New project: South Ethiopia Network of Universities in Public Health II (SENUPH II)

The SENUPH II project represents a network of three universities in southern Ethiopia as well as the University of Bergen. The focus is on public health. Based on history of 20-year collaboration, we aim to strengthen the existing collaboration so to enhance efforts to improve capacity building, research, building independent senior researchers, and collaborate with the Ministry of Health with the relevant health information to improve the health of peoples in southern Ethiopia.

Project’s particular importance

Even if there has been a substantial economic growth in Ethiopia, the country remains among the 20 poorest countries. The population is in a transition with declining fertility, increasing life expectancy, heavy burdens of poverty-related diseases and increasing load of non-communicable diseases. Thus, the country needs evidence-based healthcare to improve health policy and improve the health of the population.

This project focuses on health challenges and priority setting. We believe universities in southern Ethiopia, can produce relevant information for policymakers to enhance public health work. By focusing on infectious diseases, malnutrition and the emerging burden of non-communicable diseases, we aim to build capacity in higher education both at universities and at the Ministry of health.

By the end of the project and through building strong research groups, we expect to have nine independent researchers capable of research leadership, supervising future PhD students, mentoring post docs, that further can develop their institutions when this project ends. Furthermore, we expect to have strengthened two PhD programs that would be sustainable in an Ethiopian context.

Building on a previous joint PhD degree programme between Hawassa University and the University of Bergen, and strengthening research at Dilla and Arba Minch University, we plan through PhD and post doc research, linked to training at the master’s level, strengthen the ownership, capability, and sustainability of the universities and of the Ministry of health to carry out evidence-based healthcare. The teaching, research, and implementation work will be interdisciplinary and integrated and involve disciplines such as epidemiology, medicine, priority setting and health economics, household economy, essential laboratory disciplines for emerging and existing epidemics.

Project goals

Through this six-year project, we aim to strengthen the institutional capacity for teaching, supervision and research by developing teams of researchers consisting of both senior (post docs) and junior researchers (PhD students and PhD holders) and thereby obtaining a critical mass needed for future sustainability of the institution. This will also focus on enhancing leadership capability of researchers so that they become independent researchers.

We shall strengthen research groups on thematic areas such as communicable diseases (malaria, emerging and re-emerging infections, and tuberculosis), nutrition, and priority setting on non-communicable diseases and health economics.

Relevant SDGs in the project

This project will deal with several of the sustainable development goals. The main goal is good health and well-being (SDG3). However, a large proportion of the efforts will be to reduce hunger in an area where chronic malnutrition is highly prevalent (SDG2). Our program will be based on quality teaching (DG4), and gender equality (SDG5).

Partner institutions

In Ethiopia, Hawassa University, Arba Minch University, and Dilla University, and the University of Bergen

New important research from Arba Minch University

Arba Minch University has recently published three important papers. This work comes from the resaearch group on malaria and leishmaniasis. You will find the references with links to fulltext papers below:

Mekuriaw W, Balkew M, Messenger LA, Yewhalaw D, Woyessa A, Massebo F. The effect of ivermectin® on fertility, fecundity and mortality of Anopheles arabiensis fed on treated men in Ethiopia. Malaria Journal. 2019;18(1).

Pareyn M, Van den Bosch E, Girma N, van Houtte N, Van Dongen S, Van der Auwera G, et al. Ecology and seasonality of sandflies and potential reservoirs of cutaneous leishmaniasis in Ochollo, a hotspot in southern Ethiopia. PLoS Negl Trop Dis. 2019;13(8):e0007667

Pareyn M, Kochora A, Van Rooy L, Eligo N, Vanden Broecke B, Girma N, et al. Feeding behavior and activity of Phlebotomus pedifer and potential reservoir hosts of Leishmania aethiopica in southwestern Ethiopia. PLoS Negl Trop Dis. 2020;14(3):e0007947.

