Svein Gunnar Gundersen

• Søfteland, Solrun; Sebitloane, Motshedisi; Galappaththi-Arachchige, Hashini Nilushika; Kleppa, Elisabeth; Holmen, Sigve & Pillay, Pavitra [Show all 14 contributors for this article] (2024). Diagnosis of female genital schistosomiasis and other genital infections in young South African women: challenges in the syndromic approach. Frontiers in tropical diseases. ISSN 2673-7515. 5. doi: 10.3389/fitd.2024.1379526.
• Nemungadi, Takalani Girly; Kleppa, Elisabeth; Galappaththi-Arachchige, Hashini Nilushika; Pillay, Pavitra; Gundersen, Svein Gunnar & Vennervald, Birgitte Jyding [Show all 10 contributors for this article] (2024). Predictors for participation in mass-treatment and female genital schistosomiasis reinvestigation, and the effect of praziquantel treatment in South African adolescents. PLoS Neglected Tropical Diseases. ISSN 1935-2727. 18(3). doi: 10.1371/journal.pntd.0011798.
• Mekonnen, Hailemichael Desalegn; Orlien, Stian; Aberra, Hanna; Mamo, Eyerusalem; Grude, Sine & Hommersand, Kristina [Show all 9 contributors for this article] (2023). Five-year results of a treatment program for chronic hepatitis B in Ethiopia. BMC Medicine. ISSN 1741-7015. 21(1). doi: 10.1186/s12916-023-03082-4. Full text in Research Archive Show summary

  In sub-Saharan Africa, less than 1% of treatment-eligible chronic hepatitis B (CHB) patients receive antiviral therapy. Experiences from local CHB programs are needed to inform treatment guidelines and policies on the continent. Here, we present 5-year results from one of the first large-scale CHB treatment programs in sub-Saharan Africa. Methods Adults with CHB were enrolled in a pilot treatment program in Addis Ababa, Ethiopia, in 2015. Liver enzymes, viral markers, and transient elastography were assessed at baseline and thereafter at 6-month intervals. Tenofovir disoproxil fumarate was initiated based on the European Association for the Study of the Liver (EASL) criteria, with some modifications. Survival analysis was performed using the Kaplan–Meier method. Results In total, 1303 patients were included in the program, of whom 291 (22.3%) started antiviral therapy within the initial 5 years of follow-up. Among patients on treatment, estimated 5-year hepatocellular carcinoma-free survival was 99.0% in patients without cirrhosis at baseline, compared to 88.8% in patients with compensated cirrhosis, and 54.2% in patients with decompensated cirrhosis (p < 0.001). The risk of death was significantly higher in patients with decompensated cirrhosis at baseline (adjusted hazard ratio 44.6, 95% confidence interval 6.1–328.1) and in patients older than 40 years (adjusted hazard ratio 3.7, 95% confidence interval 1.6–8.5). Liver stiffness declined significantly after treatment initiation; the median change from baseline after 1, 3, and 5 years of treatment was − 4.0 kPa, − 5.2 kPa, and − 5.6 kPa, respectively. Conclusions This pilot program demonstrates the long-term benefits of CHB therapy in a resource-limited setting. The high mortality in patients with cirrhosis underscores the need for earlier detection of CHB and timely initiation of antiviral treatment in sub-Saharan Africa.

• Shukla, Jilna Dilip; Kleppa, Elisabeth; Holmen, Sigve; Ndhlovu, Patricia D.; Mtshali, Andile & Sebitloane, Motshedisi [Show all 10 contributors for this article] (2023). The Association Between Female Genital Schistosomiasis and Other Infections of the Lower Genital Tract in Adolescent Girls and Young Women: A Cross-Sectional Study in South Africa. Journal of Lower Genital Tract Disease. ISSN 1089-2591. 27(3), p. 291–296. doi: 10.1097/LGT.0000000000000756. Full text in Research Archive Show summary

  Objectives/Purposes of the Study This study aimed to explore the relationship between female genital schistosomiasis (FGS), sexually transmitted infections, bacterial vaginosis, and yeast among young women living in Schistosoma haematobium-endemic areas. Methods In a cross-sectional study of young women, sexually active, aged 16 to 22 years in rural KwaZulu-Natal, South Africa, in 32 randomly selected rural schools in schistosomiasis-endemic areas, the authors performed gynecological and laboratory investigations, diagnosed FGS and other infections, and did face-to-face interviews. Results Female genital schistosomiasis was the second most prevalent current genital infection (23%), significantly more common in those who had urinary schistosomiasis (35%), compared with those without (19%, p < .001). In the FGS-positive group, 35% had human papillomavirus compared with 24% in the FGS-negative group (p = .010). In the FGS-positive group, 37% were seropositive for herpes simplex virus infection, compared with 30% in the FGS-negative group (p = .079). There were significantly fewer chlamydia infections among women with FGS (20%, p = .018) compared with those who did not have FGS (28%). Conclusions Female genital schistosomiasis was the second most common genital infection after herpes simplex virus. Human papillomavirus infection was significantly associated with FGS, but Chlamydia was negatively associated with FGS. Women with FGS may have had more frequent contact with the health system for genital discharge. The results show the importance of the inclusion of FGS in the national management protocols for genital infections in areas endemic for S. haematobium and highlight a more comprehensive approach to diagnosis and genital disease management.

• Sommerfelt, Ingvild; Ndhlovu, Patricia; Taylor, Myra; Naidoo, Saloshni; Pillay, Pavitra & Haaland, Hanne [Show all 9 contributors for this article] (2023). Health professionals’ knowledge about female genital schistosomiasis. A qualitative investigation in a schistosomiasis endemic area in South Africa. SSM - Qualitative Research in Health. 3. doi: 10.1016/j.ssmqr.2023.100292. Full text in Research Archive Show summary

  Female Genital Schistosomiasis (FGS) is a neglected tropical disease that affects the lives of millions of women living in endemic areas. The aim of this study was to identify South African healthcare professionals' perceptions and experiences of Female Genital schistosomiasis. This qualitative study took place in Ugu District, KwaZulu-Natal, South Africa, in one Community Health Centre and two Primary Health Care clinics. The purpose was to explore local healthcare professionals' views and knowledge on FGS in an area endemic for Schistosoma haematobium, referred to as bilharzia, or isichenene in isiZulu. The empirical findings collected through interviews and observations are discussed in relation to the well-established research on FGS. This project also took cognizance of the United Nations (UN) sustainability development goals (SDGs) with a focus on gender and sanitation, as well as control programmes to prevent schistosomiasis. The study showed that there was a multi-faceted gap in knowledge between local midwives and professional nurses’ work-related knowledge and the medical research team. Among the main causes are skewed power relations, whereby the women affected by FGS often have low socioeconomic status in society while the higher power structures do not prioritize FGS. This leads to health professionals being in a “middle position” where they are responsible for community health but are governed by their training and the guidelines of the institution in which they are a part. Furthermore, the study showed the importance of culture since nurses and midwives consult with patients, as they are part of a framework where their role is constrained due to governmental policies, protocols for patient care and the local culture. To provide adequate health services for FGS patients, this study indicates that policy, female patient management protocols, curricula, post graduate training, clinical practice and schistosomiasis prevention programs should include FGS.

