different intervention strategies. Unfortunately, for many countries there is a controversy over the level of the MMR. If we use Ethiopia as an example, a UN estimate of MMR in 2010 is 350 per 100,000 live births, whereas the DHS estimated it to be 676 for the same year.
As a follow-up to our paper, Maternal and Neonatal Mortality in South-West Ethiopia: Estimates and Socio-Economic Inequality, we developed, validated, and used community based birth registration in a population of about half a million people in four woredas, or districts, in rural southern Ethiopia. We aimed to estimate maternal mortality rates and to monitor progress in reducing deaths. The most important lesson we learnt, that may be applicable in similar settings in Ethiopia and in Africa, is that it is possible to obtain high-coverage birth registration and measure maternal mortality in rural communities with trained community health workers.
In southern Ethiopia, the MMR was high and most births and maternal deaths occurred at home. The MMR was about 500 per 100,000 live births in 2010, and data from 2014 show that this ratio may have been reduced by about 60%.
We also registered that when women’s access to comprehensive and basic obstetric services improves, a birth registration system can document important societal changes:
In our experience, it is possible to register most births in rural Ethiopian communities using the health extension workers. However, we advise that a birth registry should be expanded to include registration of pregnancies as well as pregnancy outcomes. Such a system could provide the community health workers with a new tool to actively follow up pregnant women and ensure proper antenatal controls and referrals to institutions. It could also help in monitoring neonatal heath and be a tool to provide essential services to women in the weeks after birth.
Dangisso MH, Datiko DG, Lindtjørn B (2014) 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 9(12): e114225. doi:10.1371/journal.pone.0114225
Background: Ethiopia is one of the high tuberculosis (TB) burden countries. An analysis of trends and differentials in case notifications and treatment outcomes of TB may help improve our understanding of the performance of TB control services. Methods: A retrospective trend analysis of TB cases was conducted in the Sidama Zone in southern Ethiopia. We registered all TB cases diagnosed and treated during 2003–2012 from all health facilities in the Sidama Zone, and analysed trends of TB case notification rates and treatment outcomes.
Results: The smear positive (PTB+) case notification rate (CNR) increased from 55 (95% CI 52.5–58.4) to 111 (95% CI 107.4–114.4) per 105 people. The CNRs of PTB+ in people older than 45 years increased by fourfold, while the mortality of cases during treatment declined from 11% to 3% for smear negative (PTB-) (X2 , trend P,0.001) and from 5% to 2% for PTB+ (X2trend, P,0.001). The treatment success was higher in rural areas (AOR 1.11; CI 95%: 1.03–1.2), less for PTB- (AOR 0.86; CI 95%: 0.80–0.92) and higher for extra-pulmonary TB (AOR 1.10; CI 95%: 1.02– 1.19) compared to PTB+. A higher lost-to-follow up was observed in men (AOR 1.15; CI 95%: 1.06–1.24) and among PTB- cases (AOR 1.14; CI 95%: 1.03–1.25). More deaths occurred in PTB-cases (AOR 1.65; 95% CI: 1.44–1.90) and among cases older than 65 years (AOR 3.86; CI 95%: 2.94–5.10). Lastly, retreatment cases had a higher mortality than new cases (6% vs 3%).
Conclusion: Over the past decade TB CNRs and treatment outcomes improved, whereas the disparities of disease burden by gender and place of residence reduced and mortality declined. Strategies should be devised to address higher risk groups for poor treatment outcomes.
Daniel Gemechu Datiko completed his PhD at the University of Bergen in 2011. He did his PhD on active case-finding of tuberculosis.
After he completed his PhD he continued working on the same topic, and now his team has been awarded with this international recognition.
Congratulations from Bergen!