New article: Few pregnant women seek health care in Gedeo in southern Ethiopia

Borde MT, Loha E, Johansson KA, Lindtjorn B (2019) Utilisation of health services fails to meet the needs of pregnancy-related illnesses in rural southern Ethiopia: A prospective cohort study. PLoS ONE 14(12): e0215195. https://doi.org/10.1371/journal.pone.0215195

Although maternal survival has improved in the last decades, evidence on illnesses and the use of health services during pregnancy remains scarce. Therefore, we aimed to assess the incidence and risk factors for illnesses among pregnant women and measure the use of health services. A prospective cohort study was conducted in three kebeles in rural southern Ethiopia among 794 pregnant women from May 2017 to July 2018. Each woman was followed every two weeks at home. Poisson and survival regression models were used for analysis. The incidence rate of episodes of illnesses was 93 per 100 pregnant-woman-weeks (95%CI: 90.6, 94.2), with an average of eight episodes of illnesses per woman. Anaemia accounted for 22% (177 of 794 women), and hypertension 3% (21 women of 794 women). However, utilization of health services for any illness episodes was only 8% (95%CI: 7.6%, 8.9%). The main reasons for not using health services were that the women thought the illness would heal by itself, women thought the illness was not serious, women could not afford to visit the health institutions, or women lacked confidence in the health institutions. The risk factors for illnesses are having many previous pregnancies in life time (ARR = 1.42; 95%CI = 1.02, 1.96), having history of stillbirth (ARR = 1.30; 95%CI = 1.03, 1.64), having history of abortion (AHR = 1.06; 95%CI = 1.02, 1.11), and walking more than 60 minutes to access the nearest hospital (AHR = 1.08; 95%CI = 1.03, 1.14). The risk factors for low use of health services are also having history of abortion (AHR = 2.50; 95%CI = 1.00, 6.01) and walking more than 60 minutes to access the nearest hospital (AHR = 1.91; 95%CI = 1.00, 3.63). Rural Ethiopian pregnant women experience a high burden of illness during pregnancy. Unfortunately, very few of these women utilize health services.

New article: Can we measure household Food Insecurity?

Kabalo, Bereket Yohannes, Seifu Hagos Gebreyesus, Eskindir Loha, and Bernt Lindtjørn. “Performance of an Adapted Household Food Insecurity Access Scale in Measuring Seasonality in Household Food Insecurity in Rural Ethiopia: A Cohort Analysis.” BMC Nutrition 5, no. 1 (2019/11/20 2019): 54. https://doi.org/10.1186/s40795-019-0323-6

Background  Seasonality poses a considerable food security challenge in Ethiopia. Yet, measuring seasonal variations in food insecurity, particularly the dimension of food access, lacks an adequately validated tool. We therefore evaluated the performance of an adapted Household Food Insecurity Access Scale (HFIAS) to estimate seasonal variations in food insecurity (FI) among subsistence villagers in Ethiopia.

Methods  We employed a cohort study design using a panel of four repeated measurements taken in June, September, and December in the year 2017, and in March 2018. The study recruited 473 villagers from the drought-affected Wolaita area in southwest Ethiopia. The performance of the HFIAS was evaluated via internal consistency (Chronbach’s alpha values) and criterion validation techniques. The set of criteria include: parallelism between affirmative responses to FI questions and wealth strata; dose-response relationship between FI and dietary intake; and also FI severity and household wealth status.

Results  This study revealed that the HFIAS had satisfactory performance in four repeated measurements. The likelihood of affirmative responses to questions about FI decreased with ascending wealth quintiles. We observed an inverse dose-response relationship between FI and wealth status, and between FI and household dietary diversity.

Conclusions  The HFIAS showed an acceptable potential for measuring seasonal variations in FI in the study area. Our findings complement efforts to evaluate the scale’s applicability in various settings, in order to promote cross-culture monitoring and comparisons. However, it required a careful adaption for contextual and cultural sensitivities.

New and important publication from the Arba Minch group

Mulchandani R, Massebo F,Bocho F, Jeffries CL, Walker T, Messenger LA. A community-level investigation following a yellow fever virus outbreak in South Omo Zone, South-West Ethiopia. PeerJ. 2019;7. doi: 10.7717/peerj.6466.

Background

Despite the availability of a highly effective vaccine, yellow fever virus (YFV) remains an important public health problem across Africa and South America due to its high case-fatality rate. This study investigated the historical epidemiology and contemporary entomological and social determinants of a YFV outbreak in South Omo Zone (SOZ), Ethiopia.