• Nemungadi, Takalani Girly; Kleppa, Elisabeth; van Dam, Govert J.; Corstjens, Paul L. A. M.; Galappaththi-Arachchige, Hashini Nilushika & Pillay, Pavitra [Show all 12 contributors for this article] (2022). Female Genital Schistosomiasis Lesions Explored Using Circulating Anodic Antigen as an Indicator for Live Schistosoma Worms. Frontiers in tropical diseases. ISSN 2673-7515. 3. doi: 10.3389/fitd.2022.821463.
• Assefa, Alemayehu; Erko, Berhanu; Gundersen, Svein Gunnar; Medhin, Girmay & Berhe, Nega (2021). Co-infections and Comorbidities of Multiple Parasites and Hepatitis B Virus Infections in the Lowland Area of Western Ethiopia: Implications for Integrated Approaches. Journal of Multidisciplinary Healthcare. ISSN 1178-2390. 14, p. 3369–3383. doi: 10.2147/JMDH.S341100.
• Assefa, Alemayehu; Erko, Berhanu; Gundersen, Svein Gunnar; Medhin, Girmay & Berhe, Nega (2021). Low awareness and common misconceptions about schistosomiasis in endemic lowland areas in Western Ethiopia: a mixed-methods study. BMC Public Health. ISSN 1471-2458. 21(1). doi: 10.1186/s12889-021-11106-y. Full text in Research Archive
• Assefa, Alemayehu; Erko, Berhanu; Gundersen, Svein Gunnar; Medhin, Girmay & Berhe, Nega (2021). Current status of Schistosoma mansoni infection among previously treated rural communities in the Abbey and Didessa Valleys, Western Ethiopia: Implications for sustainable control. PLOS ONE. ISSN 1932-6203. 16(2). doi: 10.1371/journal.pone.0247312. Full text in Research Archive
• Livingston, Mahala; Pillay, Pavitra; Zulu, Siphosenkosi Gift; Sandvik, Leiv; Kvalsvig, Jane D. & Gagai, S. [Show all 13 contributors for this article] (2021). Mapping Schistosoma haematobium for Novel Interventions against Female Genital Schistosomiasis and Associated HIV Risk in KwaZulu-Natal, South Africa. American Journal of Tropical Medicine and Hygiene. ISSN 0002-9637. 104(6), p. 2055–2064. doi: 10.4269/ajtmh.20-0679. Full text in Research Archive
• Søfteland, Solrun; Sebitloane, Motshedisi; Taylor, Myra; Roald, Borghild; Holmen, Sigve & Galappaththi-Arachchige, Hashini Nilushika [Show all 8 contributors for this article] (2020). A systematic review of handheld tools in lieu of colposcopy for cervical neoplasia and female genital schistosomiasis. International Journal of Gynecology & Obstetrics. ISSN 0020-7292. p. 1–10. doi: 10.1002/ijgo.13538. Full text in Research Archive
• Orlien, Stian; Ahmed, Tekabe Abdosh; Ismael, Nejib Yusuf; Berhe, Nega; Kran, Anne-Marte Bakken & Gundersen, Svein Gunnar [Show all 7 contributors for this article] (2020). Field performance of HBsAg rapid diagnostic tests in rural Ethiopia. Journal of Virological Methods. ISSN 0166-0934. 289. doi: 10.1016/j.jviromet.2020.114061. Full text in Research Archive Show summary

  Point-of-care rapid diagnostic tests (POC-RDTs) are widely used to screen and diagnose hepatitis B virus (HBV) infection and are often the only available diagnostic tools in resource-limited settings. The aim of this study was to evaluate the validity of three hepatitis B surface antigen (HBsAg) POC-RDTs (Healgen®, Advanced Quality™ and Determine™) in an area with high prevalence of HBV in eastern Ethiopia. Results were compared with a commercial enzyme linked immunosorbent assay (ELISA) as gold standard. Quantification of HBsAg was performed in false negative samples. A total of 511 subjects were screened, of whom 81 (15.9%) were HBsAg-positive with the gold standard. All three POC-RDTs were positive in 65 of the 81 positive samples, yielding a sensitivity (95% confidence interval) of 80.2% (70.3-87.5) and a specificity of 99.8% (98.7-100 for Healgen® and Determine™; 98.6-100 for Advanced Quality™). False negatives were observed in 16 patients associated with low levels of HBsAg (median 1.5 IU/mL). All three POC-RDTs had reasonably high sensitivity and excellent specificity, but false negative results were observed in patients with low titres of HBsAg. Thus, these POC-RDTs might be useful to identify patients in need of HBV treatment, but cannot be recommended as blood donor screening tests.

• Maphumulo, A.; Mahomed, O.; Vennervald, Birgitte Jyding; Gundersen, Svein Gunnar; Taylor, Myra & Kjetland, Eyrun Floerecke (2020). The cost of a school based mass treatment of schistosomiasis in Ugu District, KwaZulu Natal, South Africa in 2012. PLOS ONE. ISSN 1932-6203. 15(6). doi: 10.1371/journal.pone.0232867. Full text in Research Archive
• Desalegn, Hailemichael; Aberra, Hanna; Berhe, Nega; Medhin, Girmay; Mekasha, Bitsatab & Gundersen, Svein Gunnar [Show all 7 contributors for this article] (2019). Predictors of mortality in patients under treatment for chronic hepatitis B in Ethiopia: a prospective cohort study. BMC Gastroenterology. ISSN 1471-230X. 19(74). doi: 10.1186/s12876-019-0993-1. Full text in Research Archive Show summary

  Background Antiviral treatment for chronic hepatitis B (CHB) is largely unavailable in sub-Saharan Africa; hence, little is known about the prognosis after initiating treatment in African CHB patients. In this study we aimed to assess predictors of mortality in one of the largest CHB cohorts in sub-Saharan Africa. Methods Two-hundred-and-seventy-six CHB patients who started treatment with tenofovir disoproxil fumarate at a public hospital in Ethiopia between March 18, 2015, and August 1, 2017, were included in this analysis. Patients were followed up until October 1, 2017, and deaths were ascertained through hospital records and telephone interview with relatives. Decompensated cirrhosis was defined as current or past evidence of ascites, either by clinical examination or by ultrasonography. Cox proportional hazard models were used to identify independent predictors of mortality. Results Thirty-five patients (12.7%) died during follow-up, 33 of whom had decompensated cirrhosis at recruitment. The median duration from start of treatment to death was 110 days (interquartile range 26–276). The estimated survival was 90.3, 88.2 and 86.3% at 6, 12 and 24 months of follow-up, respectively. Independent predictors of mortality were decompensated cirrhosis (adjusted hazard ratio [AHR] 23.68; 95% CI 3.23–173.48; p = 0.002), body mass index < 18.5 kg/m2 (AHR 3.65; 95% CI 1.73–7.72; p = 0.001) and older age (per 1-year increment; AHR 1.06; 95% CI 1.02–1.10; p = 0.007). Conclusions Decompensated cirrhosis, low body mass index and older age were independent predictors of mortality. Improved access to antiviral treatment and earlier initiation of therapy could improve the survival of African CHB patients.

