NORHED-SENUPH II Project Workshop and Field Visit: Advancing Malaria Research and Capacity Building

This text is written by the Communication Affairs Directorate at Arba Minch University. See

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NORHED-SENUPH II held a progress report workshop at Arba Minch University/AMU and a field visit to the Arba Minch area and Mirab Abaya districts on September 19, 2024. The project, which runs from 2022 to 2027, is a continuation of the NORHED-SENUPH I project, which began in 2014.

Dr. Alemayehu Chufamo, Vice President for Academic Affairs at AMU, praised the project’s unique approach to capacity building in sponsoring students and staff for MSc and PhD programs. He also expressed his gratitude to Professor Bernt Lindtjørn for devising a mechanism that makes the research process effective.

Professor Bernt Lindtjørn from the University of Bergen discussed the project’s successes, challenges, and focus areas to sustain the partnership. He mentioned that NORHED-SENUPH II strategically strengthens AMU’s research platforms on vector-borne diseases, advances lab infrastructure and equipment, and supports students and staff focusing on entomology, molecular biology, and immunology research. AMU should work hard to organize all potential to sustain future NORHED funds by promoting scientific and novel ideas, developing new scientific networks and executing the project tasks as planned, he advised.

The local project coordinator and senior researcher, Dr. Fekadu Massebo, presented the project’s progress report and the current status of the malaria trial. He explained that they are implementing door and window mesh screening and animal treatment intervention to check their impact on malaria epidemiology and fill some of the gaps in the current malaria control strategies, such as drug-resistant malaria parasites, changes in mosquito populations and behaviour, and limitations in current diagnostic and treatment options. These challenges require innovative strategies, Dr. Fekadu noted.

The field visit to the trial sites allowed the participants to observe the firsthand project’s activities. It was observed that house mesh-screening has been in place and the communities’ acceptance is exceptionally high which makes the future interventions seem promising. The trial’s unique aspect is bridging the public and veterinary health sectors to combat malaria; the trial evaluation will span 18 months and the findings will be shared with all stakeholders.

The NORHED-SENUPH II project focuses on building research capacity, supporting existing MSc programs, and expanding support for the PhD program on Infectious Diseases. The project is conducting a large malaria trial in the Southern Rift Valley of Ethiopia. The trial aims to combat malaria by using mesh screens on houses to prevent mosquitoes from entering and treating animals with ivermectin to kill the mosquitoes they feed on. Over 8,000 people in 12 Kebeles in the Arba Minch and Mirab Abaya districts are included in the trial. Several stakeholder meetings have also been held to enhance community participation and ownership.

Treatment of malaria in Arba Minch

Treatment of malaria:

Daka D, Woldeyes D, Golassa L, Alemayehu GS, Zewde Z, Tamiru G, et al. Therapeutic efficacy of artemether-lumefantrine in the treatment of uncomplicated Plasmodium falciparum malaria in Arba Minch Zuria District, Gamo Zone, Southwest Ethiopia. Malar J. 2024;23(1):282. DOI: 10.1186/s12936-024-05087-7

Abstract

Background: Artemether-lumefantrine (AL) has been the primary anti-malarial drug used to treat uncomplicated Plasmodium falciparum malaria in Ethiopia since 2004. However, there have been recent reports of AL resistance mutations in different African countries, including Ethiopia. This is concerning and requires periodic monitoring of anti-malarial drug resistance. Therefore, the current study aimed to evaluate the therapeutic efficacy of AL in treating uncomplicated P. falciparum malaria in the Arba Minch Zuria District, Gamo Zone, Southwest Ethiopia.

Methods: A single-arm prospective study with a 28-day follow-up period was conducted from July to October 2022. Capillary blood samples were collected for RDT and microscopic examination. The study enrolled monoinfected P. falciparum patients aged ≥ 18 years at Ganta Sira Health Post. Sociodemographic and clinical data were recorded, and a dried blood spot (DBS) was prepared for each participant. Nested polymerase chain reaction (nPCR) genotyping of the msp-1 and msp-2 genes was only performed for recurrent cases to distinguish between recurrence and reinfection. Data entry and analysis were performed using the WHO Excel spreadsheet and SPSS version 26.

