Learning statistics in the nature

As Robin Williams says spring is nature’s way of saying “Let’s Party”, but during this wonderful time the students from Norway and Georgia decided to attend the course in Register and Bio-bank Epidemiology at Lopota lake resort in Georgia in the beautiful Caucasus area. The course was full with statistics and epidemiology and the students, who were supervised by lecturers working on articles about scientific research, gained a lot of knowledge about registry based studies and in general, about health registries. In total, 36 participants attended the course including 10 teachers and administrate persons.

The course was organized and lead by UiT – The Arctic University of Norway in the frame of the project “Georgian-Norwegian Collaboration in Public Health“, financed by Diku (Norwegian Agency for International Cooperation and Quality Enhancement in Higher Education). Additionally, Georgian participants were from Tbilisi State University, University of Georgia and National Center for Disease Control and Public Health. 10 PhD students from Norway and 16 Georgians had full time course during 6-10 May in one of the truly green and awesome places in the Eastern part of Georgia. Three of this are members of the Norwegian Research School of Global Health (NRSGH).

Excellent weather, beautiful forest surroundings and a magnificent green lake was perfectly aligned with the data management, critical appraisal of the scientific articles and overview of the studies from medical registries. The course is PhD level and especially designed for researchers who are working on registry or other big data. Since the lectures started from 9 in the morning and lasted until 6.30 in the evening the course was really intensive with a lot of group works.

Spending five days in the same place, away from daily life disturbances,  is an excellent opportunity for people with different educational backgrounds and research interests to connect and make future friendships. Sharing experience and improving knowledge in epidemiology is the main aim of the course. It’s also one additional step forward to strengthen Georgian-Norwegian collaboration in public health and provide opportunities for students to travel abroad, visit countries with different cultures and meet new people working on the similar topics – just the kind of networking that’s so crucial for research projects to succeed.

One of the course participants from the research school described the course as really useful: ” – The course widened our perspective on registry research with the help of experienced scholars from Norway, Sweden and Finland. While enjoying Georgian hospitality we were able to discuss advantages and challenges when using registries for health research both in the Nordic countries and in Georgia. The presentation about linking registries with biobank data was particularly intriguing for planning my future research.”

Group Foto32NRSGH_blog picture_5_May 2019

In other words, Caucasus is not the worst place to start spring, even from an academic perspective.


Three good reasons for why engaging in popular science is useful for scientists

If you as a researcher had a tool that would both increase your writing skills and help you to reach out to a broader audience and potential funders – would you use it? Research communication is such a tool. Or, more correctly, it’s a tool package containing instruments such as public-oriented presentations, popular science articles, engagement in social media, blogging, and more.

Here are three reasons why engaging in popular science makes you a better researcher:


  1. Building professional identity

Popular science dissemination helps the researcher to export her science to a wider audience compared to traditional scientific dissemination. Reaching out to a wide audience is important in many aspects. Research does not happen in solitude and researchers are dependent on cooperation with other researchers and research institutions. Networking is consequently a crucial element here.

This is also a question about legitimacy. Publicly funded research are paid for by tax-payers and the results should thus be easily accessible also outside academic circles.

Further, popular science dissemination is a great way to increase a researcher’s professional identity, which in term will increase the institutional reputation of the institution to which the researcher belongs.


  1. Better funding opportunities

Reaching out to a broader audience also means reaching out to potential funders. This is relevant also because a researcher who engages in various channels, for instance through blogging, social media, television or book writing, becomes more visible also for funders. More funding institutions require a plan for dissemination when funding a research project, and a solid plan for science –  both popular and traditional – dissemination helps strengthening funding applications.


  1. Better research

Science communication is not only a question for researchers about reaching out to a wide audience, be that other researchers, potential funders, or the public. It is also about giving the audience easy access to researchers. Giving the audience an opportunity to comment and follow research secures reciprocity. This approach ensures that the researchers are in tune with the real world and can potentially increase knowledge around a certain topic.

Research groups that are visible also outside academia may spur interest for a certain research topic, which in turn may help recruiting new researchers to the field.

So, how do you as researcher get going with popular dissemination? It is not necessary to engage in book writing or appearing on television to reach out to a broad audience. Writing articles and op-eds in magazines and journals, for instance Aftenposten Viten, forskning.no and NRK ytring, is a great way to communicate your research with new groups.

Social media, such as Facebook, Twitter and ResearchGate, provides platforms where posts potentially can reach an enormous audience. Blogging is another great way for researchers to write about aspects by their research that do not necessarily gets encapsuled in academic dissemination.