• Aberra, Hanna; Desalegn, Hailemichael; Berhe, Nega; Mekasha, Bitsatab; Medhin, Girmay & Gundersen, Svein Gunnar [Show all 7 contributors for this article] (2019). The WHO guidelines for chronic hepatitis B fail to detect half of the patients in need of treatment in Ethiopia. Journal of Hepatology. ISSN 0168-8278. 70(6), p. 1065–1071. doi: 10.1016/j.jhep.2019.01.037.
• Desalegn, Hailemichael; Aberra, Hanna; Berhe, Nega; Mekasha, Bitsatab; Stene-Johansen, Kathrine & Krarup, Henrik [Show all 9 contributors for this article] (2018). Treatment of chronic hepatitis B in sub-Saharan Africa: 1-year results of a pilot program in Ethiopia. BMC Medicine. ISSN 1741-7015. 16. doi: 10.1186/s12916-018-1229-x. Full text in Research Archive
• Orlien, Stian; Ahmed, Tekabe Abdosh; Ismael, Nejib Yusuf; Berhe, Nega; Lauritzen, Trine & Gundersen, Svein Gunnar [Show all 7 contributors for this article] (2018). High Seroprevalence of Autoantibodies Typical of Autoimmune Liver Disease in Eastern Ethiopia: Is Chewing of Khat (Catha edulis) a Triggering Factor? Canadian Journal of Gastroenterology and Hepatology. ISSN 2291-2789. p. 1–10. doi: 10.1155/2018/4980597.
• Galappaththi-Arachchige, Hashini Nilushika; Zulu, Siphosenkosi Gift; Kleppa, Elisabeth; Lillebø, Kristine; Qvigstad, Erik & Ndhlovu, Patricia [Show all 10 contributors for this article] (2018). Reproductive health problems in rural South African young women: Risk behaviour and risk factors. Reproductive Health. ISSN 1742-4755. 15:138, p. 1–10. doi: 10.1186/s12978-018-0581-9. Full text in Research Archive
• Orlien, Stian; Sandven, Irene; Berhe, Nega; Ismael, Nejib Yusuf; Ahmed, Tekabe Abdosh & Stene-Johansen, Kathrine [Show all 9 contributors for this article] (2018). Khat chewing increases the risk for developing chronic liver disease: A hospital-based case-control study. Hepatology. ISSN 0270-9139. 68(1), p. 248–257. doi: 10.1002/hep.29809.
• Galappaththi-Arachchige, Hashini Nilushika; Holmen, Sigve; Koukounari, Artemis; Kleppa, Elisabeth; Pillay, Pavitra & Sebitloane, Motshedisi [Show all 12 contributors for this article] (2018). Evaluating diagnostic indicators of urogenital Schistosoma haematobium infection in young women: A cross sectional study in rural South Africa. PLOS ONE. ISSN 1932-6203. 13:e0191459(2), p. 1–15. doi: 10.1371/journal.pone.0191459. Full text in Research Archive
• Christensen, Erik; Taylor, Myra; Zulu, Siphosenkosi Gift; Lillebø, Kristine; Gundersen, Svein Gunnar & Holmen, Sigve [Show all 10 contributors for this article] (2018). Seasonal variations in schistosoma haematobium egg excretion in school-age girls in rural Kwazulu-Natal province, South Africa. South African Medical Journal. ISSN 0256-9574. 108(4), p. 352–355. doi: 10.7196/SAMJ.2018.v108i4.12775. Full text in Research Archive
• Aberra, Hanna; Gordien, Emmanuel; Desalegn, Hailemichael; Berhe, Nega; Medhin, Girmay & Mekasha, Bitsatab [Show all 11 contributors for this article] (2018). Hepatitis delta virus infection in a large cohort of chronic hepatitis B patients in Ethiopia. Liver international (Print). ISSN 1478-3223. 38(6), p. 1000–1009. doi: 10.1111/liv.13607.
• Orlien, Stian Magnus Staurung; Ismael, Nejib Yusuf; Ahmed, Tekabe Abdosh; Berhe, Nega; Lauritzen, Trine & Roald, Borghild [Show all 12 contributors for this article] (2018). Unexplained chronic liver disease in Ethiopia: a cross-sectional study. BMC Gastroenterology. ISSN 1471-230X. 18(1). doi: 10.1186/s12876-018-0755-5. Full text in Research Archive
• Desalegn, Hailemichael; Aberra, Hanna; Berhe, Nega; Gundersen, Svein Gunnar & Johannessen, Asgeir (2017). Are non-invasive fibrosis markers for chronic hepatitis B reliable in sub-Saharan Africa? Liver international (Print). ISSN 1478-3223. 37(10), p. 1461–1467. doi: 10.1111/liv.13393.
• Molvik, Mari; Helland, Elin; Zulu, Siphosenkosi Gift; Kleppa, Elisabeth; Lillebø, Kristine & Gundersen, Svein Gunnar [Show all 10 contributors for this article] (2017). Co-infection with Schistosoma haematobium and soil-transmitted helminths in rural South Africa. South African Journal of Science. ISSN 0038-2353. 113(3-4), p. 1–6. doi: 10.17159/sajs.2017/20160251.
• Aberra, Hanna; Desalegn, Hailemichael; Berhe, Nega; Medhin, Girmay; Stene-Johansen, Kathrine & Gundersen, Svein Gunnar [Show all 7 contributors for this article] (2017). Early experiences from one of the first treatment programs for chronic hepatitis B in sub-Saharan Africa. BMC Infectious Diseases. ISSN 1471-2334. 17(1). doi: 10.1186/s12879-017-2549-8. Full text in Research Archive
• Galappaththi-Arachchige, Hashini Nilushika; Hegertun, Ingrid Amilie; Holmen, Sigve; Qvigstad, Erik; Kleppa, Elisabeth & Sebitloane, Motshedisi [Show all 11 contributors for this article] (2016). Association of Urogenital Symptoms with History of Water Contact in Young Women in Areas Endemic for S. haematobium. A Cross-Sectional Study in Rural South Africa. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 13(11). doi: 10.3390/ijerph13111135.
• Gebrehiwot, Kiros Tedla; Asmare, Tigabie; Gundersen, Svein Gunnar; Gebresilase, Gebremedhin & Berhe, Nega (2015). Association of Total Levels of Serum Antioxidants with Periportal Fibrosis and Intensity of Schistosoma mansoni Infections in Cheretee, North East Ethiopia. Journal of Bacteriology & Parasitology. ISSN 2155-9597. 6(2). doi: 10.4172/2155-9597.1000220.
• Randrianasolo, Bodo Sahondra; Jourdan, Peter Mark; Ravoniarimbinina, Pascaline; Ramarokoto, Charles Emile; Rakotomanana, Fanjasoa & Ravaoalimalala, Vololomboahangy Elisabeth [Show all 13 contributors for this article] (2015). Gynecological manifestations, histopathological findings, and schistosoma-specific polymerase chain reaction results among women with schistosoma haematobium infection: A cross-sectional study in Madagascar. Journal of Infectious Diseases. ISSN 0022-1899. 212(2), p. 275–284. doi: 10.1093/infdis/jiv035.
• Randjelovic, A.; Frønæs, S. G.; Munsami, M.; Kvalsvig, J. D.; Zulu, S.G. & Gagai, S. [Show all 11 contributors for this article] (2015). A study of hurdles in mass treatment of schistosomiasis in KwaZulu-Natal, South Africa. South African Family Practice. ISSN 1726-426X. 57(2). doi: 10.1080/20786190.2014.978121.
• Kleppa, Elisabeth; Klinge, Kari Furseth; Galappaththi-Arachchige, Hashini Nilushika; Holmen, Sigve; Lillebø, Kristine & Onsrud, Mathias [Show all 10 contributors for this article] (2015). Schistosoma haematobium Infection and CD4+ T-cell levels: A cross-sectional study of young South African women. PLOS ONE. ISSN 1932-6203. 10(3). doi: 10.1371/journal.pone.0119326. Full text in Research Archive
• Holmen, Sigve; Kjetland, Eyrun Floerecke; Taylor, Myra; Kleppa, Elisabeth; Lillebø, Kristine & Gundersen, Svein Gunnar [Show all 8 contributors for this article] (2015). Colourimetric image analysis as a diagnostic tool in female genital schistosomiasis. Medical Engineering and Physics. ISSN 1350-4533. 37(3), p. 309–314. doi: 10.1016/j.medengphy.2014.12.007.
• Kleppa, Elisabeth; Holmen, Sigve Dhondup; Lillebø, Kristine; Kjetland, Eyrun Floerecke; Gundersen, Svein Gunnar & Taylor, Myra [Show all 8 contributors for this article] (2015). Cervical ectopy: associations with sexually transmitted infections and HIV. A cross-sectional study of high school students in rural South Africa. Sexually Transmitted Infections. ISSN 1368-4973. 91, p. 124–129. doi: 10.1136/sextrans-2014-051674.
• Norseth, Hanne Marie; Ndhlovu, PD; Kleppa, Elisabeth; Randrianasolo, Bodo Sahondra; Jourdan, Peter Mark & Roald, Borghild [Show all 11 contributors for this article] (2014). The Colposcopic Atlas of Schistosomiasis in the Lower Female Genital Tract Based on Studies in Malawi, Zimbabwe, Madagascar and South Africa. PLoS Neglected Tropical Diseases. ISSN 1935-2727. 8(11). doi: 10.1371/journal.pntd.0003229.
• Kjetland, Eyrun Floerecke; Norseth, Hanne Marie; Taylor, Myra; Lillebø, Kristine; Kleppa, Elisabeth & Holmen, Sigve Dhondup [Show all 13 contributors for this article] (2014). Classification of the lesions observed in female genital schistosomiasis. International Journal of Gynecology & Obstetrics. ISSN 0020-7292. 127(3), p. 227–228. doi: 10.1016/j.ijgo.2014.07.014.
• Kleppa, Elisabeth; Ramsuran, V.; Zulu, Siphosenkosi Gift; Karlsen, G.H.; Bere, Alfred & Passmore, J. [Show all 14 contributors for this article] (2014). Effect of female genital schistosomiasis and anti-schistosomal treatment on monocytes, CD4+ T-Cells and CCR5 expression in the female genital tract. PLOS ONE. ISSN 1932-6203. 9(6). doi: 10.1371/journal.pone.0098593.
• Pillay, Pavitra; Taylor, Myra; Zulu, Siphosenkosi Gift; Gundersen, Svein Gunnar; Verweij, Jaco J. & Hoekstra, Pytsje [Show all 10 contributors for this article] (2014). Real-time polymerase chain reaction for detection of Schistosoma DNA in small-volume urine samples reflects focal distribution of urogenital schistosomiasis in primary school girls in KwaZulu Natal, South Africa. American Journal of Tropical Medicine and Hygiene. ISSN 0002-9637. 90(3), p. 546–552. doi: 10.4269/ajtmh.13-0406.
• Hegertun, Ingrid Amilie; Gundersen, Kristin; Kleppa, Elisabeth; Zulu, Siphosenkosi Gift; Gundersen, Svein Gunnar & Taylor, Myra [Show all 8 contributors for this article] (2013). S-haematobium as a Common Cause of Genital Morbidity in Girls: A Cross-sectional Study of Children in South Africa. PLoS Neglected Tropical Diseases. ISSN 1935-2727. 7(3). doi: 10.1371/journal.pntd.0002104.
• Kivuyo, Sokoine; Johannessen, Asgeir; Trøseid, Marius; Kasubi, Mabula Joseph; Gundersen, Svein Gunnar & Naman, Ezra [Show all 10 contributors for this article] (2011). p24 antigen detection on dried blood spots is a feasible and reliable test for infant HIV infection in rural Tanzania. International Journal of STD and AIDS. ISSN 0956-4624. 22(12), p. 719–721. doi: 10.1258/ijsa.2009.009382.
• Jourdan, Peter Mark; Holmen, Sigve; Gundersen, Svein Gunnar; Roald, Borghild & Kjetland, Eyrun Flørecke (2011). HIV Target Cells in Schistosoma haematobium-Infected Female Genital Mucosa. American Journal of Tropical Medicine and Hygiene. ISSN 0002-9637. 85(6), p. 1060–1064. doi: 10.4269/ajtmh.2011.11-0135.
• Jourdan, Peter Mark; Roald, Borghild; Poggensee, Gabriele; Gundersen, Svein Gunnar & Kjetland, Eyrun Flørecke (2011). Increased Vascularity in Cervicovaginal Mucosa with Schistosoma haematobium Infection. PLoS Neglected Tropical Diseases. ISSN 1935-2727. 5(6). doi: 10.1371/journal.pntd.0001170.
• Johannessen, Asgeir; Naman, Ezra; Gundersen, Svein Gunnar & Bruun, Johan Nikolai (2011). Antiretroviral treatment reverses HIV-associated anemia in rural Tanzania. BMC Infectious Diseases. ISSN 1471-2334. 11. doi: 10.1186/1471-2334-11-190. Full text in Research Archive
• Berge, Simen Tviten; Kabatereine, Narciss; Gundersen, Svein Gunnar; Taylor, Myra; Kvalsvig, Jane Dene & Mkhize-Kwitshana, Zilungile [Show all 8 contributors for this article] (2011). Generic praziquantel in South Africa: the necessity for policy change to provide cheap, safe and efficacious schistosomiasis drugs for the poor, rural population. Southern African Journal of Infectious Diseases (SAJID). ISSN 2312-0053. 26(1), p. 22–25.
• Kjetland, Eyrun Flørecke; Ndhlovu, PD; Mduluza, T; Deschoolmeester, V; Midzi, N & Gomo, E [Show all 12 contributors for this article] (2010). The effects of genital Schistosoma haematobium on human papillomavirus and the development of cervical neoplasia after five years in a Zimbabwean population. European Journal of Gynaecological Oncology. ISSN 0392-2936. 31(2), p. 169–173. Show summary

