New publications

The Senuph project has recently got three new papers:

Endriyas, M., et al. (2025). “A decline in the coverage and utilization of long-lasting insecticidal nets in Southern Ethiopia: A repeated cross-sectional study.” PLoS One 20(4).

Gebretsadik, A., et al. (2025). “Cluster randomized controlled trial to assess the effectiveness of a package of community-based interventions on continuum of maternal and newborn healthcare in Sidama, Ethiopia: The SiMaNeH trial protocol.” PLoS One 20(4): e0310341.

Yilma, M. T., et al. (2025). “Effect of Amaranth-Containing Dietary Intervention in Improving Hemoglobin Concentration: A Systematic Review and Meta-Analysis.” Public Health Rev 4

Good progress on the Senuph project

The South Ethiopia Network of Universities in Public Health (SENUPH) is a collaborative initiative to enhance public health education and research capacity in southern Ethiopia.

A recent mid-term evaluation concluded, “In SENUPH II, all planned research groups were formed, including senior researchers, PhD candidates, and master’s students. Their research outputs, with a high percentage of published work by master’s graduates, highlighted the program’s effectiveness. Furthermore, collaboration with the Ministry of Health in Ethiopia ensured that the research had direct implications for national health policies. “

Publications from the project can be seen here.

The picture shows PhD students from Arba Minch and Hawassa universities participating in epidemiological training courses while visiting Bergen.

Dr. Aschenaki Zerihun Kea defended his PhD thesis

Dr. Aschenaki Zerihun Kea defended his PhD thesis on October 22. He received this joint degree from Hawassa University in Ethiopia and the University of Bergen.

The thesis: «Maternal mortality in Sidama Region, southern Ethiopia: Results from surveys on mortality and the coverage of available interventions,» is available for download from Bergen Open Research Archive here: https://bora.uib.no/bora-xmlui/handle/11250/3155973

Yesterday, we visited his work at Yirga Alem Hospital Medical College and discussed the possibility of continuing research in the Sidama Region.

 

Later, we celebrated his excellent achievement with good Ethiopian food in Hawassa.

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

Facebook – https://www.facebook.com/ArbaMinchUniversityCAD/

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.