An example from the blog of the Norwegian Research School of Global Health suits as a good illustration of how blogging can benefit researchers. Hanneke Pot from UiO wrote a blog post about doing field work in Malawi. The blog post was shared on various channels, including Facebook. Some weeks after the blog post was published, Hanneke was contacted by a film crew engaged in a film project that included some of the aspects Hanneke was doing her research on. This way, Hanneke achieved more attention to her research project and enhanced her network with actors engaged in topics that are of great importance for her research project. A win-win situation, both for the researcher and for the film crew.

There is no doubt that researchers than benefit from engaging in popular science, so pick up your tool box and get started!


Would you like to contribute to the blog or are you looking for input on how to engage in popular science in general? Feel free to contact Turid Austin Wæhler or Elin Yli Dvergsdal from The Norwegian Research School of Global Health. 

Supervision seminar in Uganda

Being a PhD student is not a walk on roses, and life while pursuing the PhD is usually filled with ups and downs. We strive to achieve academic success while working to get new knowledge and improve a specific research area. You might get the results you hope for, but unfortunately there are often disappointing results and struggles as well. I would be surprised if there is a PhD student who didn’t have periods where the motivation was low, and insecure feelings about their PhD and their ability to finish.

A good supervisor can be the key to having a positive experience with your PhD and achieving the academic results that you want. However, how to be a good supervisor isn’t obvious. Being a supervisor means to look over. You should guide your student in her process to make sure to reach their goal, but also you have to give them enough space to develop and think for themselves.

The challenge of good supervision can become particularly difficult when you are working within global health. This is an area where almost all the supervisors and the students come from different countries, and work in different countries. You don’t just have the regular meeting places for a student-supervisor relationship. Often there are big distances between you and your student, and you are dependent on good internet connections which is not always available everywhere. Additionally, there are cultural barriers and obstacles. Hence, it is not always easy to know how to give the best possible supervision, especially when you are on the other side of the world.

The Norwegian Research School of Global Health (NRSGH) aims to strengthen the quality of PhD education and to facilitate recruitment of young researchers in global health. As a part of this NRSGH has arranged supervision seminars in Norway to make sure that the students get the best possible guidance. However, many of the PhD students in the NRSGH are either from Southern Africa or working in this area. Therefore, there was a need to do a supervision course for the local supervisors.

In the end of October this year about 20 supervisors from the whole region was gathered for a two-day seminar in Entebbe, Uganda, on how to be a good supervisor. Sofie Kobayashi from the University of Copenhagen, whom holds a PhD on the subject and has extensive experience with teaching both PhD students and supervisors, was the keynote speaker. Supervisors from Uganda, Tanzania, Malawi, Zambia, Ethiopia, Norway and Sweden were present. Kobayashi gave valuable insight and got the group to reflect on how to be a good supervisor. There were active discussions where the supervisors could share their previous experiences and challenges.

One of the take-home messages was that different students have different needs, but you should try to meet the students where they are. Defining roles and a good two-way communication is important. Identify when your student is struggling. Make sure the relationship is professional, but also relaxed. These were among the many things that were discussed during this two-day seminar. The feedback from the participants was very good, and I personally think this seminar will be benefit both the supervisors and the PhD students in the future. Never forget – the main goal for us is to provide high level research that can bring the world forward.

Water and sanitation in a changing climate — Why community approaches matter

There is an urgent need to invest in climate-related public health interventions that focus on local and community-identified health. Even though the world may need more toilets, building flush toilets that require water is not the best solution in all contexts.

Globally, almost one billion people defecate in the open. This is a major health challenge, as it can threaten the quality of water sources, which can put individuals at risk for diarrheal disease (the second leading cause of death among children under five globally). Many governments attempt to solve open defecation by building toilets; however, flush toilets are one of the most unsustainable inventions of all time because they require water to facilitate the expulsion of human excreta from the structure.

This is also the case in India, where the government has been building pour-flush toilets to solve challenges with open defecation for decades.

Even though the world may need more toilets, it does not need ones that require water.

Anise 1

Coping with climate

As a result of the global climate changing, weather patterns have become increasingly unpredictable and extreme; which often affects the duration and severity of wet and dry seasons. There are several direct health impacts from these changes in weather patterns. For example, in seasons with heavy rainfall, vector-borne diseases (malaria and dengue fever) will be high. Similarly, seasons with humid weather will affect pathogen development. These seasonal fluctuations affect ecosystems and infectious disease and can in many areas influence water quality and availability (a key component in water, sanitation, and hygiene (WASH)).