  Background: High-risk human papillomavirus (HPV) is responsible for cervical cancer and genital Schistosoma haematobium infection has been hypothesized to be an additional co-factor or even an independent risk factor for cervical neoplasia. The present study aimed to investigate the impact of schistosomiasis on HPV persistence and development of cell atypia in a group of rural Zimbabwean women with confirmed high-risk Methods: A five-year follow-up was clone among women previously included in a study on genital schistosomiasis. Women who had high-risk HPV at baseline were invited after 5 years for examination of cell atypia, genital schistosomiasis, and high-risk HPV. Both vaginal lavage samples (low-cost) and cervix brush samples (high-cost) were obtained for further analysis. Results: Thirty-seven women were re-examined. Genital Schistosoma haematobium of a minimum of five years' duration was associated with the development high-grade squamous intraepithelial neoplasia, but not with persistent high-risk HPV. There was a high concordance between the brush and vaginal lavage (96.3% agreement, kappa 0.93); however, the number of beta-globin negative vaginal lavage samples was unacceptably high. Conclusions: Findings warrant an exploration in a larger longitudinal study where a vaginal swab should be explored.

• Johannessen, Asgeir; Holberg-Petersen, Mona; Løvgården, Gunilla; Naman, Ezra; Ormaasen, Vidar & Matee, Mecky I [Show all 8 contributors for this article] (2010). HIV type-1 drug resistance testing on dried blood spots is feasible and reliable in patients who fail antiretroviral therapy in rural Tanzania. Antiviral Therapy. ISSN 1359-6535. 15(7), p. 1003–1009. doi: 10.3851/IMP1660. Show summary

  Background: HIV type-1 (HIV-1) drug resistance testing is rarely available in resource-limited settings because of high costs and stringent requirements for storage and transport of plasma. Dried blood spots (DBS) can be a convenient alternative to plasma, but the use of DBS needs validation under field conditions. We assessed the performance of DBS in genotypic resistance testing of patients who failed first-line antiretroviral therapy (ART) in rural Tanzania. Methods: A total of 36 ART-experienced patients with viral loads >1,000 copies/ml (median 15,180 copies/ml [range 1,350?3,683,000]) and with various HIV-1 subtypes were selected for resistance testing. DBS were stored with desiccant at ambient temperature for a median of 29 days (range 8?89). Samples were amplified using an in-house reverse transcriptase-nested PCR method and sequenced using the ViroSeq? assay (Abbott Molecular, Des Plaines, IL, USA). DBS-derived genotypes were compared with genotypes from plasma. Results: Overall, 34 of 36 (94%) DBS specimens were successfully genotyped. In the protease region, of 142 polymorphisms found in plasma, 132 (93%) were also detected in DBS. In the reverse transcriptase region, of 57 clinically relevant mutations present in plasma, 51 (89%) were also detected in DBS. A total of 30 of 34 (88%) patients had identical resistance profiles to antiretroviral drugs in plasma and DBS. Conclusions: Genotyping was successful in the vast majority of DBS specimens stored at ambient temperature for up to 3 months, and there was high concordance between mutations found in DBS and plasma. Our study suggests that DBS can be a feasible and reliable tool to monitor HIV-1 drug resistance in patients on ART in resource-limited settings.