Results: A total of 89 patients were enrolled, and 67 adequately completed the 28-day follow-up period. AL showed a 100% clearance rate for fever on day 2 and asexual parasites on day 3. Gametocytes were detected in 13.5% (12/89) of the participants. The gametocyte clearance rate was 58.3% (7/12) until day 7 and 100% (12/12) until day 14. Five participants developed recurrent malaria, three of whom experienced relapse and two of whom experienced reinfection. Based on the Kaplan-Meier survival analysis, the PCR-uncorrected and PCR-corrected cumulative incidence of success were 93.7% (95% CI 85.5-97.3) and 96.2% (95% CI 85.5-98.7), respectively.

Conclusion: AL was efficacious in treating uncomplicated P. falciparum malaria in the study area. However, the detection of recurrent patients highlights the need for continuous efficacy studies in this area.

Keywords: Cure rate; Malaria; Parasite clearance; Recurrence.

Anopheles stephensi is in Arba Minch: A new malaria vector

Malaria is currently spreading fast in Ethiopian towns. The cause is probably a new mosquito.

Massebo F, Ashine T, Negash N, Eligo N, Hailemeskel E, Minda TT, et al. The expansion of an invasive malaria vector: Anopheles stephensi emergence in Arba Minch town in the southern Rift Valley of Ethiopia. Parasitology research. 2024;123(9):333.

DOI: 10.1007/s00436-024-08356-1

Abstract

Urban areas in malaria-endemic countries in East Africa are experiencing a significant increase in malaria cases, with the establishment of an “exotic” urban malaria vector, Anopheles stephensi, increasing the risk of urban malaria. To this end, the present study aimed to investigate the emergence of this species in Arba Minch, Ethiopia. Following the detection of An. stephensi in other parts of Ethiopia, 76 artificial containers (55 discarded tyres, 18 concrete water storage, and three plastic containers) were sampled in 21 locations in Arba Minch town, for immature Anopheles mosquito stages, using the standard dipping technique. Larvae were reared into adults which were morphologically identified at the species level 2-3 days after emergence. Morphological identification results were confirmed by species-specific polymerase chain reaction. Of the examined containers, 67 (88%) had at least one Anopheles larva. Thirty-two of the adults emerged were morphologically identified as An. stephensi, with 26 (81%) confirmed by molecular analysis. This is the first study to report An. stephensi from Arba Minch, one of South Ethiopia’s largest towns, highlighting the need for increased vigilance. The planned and ongoing study in and around Arba Minch will contribute to understanding the bionomics and role of An. stephensi in malaria parasite transmission, helping develop a strategy to address the impending risk of urban malaria in Ethiopia.

Keywords: Anopheles stephensi; Arba Minch; Entomological surveillance.

 

Cluster randomized controlled trial to improve maternal and newborn healthcare in Sidama

Pre-print of Research protocol:

This is the pre-print of the protocol for the research group on Neonatal and Maternal Health

Achamyelesh Gebretsadik, Yemisrach Shiferaw, Hirut Gemeda, Yaliso Yaya. Cluster randomized controlled trial to assess the effectiveness of a package of community-based intervention on continuum of maternal and newborn healthcare in Sidama, Ethiopia: The SiMaNeH trial protocol. medRxiv preprint doi: https://doi.org/10.1101/2024.09.01.24312899

Background: Maternal and newborn mortality and morbidity remain high in low- and middle-income countries such as Ethiopia. Limited access and dropouts from essential continuum of care interventions are critical factors. In Ethiopia about one in five complete the continuum of essential care through pregnancy, childbirth, and postnatal period Ethiopia. Evidence is limited on whether a package of interventions involving key community health actors increase the proportion completing essential maternal and newborn healthcare continuum in rural Sidama regional state, Ethiopia.

Objective: This study aims to implement and evaluate the effectiveness of community-based interventions designed to enhance involvement of key community health actors to improve completion rate of continuum of maternal care and utilization of newborn care.

Methods: Twenty rural kebeles (clusters) in Sidama Regional State, Ethiopia, are randomly allocated to intervention and control arms. A total of 2000 pregnant women, 1000 per arm, will be recruited between 20th and 26th week of gestation after intervention. Then they will be followed until six weeks postpartum between June 2024 and February 2025. In the intervention arm, mothers and newborns will receive targeted interventions at home and in their community through a package of interventions designed to improve completion rate of recommended maternal and newborn care. Control clusters will receive normal care from the state public health system. Primary outcomes will be the difference in the completion of continuum of maternal care and essential and emergency newborn care between intervention and control clusters measured by composite indicator constructed from variables. Secondary outcomes include rates of antenatal care completion, facility deliveries with skilled care, completion of at least four postnatal care, essential newborn care, and emergency identification and referrals, mortality measures.