Methods

A YFV outbreak occurred in SOZ, Ethiopia in 2012–2014. Historical epidemiological data were retrieved from the SOZ Health Department and analyzed. Entomological sampling was undertaken in 2017, including mosquito species identification and molecular screening for arboviruses to understand mosquito habitat distribution, and finally current knowledge, attitudes and preventative practices within the affected communities were assessed.

Results

From October 2012 to March 2014, 165 suspected cases and 62 deaths were reported, principally in rural areas of South Ari region (83.6%). The majority of patients were 15–44 years old (75.8%) and most case deaths were males (76%). Between June and August 2017, 688 containers were sampled across 180 households to identify key breeding sites for Aedesmosquitoes. Ensete ventricosum(“false banana”) and clay pots outside the home were the most productive natural and artificial breeding sites, respectively. Entomological risk indices classified most sites as “high risk” for future outbreaks under current World Health Organization criteria. Adult mosquitoes in houses were identified as members of the Aedes simpsonicomplex but no YFV or other arboviruses were detected by PCR. The majority of community members had heard of YFV, however few activities were undertaken to actively reduce mosquito breeding sites.

Discussion

Study results highlight the potential role vector control could play in mitigating local disease transmission and emphasize the urgent need to strengthen disease surveillance systems and in-country laboratory capacity to facilitate more rapid responses to future YFV outbreaks.

 

Successful midway evaluations for 7 PhD students

On Thursday April 25, seven PhD students admitted to the joint PhD degree programme between the Hawassa University and the University of Bergen, had their mid-way evaluations. Evaluators were senior staff from both Hawassa University and the University of Bergen.

The midway evaluation has the following goals:

  • to find the status regarding the progress and development of the individual PhD project
  • to give the candidate the possibility to present the whole project for a committee

The following students presented their projects:

Alemselam Zebdewos: Preventing iron deficiency anaemia: Evaluation of amaranth grain supplementation to 2-5 years old children in southern Ethiopia, a randomized controlled trial

Samrawit Hailu: Childhood illness and health service utilization in Wonago District, South Ethiopia. A community –based cohort study

Sewhareg Belay: Intimate Partner violence during pregnancy: Prevalence, health effect and knowledge about it in Sidama zone, Southern Ethiopia

Hiwot Hailu: Assessment of school health problems in Gedeo Zone, Southern Ethiopia

Bereket Yohannes: Assessing validity of the ‘Household Food Insecurity Access Scale’, and seasonality in food insecurity and undernutrition in rural Southwest Ethiopia

Mehretu Belayneh: Magnitude, seasonality and spatial distribution of under-nutrition among children aged 6-59 months, Boricha, Southern Ethiopia

Moges Tadesse: Maternal and Neonatal illnesses, its economic burden, and health service utilisation in rural Ethiopia: A community-based prospective cohort study

PhD student poster presentations

On December 13, all students at the PhD training programme presented their preliminary research results or their research plans. The 1.5 hour poster session took part at an international malaria scientific conference in Hawassa: International Research Seminar on Malaria Control held at Hawassa 

Again, on December 18, the Joint PhD programme between Hawassa University and the University of Bergen was presented at a seminar in Bergen: Hawassa- UiB Joint PhD program thriving

Recent publications

Publications by students attached to the SENUPH programme:

Arba Minch University

Abraham M, Massebo F, Lindtjørn B: High entomological inoculation rate of malaria vectors in area of high coverage of interventions in southwest Ethiopia: Implication for residual malaria transmission. Parasite Epidemiology and Control 2017, 2:61-69.

Wolaita Sodo University

Tadesse Tantu A, Demissie Gamebo T, Kuma Sheno B, Yohannis Kabalo M: Household food insecurity and associated factors among households in Wolaita Sodo town, 2015. Agriculture & Food Security 2017, 6:19.

Shone M, Demissie T, Yohannes B, Yohannis M: Household food insecurity and associated factors in West Abaya district, Southern Ethiopia, 2015. Agriculture & Food Security 2017, 6:2.

Lenja A, Demissie T, Yohannes B, Yohannis M: Determinants of exclusive breastfeeding practice to infants aged less than six months in Offa district, Southern Ethiopia: a cross-sectional study. Int Breastfeed J 2016, 11:32.