• Bratholm, Clara Sofie; Johannessen, Asgeir; Naman, Ezra; Gundersen, Svein Gunnar; Kivuyo, Sokoine & Holberg-Petersen, Mona [Show all 8 contributors for this article] (2010). Drug resistance is widespread among children who receive long-term antiretroviral treatment at a rural Tanzanian hospital. Journal of Antimicrobial Chemotherapy. ISSN 0305-7453. 65(9), p. 1996–2000. doi: 10.1093/jac/dkq234. Full text in Research Archive
• Thomassen Morgas, DE; Kvalsvig, Jane D.; Gundersen, Svein Gunnar; Taylor, Myra & Kjetland, Eyrun Floerecke (2010). Schistosomiasis and water-related practices in school girls in rural KwaZulu-Natal, South Africa. Southern African Journal of Infectious Diseases (SAJID). ISSN 2312-0053. 25(4), p. 30–33.
• Thomassen Morgas, DE; Kvalsvig, Jane D.; Gundersen, Svein Gunnar; Taylor, Myra & Kjetland, Eyrun Floerecke (2010). Schistosomiasis and water-related practices in school girls in rural KwaZulu-Natal, South Africa. Southern African Journal of Infectious Diseases (SAJID). ISSN 2312-0053. 25(4), p. 30–33.
• Kjetland, Eyrun Flørecke; Ten Hove, Robert Jan; Gomo, Exenevia; Midzi, Nicholas; Gwanzura, Lovemore & Mason, Peter [Show all 12 contributors for this article] (2009). Schistosomiasis PCR in Vaginal Lavage as an Indicator of Genital Schistosoma haematobium Infection in Rural Zimbabwean Women. American Journal of Tropical Medicine and Hygiene. ISSN 0002-9637. 81(6), p. 1050–1055. doi: 10.4269/ajtmh.2009.09-0081. Show summary

  Schistosoma real-time polymerase chain reaction (PCR) is sensitive and specific in urine and stool. We sought to explore the relationship between genital schistosomiasis and the Schistosoma PCR in women. PCR was run on 83 vaginal lavage samples from a rural Zimbabwean population. Women underwent clinical and colposcopic investigations, analyses for sexually transmitted infections, and genital schistosomiasis. Thirty samples were positive for Schistosoma PCR: 12 were strong and 18 were weak positive. Sensitivity (67%) and specificity (83%) were best in women below the age of 25 years. A positive schistosome PCR result was associated with S. haematobium ova in genital tissue, so-called sandy patches, and bleeding. Prevalence determined by PCR were lower and real-time PCR values were weaker in older women. The presence of Schistosoma DNA may be greater in the recent lesions (e.g., in younger women). For diagnosis in rural areas and in large studies, Schistosoma PCR could become a supplement to gynecologic examinations.

• Johannessen, Asgeir; Naman, Ezra; Kivuyo, Sokoine; Kasubi, Mabula J.; Holberg-Petersen, Mona & Matee, M. [Show all 9 contributors for this article] (2009). Virological efficacy and emergence of drug resistance in adults on antiretroviral treatment in rural Tanzania. BMC Infectious Diseases. ISSN 1471-2334. 9. Show summary

  Conclusion: Virological suppression rates were good up to 4 years after initiating ART in a rural Tanzanian hospital. However, drug resistance increased with time, and dual-class resistance was common, raising concerns about exhaustion of future antiretroviral drug options. This study might provide a useful forecast of drug resistance and demand for second-line antiretroviral drugs in rural Africa in the coming years.

• Johannessen, Asgeir; Garrido, Carolina; Zahonero, Natalia; Sandvik, Leiv; Naman, Ezra & Kivuyo, Sokoine [Show all 10 contributors for this article] (2009). Dried Blood Spots Perform Well in Viral Load Monitoring of Patients Who Receive Antiretroviral Treatment in Rural Tanzania. Clinical Infectious Diseases. ISSN 1058-4838. 49(6), p. 976–981. doi: 10.1086/605502. Show summary

  Conclusions. DBS, in combination with the NucliSENS EasyQ HIV-1 v1.2 asay, performed well in monitoring HIV viral loads in patients who received ART in rural Tanzania, although the sensitivity was reduced when viral burden was low. The use of DBS can simplify virological monitoring in resource-limited settings.

• Berhe, Nega; Myrvang, Bjørn & Gundersen, Svein Gunnar (2009). Gastro-intestinal symptoms associated with intense Schistosoma mansoni infection affect class-attentiveness of schoolchildren in Ethiopia. Acta Tropica. ISSN 0001-706X. 110(1), p. 52–56. doi: 10.1016/j.actatropica.2009.01.007. Show summary

  Conclusion: Symptoms associated with intense S. mansoni infection may negatively affect class-attentiveness of schoolchildren which may have important implications on their overall educational achievements. Further detailed intervention-based prospective studies are recommended to validate these findings which, if confirmed, could further justify school-age targeted praziquantel-based control of schistosomiasis. (c) 2009 Elsevier B.V. All rights reserved.

• Johannessen, Asgeir; Naman, Ezra; Kivuyo, Sokoine; Kasubi, Mabula; Holberg-Petersen, Mona & Matee, Mecky I [Show all 8 contributors for this article] (2009). Virological efficacy and emergence of drug resistance in adults on antiretroviral treatment in rural Tanzania. BMC Infectious Diseases. ISSN 1471-2334. 9. doi: 10.1186/1471-2334-9-108.
• Kjetland, EF; Kurewa, EN; Ndhlovu, PD; Midzi, N; Gwanzura, L & Mason, P.R. [Show all 11 contributors for this article] (2008). Female genital schistosomiasis : a differential diagnosis to sexually transmitted disease: genital itch and vaginal discharge as indicators of genital Schistosoma haematobium morbidity in a cross-sectional study in endemic rural Zimbabwe. Tropical medicine & international health. ISSN 1360-2276. 13(12), p. 1509–1517. Show summary

  Objective: To examine the association between schistosomiasis and reproductive tract symptoms. Method: A cross-sectional study was conducted in a Schistosoma haematobium-endemic area of rural Zimbabwe. A total of 483 permanently resident adult women of Mupfure Ward aged 20¿49 were interviewed and examined clinically, each providing three consecutive urine samples. Logistic regression analysis was used to control for sexually transmitted diseases (STDs). Results: Women with genital sandy patches had significantly more genital itch (P = 0.009) and perceived their discharge as abnormal (P = 0.003). Eighty percent of the women who had genital itch, yellow discharge, and childhood or current waterbody contact had sandy patches. Fifty-two percent of the women with genital sandy patches did not have detectable S. haematobium ova in urine. Genital schistosomiasis was associated with stress incontinence and pollakisuria, but not with menstrual irregularities, current or previous ulcers, or tumours. Conclusion: Genital schistosomiasis may be a differential diagnosis to the STDs in women who have been exposed to fresh water in endemic areas. Because of the chronic nature of the disease in adults, we suggest to pay special attention to the prevention of morbidity.

• Berhe, Nega; Myrvang, Bjørn & Gundersen, Svein Gunnar (2008). Reversibility of schistosomal periportal thickening/fibrosis after praziquantel therapy: A twenty-six month follow-up study in Ethiopia. American Journal of Tropical Medicine and Hygiene. ISSN 0002-9637. 78(2), p. 228–234. Show summary

  To study outcome determinants of schistosomal periportal thickening/fibrosis (PPT/F), 199 subjects (mean age = 24.0 years, range = 7-68 years), 109 with mild (image pattern C) PPT/F, 69 with moderate (image pattern D) PPT/F, and 21 with severe (image patterns E and F) PPT/F were treated with praziquantel and evaluated every six months for a mean duration of 26 months. Subjects excreting Schistosoma mansoni eggs during any of the six-month evaluations were offered repeat treatment. Thirty-five had some improvement, and 69 had total resolution of PPT/F, of which 63.8% resolved within one year. Compared with subjects with moderate lesions, a significantly higher proportion of subjects with mild lesions had resolution/improvement of PPT/F (40.6% versus 69.7%, P < 0.001). Subjects with severe PPT/F showed no improvement. Resolution of PPT/F was significantly more frequent at a younger age, among seronegative for hepatitis B virus and among. those with a lower frequency of post-treatment recurrence of S. mansoni infections.

