Author Archives: Bernt Lindtjørn

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.

Current status of the Senuph-2 project

Three years have passed since we started the Senuph-2 project. Here is a summary of the achievements so far.

We have established seven research groups; you can read about them on this website. Altogether, 20 PhD students have started their work. Most of them are actively doing their fieldwork or laboratory work. All of the research either includes a randomised control trial or cohort studies. The persons in the research are preparing to write their first papers that they will use in their doctoral theses.

The project also supports the work of some master’s theses. These master’s degree students work in the research teams and are exposed to how a larger research group works.

We plan to hold the annual scientific conference in November 2024. This year, the meetings will be in Arba Minch. For the scientific conference, we will let each research group present its research and its implications in separate sessions. As we did in 2023, we will invite other PhD students and researchers to present their findings in these sessions.

Reanalysis of the Maltrials study

Our malaria prevention trial in Zeway was recently reanalysed. When analysing the trial results, we particularly questioned why the entomological data showed an effect of our interventions while the randomised cluster trial was negative.

In the last year, we have tried several new reanalysis methods, and we believe we had a negative trial because we needed to account for unequal community levels. In the future, we should pay much more attention to multi-level data structures.

As you may read from the paper, we postulate that visible and hidden layers could affect the analysis of such community studies. Thus, we are currently working with people familiar with remote sensing to evaluate if the distribution of, for example, maise fields plays an essential role in the variation of malaria in communities. In addition, we are trying to map the distribution of small and temporary ponds often seen as breeding sites for Anopheles arabiensis. We’re trying to use remote sensing by downloading high-resolution satellite data for our Hawassa and Arba Minch studies.

Is it time to recruit new students, master’s or PhD, with a keen interest and relevant educational background to do work on the interdisciplinary aspects of epidemiology, remote sensing and GIS?

You can read our paper by following this link,  where you will find related research papers.

Senuph students and staff visit Bergen

During the past six weeks, students and staff from the Senuph program at Hawassa and Arba Minch Universities attended courses at the Centre for International Health at the University of Bergen.

Ten people attended the classes and returned to Ethiopia this evening.

The upper picture shows four participants from Hawassa in the health economics course, and the lower photo shows students attending a course on experimental epidemiology visiting Magnhild and Bernt Lindtjørn.

 

Anopheles stephensi in Arba Minch

Anopheles stephensi is spreading rapidly to urban settings in Ethiopia. It is a common malaria-transmitting mosquito in South Asia and the Arabian Peninsula and is believed to have spread to eastern Ethiopia in 2016. However, since 2023, there have also been reports of its presence in Hawassa, and recently we detected it in Arba Minch. We have submitted this data for publication.

Much effort has been made to understand its spread and relation to its environment. Understanding how An. stephensi behaves and contributes to malaria transmission compared with the existing local vectors is critical for designing strategies for containment. Our findings in Arba Minch suggest that the rapid geographic expansion of this invasive species may be linked to major transportation corridors.

The team in Arba Minch, in collaboration with partners from Norway and the Armauer Hansen Research Institute (AHRI) in Addis Ababa, has commenced work to enhance our comprehension of the behaviour of this mosquito and its role in malaria transmission. We aim to develop innovative control strategies to manage this rapidly spreading vector.

Preprint of publication:

Fekadu Massebo, Temesgen Ashine, Nigatu Negash, Thomas Minda, Bernt Lindtjørn, and Endalamaw Gadisa. The expansion of an invasive malaria vector: Anopheles stephensi detection in Arba Minch town in the southern Rift Valley of Ethiopia, 14 February 2024, PREPRINT (Version 1) available at Research Square [https://doi.org/10.21203/rs.3.rs-3946371/v1]

See the webpage for more developments on this research.

Strengthening neonatal and maternal health

The maternal and neonatal research team aims to improve the quality of care for mothers and newborns within the community. The team collaborates with community health workers and health development teams, directly influencing the local health system.

The photo illustrates a training session conducted by members of the maternal and neonatal research team and health extension workers for the health development teams residing in the Gala Argiso kebele in the Sidama region of Ethiopia. These health development teams are volunteers dedicated to addressing maternal and newborn health issues at the grassroots level. Additionally, it seeks to educate mothers on self-care practices during pregnancy and postpartum and guide them on when to seek medical attention for health concerns.

Arba Minch University: Our collaboration with the Ministry of Health

One of our project aims is to strengthen Ethiopia’s health system. Here is an example of how this is done in malaria control.

Our collaboration with the Ministry of Health began by establishing the Master’s Programme in Medical Entomology and Vector Control in 2014. The first cohort included three health professionals from different districts. One joined the Ethiopian Public Health Institute, while the other two returned to their respective districts to strengthen the health system, particularly in controlling malaria and other vector-borne diseases.

The second cohort was diverse, with 11 members, seven of whom belonged to the public health sector. Three worked at the Ethiopian Public Health Institute, two at the Armauer Hansen Research Institute, one at the regional malaria elimination programme, and the other at the district-level vector control programme.

The third, fourth, fifth, sixth, seventh, and eighth cohorts consisted of 4-5 individuals each, with members from different institutes and organisations working to control and prevent malaria and other vector-borne diseases.

In the third cohort, two of the four members joined the Armauer Hansen Research Institute. The fourth cohort was the largest, with 13 candidates, nine working in the health system at various levels. These candidates are associated with organisations such as the MOH National Malaria Elimination Program, the Ethiopian Public Health Institute, Zone, district malaria, and other vector-borne disease control units.

The fifth cohort had five individuals, with one person from the health sector. After completing their studies, they returned to the district office to work.

The sixth cohort also had five members, including one from the Regional Public Health Laboratory Institute. This institute’s primary objective is to monitor the quality of diagnoses made by other regional institutes. The project work of this cohort was in line with the institute’s aim to evaluate the quality of malaria diagnostics.

The seventh cohort also had five individuals, one from the Regional Public Health Laboratory Institute. Like the sixth cohort member, they also did a project on the challenges of malaria diagnosis.

The eighth cohort had four individuals, two of whom were from the National Institute of Tsetse Control Programme. This institute plays a crucial role in improving animal health in the country. One member of the first cohort and another from the fourth cohort also work at this institute.

Finally, the ninth cohort had four individuals, one from the health sector.

The Norhed-Senuph project provided uninterrupted support to these nine cohorts, producing a skilled workforce that now holds crucial positions in national, regional, zone, and district disease control and prevention programs. These graduates are making remarkable contributions to the nation’s health sector, particularly in controlling malaria and other vector-borne diseases.