Conclusion: This trial will implement and evaluate community-based intervention package within existing community healthcare infrastructure to produce evidence for informed policy and practice to achieve improved community-based healthcare.

Large regional variations in maternal mortality

Aschenaki Zerihun Kea, from Yirga Alem in southern Ethiopia, is a PhD student in the Joint PhD program at Hawassa University and the University of Bergen (Senuph – I project). He is about to defend his doctoral work.

His research aimed to measure the magnitude and variations in maternal mortality and assess the coverage of skilled birth attendants in the Sidama Region, essential for improving maternal healthcare in Ethiopia.

The study found high maternal mortality in the Sidama Region, with significant district variations. In the past decade, districts of the region have not seen an equal reduction in maternal mortality.

The main impact of this research is to highlight the importance of ensuring equitable emergency obstetric care in all districts of the region. Female education must be
strengthened, and the deployment of midwives has to be improved. All women must be
encouraged to get antenatal care.

His publications on the community surveys of maternal mortality in Sidama include:

Kea AZ, Lindtjorn B, Gebretsadik A, Hinderaker SG.. Variation in maternal mortality in Sidama National Regional State, southern Ethiopia: A population based cross sectional household survey. PLoS One. 2023 Mar 7;18(3):e0272110. doi: 10.1371/journal.pone.0272110.

Kea AZ, Lindtjorn B, Tekle AG, Hinderaker SG.. Reduction in maternal mortality ratio varies by district in Sidama National Regional State, southern Ethiopia: Estimates by cross-sectional studies using the sisterhood method and a household survey of pregnancy and birth outcomes. PLoS One. 2023 Oct 12;18(10):e0276144. doi: 10.1371/journal.pone.0276144.

Kea AZ, Lindtjørn B, Tekle AG, Hinderaker SG (2023) Southern Ethiopian skilled birth attendant variations and maternal mortality: A multilevel study of a population-based cross-sectional household survey. PLOS Glob Public Health 3(12): e0002466. https://doi.org/10.1371/journal.pgph.00024666.

 

New paper: Seasonal variations in household food security and consumption affect women’s nutritional status in rural South Ethiopia

Mezgebe B, Gari T, Belayneh M, Lindtjørn B (2024) Seasonal variations in household food security and consumption affect women’s nutritional status in rural South Ethiopia. PLOS Glob Public Health 4(8): e0003294. https://doi.org/ 10.1371/journal.pgph.0003294

Abstract
Food availability varies seasonally in most rural areas of developing nations, especially in areas affected by drought and climate change, with women being one of the most vulnerable groups. This study aimed to assess the effect of seasonal variation in household food security, adequate dietary diversity, food consumption, and wealth on the nutritional status of women of reproductive age in a rural community in South Ethiopia. Further, the study aimed at identifying associated factors with women’s nutrition status. An open cohort study was conducted from June 2021 to June 2022, with follow-up visits every three months. Anthropometric measurements were carried out along with interviews. Data were analyzed using STATA version 15. Multilevel, multiple linear regressions were employed. Findings revealed that women’s average body mass index (BMI) was 20.4 kg/m2 (95% CI: 20.4–20.5). The highest (20.6 kg/m2, 95% CI: 20.5–20.8) was observed in December, while the lowest (20.2 kg/m2, 95% CI: 20–20.3) occurred in September. During the main postharvest period in December, the household food insecurity score was the lowest (median: 4, Inter quartile range (IQR): 0–9), while the household dietary diversity score (median: 6, IQR: 5–7), and the household food consumption score were the highest (median: 50.5, IQR: 44–70). Factors such as household food security, food consumption, previous season BMI, age, marital status, and membership in safety net programs were identified as determinants of women’s BMI. The study showed the vulnerability of women in drought-prone areas to seasonal undernutrition. We recommend collaborative work among stakeholders to ensure sustainable food access and minimize seasonal food shortages’ effect on women’s nutrition and overall well-being.