• Kjetland, EF; Ndhlovu, PD; Kurewa, EN; Midzi, N; Gomo, E & Mduluza, T [Show all 8 contributors for this article] (2008). Prevention of gynecologic contact bleeding and genital sandy patches by childhood anti-schistosomal treatment. American Journal of Tropical Medicine and Hygiene. ISSN 0002-9637. 79(1), p. 79–83. Show summary

  Schistosoma haematobium infection may cause genital mucosal pathology in women with and without urinary schistosomiasis. This report seeks to explore the long-term effect of anti-schistosomal treatment on the clinical manifestations of S. haematobium infection in the lower genital tract. Prior treatment was reported by 248 (47%) of 527 women. Treatment received before the age of 20 years was significantly associated with the absence of sandy patches and contact bleeding, and this association was independent of current waterbody contact. Treatment in the past five years did not influence the prevalence of gynecologic schistosoma-induced lesions. The study indicates that early treatment may be more efficient for gynecologic morbidity control. Findings warrant an exploration into several chemotherapeutic agents administered at an early age, as well as in adults.

• Johannessen, Asgeir; Naman, Ezra; Ngowi, Bernhard J; Sandvik, Leif; Matee, M. & Aglen, Henry E [Show all 8 contributors for this article] (2008). Predictors of mortality in HIV-infected patients starting antiretroviral therapy in a rural hospital in Tanzania. BMC Infectious Diseases. ISSN 1471-2334. 8. Show summary

  Conclusion: Mortality was found to be high, with the majority of deaths occurring within 3 months of starting ART. Anemia, thrombocytopenia and severe malnutrition were strong independent predictors of mortality. A prognostic model based on hemoglobin level appears to be a useful tool for initial risk assessment in resource-limited settings.

• Berhe, Nega; Myrvang, Bjørn & Gundersen, Svein Gunnar (2007). Intensity of Schistosoma Mansoni, Hepatitis B, Age, and Sex Predict Levels of Hepatic Periportal Thickening/Fibrosis (PPT/F): A Large-Scale Community-Based Study in Ethiopia. American Journal of Tropical Medicine and Hygiene. ISSN 0002-9637. 77(6), p. 1079–1086. Show summary

  To elucidate determinants of morbidity in schistosomiasis mansoni, a community-based study was undertaken involving 2,451 subjects (mean age, 18.8 +/- 15.3 [SD] years) from four endemic sites in Ethiopia. Overall prevalence of infection was 65.9%, reported blood in stools was 35.8%, and schistosomal periportal thickening/fibrosis (PPT/F) was 4.6%. Similarly, 43.2% were positive for at least one marker of hepatitis B virus (HBV), 5.3% were HBsAg positive, and 1.3% were anti-hepatitis C virus (HCV) positive. Prevalence of PPT/F increased significantly with increasing community prevalence and intensity of S. mansoni infection. In a multiple logistic regression analysis, intensity of egg excretion, markers of HBV infection, age, and male sex were significantly associated with PPT/F, whereas co-infection with other intestinal helminths was associated with lower odds for PPT/F. HCV was not associated with S. mansoni infection or with schistosomal PPT/F. In conclusion, integrated helminth control targeting school-aged children, who have the highest burden infection, should be used to substantially reduce the risk of periportal fibrosis

• Berhe, Nega; Halvorsen, Bente L.; Gundersen, TE; Myrvang, Bjørn; Gundersen, Svein Gunnar & Blomhoff, R. (2007). Reduced serum concentrations of retinol and alpha-tocopherol and high concentrations of hydroperoxides are associated with community levels of S-mansoni infection and schistosomal periportal fibrosis in Ethiopian school children. American Journal of Tropical Medicine and Hygiene. ISSN 0002-9637. 76. Show summary

  To study the relationship between micronutrient malnutrition and schistosomiasis mansoni, a cross-sectional study was undertaken involving 421 schoolchildren (mean age 12.6 years; 333 from schistosomiasis mansoniendemic villages (Workemado and Sille) and 88 non-endemic controls from Sheno). Prevalence of schistosomiasis mansoni infection in Workemado and Sille was comparable (90.6% versus 95%, respectively), and prevalence of PPF in Workemado was significantly higher than in Sille (7.0% versus 0.6%, P<0.001). Compared with non-endemic controls, serum retinol concentrations were significantly lower and hydroperoxides were significantly higher in subjects from schistosomiasis mansoni-endemic areas. Furthermore, serum a-tocopherol concentrations in subjects from an area with high prevalence of PPF were significantly reduced while the concentrations in subjects from an area with low prevalence of PPF were comparable to the levels found in non-endemic healthy controls. In conclusion, micronutrient malnutrition and oxidative stress are associated with Schistosoma mansoni infection and levels of schistosomal PPF.

• Kjetland, EF; Ndhlovu, PD; Gomo, E; Mduluza, T; Midzi, N & Gwanzura, L [Show all 10 contributors for this article] (2006). Association between genital schistosomiasis and HIV in rural Zimbabwean women. AIDS (London). ISSN 0269-9370. 20(4), p. 593–600. Show summary

  Objective: To determine the association between female genital Schistosoma haematobium infection and HIV. Design and methods: A cross-sectional study with a 1-year follow-up. Gynecological and laboratory investigations were performed for S. haematobium and HIV. Sexually transmitted infections, demographic and urogenital history were analysed as confounders. The participants were 527 sexually active, non-pregnant, non-menopausal women between the ages of 20 and 49 years. The setting was a rural Zimbabwean community where S. haematobium related lesions were found in 46% of the women, HIV in 29% and herpes simplex type- 2 (HSV-2) in 65%. Results: In permanent residents (>3 years residency), HIV was found in 41% (29/70) of women with laboratory proven genital schistosomiasis as opposed to 26% HIV positive (96/375) in the schistosomal ova negative group [odds ratio (OR), 2.1; 95% confidence interval (CI), 1.2-3.5; P = 0.008. In multivariate analysis S. haematobium infection of the genital mucosa was significantly associated with HIV seropositivity (adjusted OR, 2.9; 95% CI, 1.11-7.5; P = 0.030). All seven women who became HIV positive during the study period (seroincidence 3.1%) had signs of S. haematobium at baseline. In accordance with other studies HIV was significantly associated with HSV-2 (OR, 3.0; 95% CI, 1.7-5.3; P < 0.001), syphilis and human papillomavirus. The highest HIV prevalence (45%) was found in the 25-29 years age group. Conclusion: Women with genital schistosomiasis had an almost three-fold risk of having HIV in this rural Zimbabwean community. Prospective studies are needed to confirm the association. (C) 2006 Lippincott Williams & Wilkins, Inc.

• Ndhlovu, PD; Mduluza, T; Kjetland, EF; Midzi, N; Nyanga, L & Gundersen, Svein Gunnar [Show all 8 contributors for this article] (2006). Prevalence of urinary schistosomiasis and HIV in females living in a rural community of Zimbabwe: does age matter? Transactions of the Royal Society of Tropical Medicine and Hygiene. ISSN 0035-9203. Show summary

  A cross-sectional study was conducted on 544 women living in Mupfure rural area of Zimbabwe to determine whether infection with urinary schistosomiasis is associated with HIV infection. Schistosoma haematobium infection was examined in urine samples and HIV infection was determined in sera. The prevalence of S. haematobium infection was highest (60%) in women below 20 years of age and declined to 29% in the oldest age group (test for trends, P < 0.001). Overall, women infected with urinary schistosomiasis had an HIV prevalence of 33.3%, whilst women without urinary schistosomiasis had an HIV prevalence of 25.6% (?2, P = 0.053). Women above the age of 35 years and infected with urinary schistosomiasis had a significantly higher HIV prevalence (37.5%) than those without urinary schistosomiasis (16.8%; ?2, P < 0.001). (Copyright © 2007 Elsevier)

• Berhe, Nega; Geitung, JT; Medhin, G & Gundersen, Svein Gunnar (2006). Large scale evaluation of WHO's ultrasonographic staging system of schistosomal periportal fibrosis in Ethiopia. Tropical medicine & international health. ISSN 1360-2276. 11, p. 1286–1294. Show summary

  CONCLUSIONS With further improvement, the WHO's ultrasonographic diagnostic criteria can be used in health institutions and community surveys. Image pattern based assessment is simple and more reproducible than PBWT based assessment of periportal thickening/fibrosis. The latter is, however, more useful in clarifying the status of an individual with doubtful image pattern, and in monitoring post-treatment outcome of periportal thickening/fibrosis. Considering the comparability of PBWT-for-height standards, setting one international standard of PBWT-for-height is more practical than developing local standards for each endemic area.

