Category Archives: Publications

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.

 

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.

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.

Scientific conference for Master’s and PhD students

From November 8 to 10,  we had a scientific conference for masters and PhD students at Hawassa University. Participants were students from the universities in both Hawassa and Arba Minch. Altogether, 28 students presented their research.

The rationale for such an annual event is to have a high-quality conference where students get scientific feedback on their presentations.

The abstracts are found here.