For more information about PhD student Bethlehem Mezgebe’s work, visit the link

Climate and Health

Dr. Taye Gari and his colleagues from Hawassa and Addis Ababa University conducted a cohort study in the Ethiopian Rift Valley, a region known for its vulnerability to drought. Their findings are particularly relevant to this context.

Climate variability, crop production, and household food security could be causally linked to women’s nutritional status, suggesting that rural people depending on rain-fed subsidence farming for crop production are vulnerable to the impact of climate variability. Government interventions such as education, membership in health insurance, and safety net programs could help mitigate the effect of climate variability. Furthermore, mitigating climate variability through improving household food security, wealth status, and educational status could reduce the stress of climate variability in the affected populations.

Taye Gari, Bethlehem Mezgebe, Mehretu Belayneh, Yonas Mersha, Bernt Lindtjorn. Effect of climate variability, crop production, and household food insecurity on malnutrition among women: A mediation analysis from a drought-prone area in Southern Ethiopia. 2024. EarthArXiv. DOI: 10.31223/X56Q6S

New PhD at Hawassa University

On April 23, 2024, Zelalem Tenaw defended his PhD thesis at Hawassa University titled “Reproductive Health Service Utilization and Burden of Problems among Women with Disabilities in Sidama Region, Ethiopia”.

His PhD thesis and publications can be downloaded here.

This study aimed to assess the utilization of reproductive health services and the burden of reproductive health problems among women with disabilities in the Sidama Region in Ethiopia. It used a cross-sectional study design of 652 women with disabilities. Two-thirds had recently experienced an unintended pregnancy, and 60% of reproductive-age females with disabilities reported sexual violence experience. Only 27 % were current contraceptive users, and transport accessibility, age, and types of disability determined their contraceptive use. Also, age, residency, income, parity, alcohol use, and sexual information were the risk factors. It is essential to implement strategies for raising contraceptive awareness and incorporating at-home contraceptive provision into the health extension programs.

Zelalem Tenaw earned his BSc in midwifery at Hawassa University and a Master’s in Maternity and reproductive health at Addis Ababa University in 2015. He is an assistant professor at Hawassa University.

Zelalem’s achievement is the first PhD in Public Health at Hawassa University, a testament to his dedication and the university’s commitment to advancing knowledge in this field. This is a significant achievement at the College of Medicine and Health Sciences. Zelalem is the first to enroll and complete his doctoral work as a “pure Hawassa PhD graduate.” Students before him were also attached to other universities.

The Senuph project aims to strengthen the College of Health Sciences to run good PhD programs. In the case of Zelalem Tenaw, both his supervisors are attached to the Senuph project, and the Senuph program has participated in giving PhD courses at the institution. We are now looking forward to more PhD graduates completing their Ph.D.

Progress of Senuph project

During the last two weeks of May, the Senuph PhD and master’s students, supervisors, and coordinators from Ethiopia and Norway met in Arba Minch and Hawassa.

The pictures show the research gatherings; the upper picture is from Arba Minch, and the lower is from Hawassa University.  (Photo: Prof Ingunn Marie S. Engebretsen).

We delved into the progress of the research components in research seminars, group discussions, and individual meetings. I’m pleased to report that our research is making significant strides forward, filling us with optimism for the future.

In addition, we started to work to strengthen the possibility of doing various kinds of mathematical modelling, especially by investigating the possible causal links between climate variability and infectious diseases or malnutrition. We hope such work will broaden our scope by including interdisciplinary teams in meteorology, environmental sciences, biology, and epidemiology.

Improving health care for patients with diabetes and hypertension

The World Health Organization has designed a package of essential non-communicable diseases (PEN) strategies to improve the detection and management of NCDs. However, the implementation of the PEN in Ethiopia is at an early stage, and the readiness of rural primary healthcare units to implement the strategy is unknown.

We aim to determine the prevalence of undiagnosed hypertension, diabetes mellitus, and sickness associated with hypertension and diabetes among older adults. Furthermore, we shall apply the WHO-PEN-based care model for participants diagnosed with diabetes and hypertension and evaluate its effectiveness in controlling these diseases.

Recently, the NCD group published a pre-pring of the protocol; see submitted paper.

The study started, and the picture shows a teaching session of fieldworkers before the study began.