• Kjetland, EF; Mduluza, T; Ndhlovu, PD; Gomo, E; Gwanzura, L & Midzi, N [Show all 9 contributors for this article] (2006). Genital schistosomiasis in women: a clinical 12-month in vivo study following treatment with praziquantel. Transactions of the Royal Society of Tropical Medicine and Hygiene. ISSN 0035-9203. 100, p. 740–752. Show summary

  Urinary schistosomiasis is known to be associated with lesions in the female genital organs, particularly with the presence of 'sandy patches' in the tower genital tract. This study sought to determine the effect of treatment with praziquantel on gynaecological schistosomiasis in residents of an area endemic for Schistosoma haematobium. A cohort study was conducted among women aged 20-49 years in rural Zimbabwe. The shape and size of lesions were mapped pre treatment and 3 and 12 months following treatment. Ova of S. haematobium were Looked for in cytology smears, wet mounts, biopsies, urine and stool. Specimens were collected for detection of sexually transmitted diseases and cancer. At baseline, almost half of the 527 women included in the study had sandy patches. Although urinary ova excretion decreased following treatment (odds ratio 10.3, 95% Cl 3.8-27.8, P < 0.001), praziquantel. treatment was not associated with a significant reduction in genital lesions or contact bleeding (P= 0.31-0.94). Sandy patches remained strongly associated with contact bleeding and vessel abnormalities even after treatment. Findings were independent of HIV status. Such lesions, which are common and apparently refractory to treatment for at Least 12 months, may be an important risk factor for both the acquisition and transmission of HIV. (C) 2005 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved.

• Kjetland, EF; Gwanzura, L; Ndhlovu, PD; Mduluza, T; Gomo, E & Mason, P.R. [Show all 9 contributors for this article] (2005). Herpes simplex virus type 2 prevalence of epidemic proportions in rural Zimbabwean women: association with other sexually transmitted infections. Archives of Gynecology and Obstetrics. ISSN 0932-0067. 272(1), p. 67–73. Show summary

  Introduction Syndromic management of sexually transmitted infections (STIs) is one important strategy in human immunodeficiency virus (HIV) prevention in developing countries, but there is a scarcity of rural community-based data on the relative prevalences of the STIs. We sought to determine the prevalences of the STIs and their clinical correlates in rural Zimbabwean women. Methods A cross-sectional study was conducted among 527 sexually active, non-pregnant, non-menopausal women between the ages of 20 and 49 years. Results The seroprevalence for herpes simplex virus type 2 (HSV-2), HIV, trichomoniasis and syphilis were 64.5, 29.3, 24.7 and 6.2% respectively. HSV-2 seropositivity was significantly associated with current non-syphilitic ulcers (adjusted odds ratio [OR] 4.91, 95% confidence interval [CI] 1.08?22.34, p=0.040). HSV-2 seroprevalence peaked at the age of 35 whereas HIV peaked at 25. The two diseases were strongly associated (OR 2.92, 95% CI 1.85?4.65, p<0.001). Conclusion There is evidence of rural epidemics of both HSV-2 and HIV, and a change in the aetiology of genital ulcers in rural Zimbabwe.

• Kjetland, EF; Ndhlovu, PD; Mduluza, T; Gomo, E; Gwanzura, L & Mason, P.R. [Show all 10 contributors for this article] (2005). Simple clinical manifestations of genital Schistosoma haematobium infection in rural Zimbabwean women. American Journal of Tropical Medicine and Hygiene. ISSN 0002-9637. 72(3), p. 311–319. Show summary

  Up to 75% of women with urinary schistosomiasis have Schistosoma haematobium ova in the genitals. This study aimed to describe the prevalence of gynecologic S. haematobium infection and to differentiate the disease from sexually transmitted infections (STIs). Gynecologic and laboratory investigations for S. haematobium and STIs were performed in 527 women between the ages of 20 and 49 in rural Zimbabwe. Genital homogenous yellow and/or grainy sandy patches, the commonest type of genital pathology, were identified in 243 (46%) women. Grainy sandy patches were significantly associated with S. haematobium ova only. Genital S. haematobium ova was also significantly associated with homogenous yellow sandy patches, mucosal bleeding, and abnormal blood vessels. The presence of ova was not a predictor for ulcers, papillomata, leukoplakia, polyps, or cell atypia. Mucosal sandy patches seem to be pathognomonic for S. haematobium infection in the female genitals. Coexistence of ova and other lesions may not be causal. Up to 75% of women with urinary schistosomiasis have Schistosoma haematobium ova in the genitals. This study aimed to describe the prevalence of gynecologic S. haematobium infection and to differentiate the disease from sexually transmitted infections (STIs). Gynecologic and laboratory investigations for S. haematobium and STIs were performed in 527 women between the ages of 20 and 49 in rural Zimbabwe. Genital homogenous yellow and/or grainy sandy patches, the commonest type of genital pathology, were identified in 243 (46%) women. Grainy sandy patches were significantly associated with S. haematobium ova only. Genital S. haematobium ova was also significantly associated with homogenous yellow sandy patches, mucosal bleeding, and abnormal blood vessels. The presence of ova was not a predictor for ulcers, papillomata, leukoplakia, polyps, or cell atypia. Mucosal sandy patches seem to be pathognomonic for S. haematobium infection in the female genitals. Coexistence of ova and other lesions may not be causal

• Abebe, Fekadu; Erko, Berhanu; Gemetchu, T & Gundersen, Svein Gunnar (2005). Control of Biomphalaria pfeifferi population and schistosomiasis transmission in Ethiopia using the soap berry endod (Phytolacca dodecandra), with special emphasis on application methods. Transactions of the Royal Society of Tropical Medicine and Hygiene. ISSN 0035-9203. 99(10), p. 787–794. Show summary

  The endod (Phytolacca dodecandra) -based schistosomiasis mansoni control project was implemented in Ethiopia between 1994 and 1999. The aim was to develop an effective, cheap and sustainable method of controlling schistosomiasis. First, different formulations of the Ethiopian endod strain 44 (E-44) were compared for potency in the laboratory. Secondly, spray and drip-feeding methods were compared for simplicity and effectiveness in the field. Lastly, the efficacy of endod powder soap was compared with the endod spray method. In Bati stream, endod powder soap was distributed to the residents every weekend at Laundry sites. In Worke stream endod was sprayed along a 1 - km stretch of the stream at 3 -month intervals. No endod was applied in Harbu stream. The immediate and long-term effects of endod application on the snail population and schistosomal infection were determined. Using the spray method, 100% snail mortality could be obtained, and it was simpler and more effective than the drip-feeding method. Snail mortality ranged from 20 to 100% using endod soap. There was a progressive decline in the snail population and infection in Bati stream compared with Worke stream, mainly due to sustained use of endod soap. The advantages and disadvantages of the different endod delivery systems are discussed

• Baay, MF; Kjetland, EF; Ndhlovu, PD; Deschoolmeester, V; Mduluza, T & Gomo, E [Show all 9 contributors for this article] (2004). Human papillomavirus in a rural community in Zimbabwe: the impact of HIV co-infection on HPV genotype distribution. Journal of Medical Virology. ISSN 0146-6615. 73(3), p. 481–485.
• Berhe, Nega; Medhin, G; Erko, Berhanu; Smith, Tara; Gedamu, Selamawitt & Bereded, Dereje [Show all 11 contributors for this article] (2004). Variations in helminth faecal egg counts in Kato-Katz thick smears and their implications in assessing infection status with Schistosoma mansoni. Acta Tropica. ISSN 0001-706X. 92(3), p. 205–212.
• Midzi, N; Ndhlovu, PD; Nyanga, L; Kjetland, EF; Reimert, CM & Vennervald, BJ [Show all 11 contributors for this article] (2003). Assessment of eosinophil cationic protein as a possible diagnostic marker for female genital schistosomiasis in women living in a Schistosoma haematobium endemic area. ?. 25(Nov-Dec), p. 11–12.
• Abebe, Fekadu; Birkeland, Kåre I; Garder, P. I.; Petros, B & Gundersen, Svein Gunnar (2002). The relationships between dehydroepiandrosterone sulphate DHEAS), the intensity of Schistosoma mansoni infection and parasite-specific antibody responses. A cross-sectional study in residents of endemic communities in north-east Ethiopia. APMIS : Acta pathologica, microbiologica et immunologica Scandinavica. Supplementum. ISSN 0903-465X.
• Erko, Berhanu; Abebe, Fekadu; Berhe, Nega; Medhin, G; Gebre-Michael, T & Gundersen, Svein Gunnar (2002). Control of Schistosoma mansoni by the soapberry Endod (Phytolacca dodecandra) in Wollo, northeastern Ethiopia: post-intervention prevalence. East African Medical Journal. ISSN 0012-835X. 79(4), p. 198–201.
• Jelinek, Thomas; Bisoffi, Zeno; van Thiel, Pieter; Bronner, Ulf; de Frey, Albie & Gundersen, Svein Gunnar [Show all 8 contributors for this article] (2002). Cluster of African Trypanosomiasis in Travelers to Tanzanian National Parks. Emerging Infectious Diseases. ISSN 1080-6040. 8(6), p. 634–635. Show summary

  Reports on outbreaks of African trypanosomias among travelers in national parks in Tanzania. Characteristics of the travelers; Treatment; Travel history

• Erko, Berhanu; Medhin, G; Abebe, Fekadu; Gebre-Michael, T & Gundersen, Svein Gunnar (2002). Epidemiological studies on intestinal schistosomiasis in Wondo Genet, southern Ethiopia. Ethiopian Medical Journal (EMJ). ISSN 0014-1755. 40(1), p. 29–39. Show summary

  A cross-sectional epidemiological survey was made on intestinal schistosomiasis due to Schistosoma mansoni in Wondo Genet, southern Ethiopia, in 1999 to generate preintervention parasitological and malacological baseline data to be used as a reference in evaluation of community-based pilot control trial to be launched using wild-growing Endod. A total of 3000 stool specimens were collected from schoolchildren enrolled in 14 schools and microscopically examined using Kato method. The overall prevalence and intensity of schistosomiasis mansoni was 34.6% and 184 eggs per gram of stool (EPG), respectively. Children excreting Schistosoma mansoni eggs were found in all of the 14 schools surveyed with a prevalence of infection ranging from 1.9% in Abaye School to 80.6% in Shesha Kekele School. The overall prevalence of S. mansoni infection among males and females was 38.4% and 27.3%, respectively (P = 0.0001, 95% C.I = 7.5%-14.7%) where as the intensity of infection was 186 EPG and 181 EPG, respectively (P = 0.8045, 95% C.I = 1.17%-1.23%). Malacological surveys of 27 water contact sites revealed the occurrence of Biomphalaria pfeifferi in 8 sites out of which 3 harbored infected snails shedding schistosome cercariae. The necessity for initiating community-based sustainable control programme is discussed

• Abebe, Fekadu; Gaarder, Per Ivar; Petros, B & Gundersen, Svein Gunnar (2002). Differences in prevalence, intensity of infection and parasite-specific antibody levels do not predict different age-infection profiles. ?. 110(07.aug), p. 535–544. Show summary

  Acquired immunity is believed to influence the age-infection profile of Schistosoma infections. We compared antibody responses against Schistosoma mansoni adult worm antigen (AWA) and soluble egg antigen (SEA) in 164 residents of two communities with different levels of infection. IgG, IgA, IgM, IgE, and IgG subclass 1 to 4 antibodies were determined by ELISA. Seventy-five of the subjects were from Harbu, an area with a prevalence of 39% and an intensity of infection of 116 eggs per gram of stool (EPG), whereas 89 subjects were from Bati, with a prevalence of 66% and intensity of infection of 256 EPG. In both communities the prevalence and the intensity of infection were highest in the age group 10-14 years, although both were significantly higher in Bati than in Harbu. Mean levels of AWA-specific IgA, IgM, IgG, IgG1 and IgG2, and of SEA-specific IgG, IgM, IgG2 and IgG3 were significantly higher in Bati than in Harbu. However, mean levels of IgE against worm and egg antigens were significantly higher in Harbu than in Bati. Significant differences were detected in the levels of IgA, IgE, IgG, IgM, IgG1 and IgG2 against AWA, and in IgE, IgM, IgG2 and IgG3 against SEA according to the place of residence. The levels of anti-AWA IgG, IgG1 and IgG2 and anti-SEA IgG, IgG1 and IgG4 were significantly associated with the intensity of infection. Anti-AWA IgM levels were associated with age, whereas sex and age had interacting effects on the levels of AWA-specific IgG1 and SEA-specific IgG and IgM. Antibody responses exhibited different age-related patterns in the two communities. This may indicate that differences in history of exposure influence the evolution of immune responses. However, the study did not support the view that differences in antibody levels between communities subject to different levels of infection result in a systematic deviation in age-infection profile (the "peak shift").

• Poggensee, G.; Reimert, CM; Nilsson, LA; Jamaly, S; Sjastad, A & Roald, B [Show all 14 contributors for this article] (1996). Diagnosis of female genital schistosomiasis by indirect disease markers: determination of eosinophil cationic protein, neopterin and IgA in vaginal fluid and swab eluates. Acta Tropica. ISSN 0001-706X. 62(4), p. 269–280. doi: 10.1016/S0001-706X(96)00028-9.
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• Kleppa, Elisabeth; Holmen, Sigve Dhondup; Lillebø, Kristine; Pillay, P; Taylor, Myra & Gundersen, Svein Gunnar [Show all 8 contributors for this article] (2014). Cevical schistosomiasis. Journal of Obstetrics and Gynaecology. ISSN 0144-3615. 2014(34), p. 755–756. doi: 10.3109/01443615.2014.920801.
• Molvik, Mari; Helland, Elin; Lillebø, Kristine; Kleppa, Elisabeth; Zulu, Siphosenkosi Gift & Gundersen, Svein Gunnar [Show all 10 contributors for this article] (2013). Co-infection with Schistosoma haematobium and soil-transmitted helminths among school girls from rural Ugu district in southern KwaZulu-Natal, South Africa: a cross-sectional survey. Tropical medicine & international health. ISSN 1360-2276. 18, p. 125–125.
• Berhe, Nega; Myrvang, Bjørn; Blomhoff, Rune & Gundersen, Svein Gunnar (2011). Access to antioxidant rich diet and development of schistosomal periportal fibrosis (PPF): report from an Ethiopian cohort revisited after 10 years. Tropical medicine & international health. ISSN 1360-2276. 16(S1), p. 276–276.
• Kjetland, EF; Kurewa, EN; Mduluza, T; Midzi, N; Gomo, E & Friis, H [Show all 8 contributors for this article] (2010). The first community-based report on the effect of genital Schistosoma haematobium infection on female fertility. Fertility and Sterility. ISSN 0015-0282. 94(4), p. 1551–1553.
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• Wolde-Yohannes, Legesse; Behre, Nega; Erko, Berhanu; Esser, Kjell; Esser, Kjell & Gundersen, Svein Gunnar [Show all 7 contributors for this article] (2002). Såpebæret som helbredet elvene : en film om det etiopiske såpebæret endod og hvordan det kan brukes til å kontrollere bilharzia-sykdommen.

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