Furthermore, an indirect consequence of climate change is the development of short-term coping strategies that lead to potentially harmful behaviors. Remember how governments build flush toilets to solve issues with open defecation? During dry seasons, (although individuals may know the harmful health outcomes associated with open defecation) individuals/households will ration water, prioritizing drinking, cooking, and washing rather than using a flush toilet. This will inevitably lead people to defecate in the open, not because they lack knowledge about the harm or consequences of open defecation, but because they lack appropriate infrastructure for today’s changing climate.

For the past two years, I spent over six months in Tamil Nadu, India conducting fieldwork focused on WASH for my PhD project.

Although, my PhD research was not focused on climate change, I discovered from both living in the community and from existing studies that individuals have a reciprocal and complex relationship with the environment. Throughout informal discussions and data collection, individuals expressed a deep appreciation for the environment.  Furthermore, they expressed frustration about a lack of sanitation solutions for waste management and a serious concern for the future. In this context, as mentioned above, climate change had direct effects on water availability. However, what was unique in my experience was my observation of how this again influenced certain WASH-associated behaviors, and discussions about the ineffectiveness of “modern” facilities versus local coping strategies.

Anise 2

What did I learn that might help mitigate this challenge?

We should challenge what and how sanitation infrastructure is constructed because solutions for a predictable climate may not be adequate for a changing one. Am I advocating that governments should not build flush toilets for their populations? Although that is also an important discussion to have, for now I am suggesting that increasingly complex weather patterns must be matched with solutions meeting local demands. Additionally, in order to improve health outcomes, there is an urgent need to invest in climate-related public health interventions that focus on local and community-identified health solutions and prevention of climate change (a distal determinant of health).

Anise 3


Burra, S., Patel, S., & Kerr, T. (2003). Community-designed, built and managed toilet blocks in Indian cities. Environment and Urbanization15(2), 11-32.

Patz, J. A., Campbell-Lendrum, D., Holloway, T., & Foley, J. A. (2005). Impact of regional climate change on human health. Nature, 438(7066), 310.

World Health Organization. (2003). Climate change and human health: risks and responses: summary.

World Health Organization. (2018). Sanitation. Retrieved from: http://www.who.int/news-room/fact-sheets/detail/sanitation

UNICEF. (2011). The Situation of Children in India: A profile. Retrieved from: http://www.unicef.org/sitan/files/SitAn_India_May_2011.pdf.


Sustainable universities?

Written by Jakob Grandin, UiB, and Turid Austin Wæhler, UiT

How can universities work towards a more sustainable and fair world? This was the topic of a recent workshop for PhD researchers at the University of Tromsø.

Providing knowledge and know-how about sustainability, develop networks across disciplines and sectors and reducing waste and CO2 emissions are all examples of initiatives where the universities can make a difference in terms of sustainability.

Universities are in a position to engage research and higher education – and to mobilize partnerships with communities, politicians, NGOs, and the business sector – in a collective effort to take responsibility in terms of sustainability. As major societal actors, usually accommodating many thousand students and employees, universities can also make a difference just by implementing simple measures in waste reduction and CO2 emissions.

A global framework for addressing sustainability is the Sustainable Development Goals (SDGs) launched by the UN in 2015. Working to achieve the SGDs means working for a more sustainable and fair world. But how can the universities best work to reach the SDGs?


An agenda for sustainable development

The Sustainable Development Goals (SDGs) are a UN initiative set up to achieve a more sustainable world. The 17 goals cover social and economic development issues including poverty, hunger, health, education, climate change, gender equality, water, sanitation, energy, urbanisation, environment and social justice.

The SDGs are to a large degree interdependent on each other, meaning that in order to achieve one goal, other goals must be dealt with simultaneously. Hence, interdisciplinary is a key word when talking about sustainability.


Bringing together PhD researchers to work on global issues

Interdisciplinary was on the agenda also during a workshop for PhD researchers at UiT The Arctic University of Tromsø recently. In the workshop, PhD researchers from various fields at UiT – including health, law, mathematics, social sciences, biology, philosophy, and pedagogics – gathered to discuss sustainability. The aim of the workshop was to create a platform where PhD students from different parts of UiT working on global issues could meet. How UiT can contribute to the SDGs and how the PhD students can relate own research to the SDGs were the questions that guided the discussion.

The workshop was a collaboration between the Norwegian Research School of Global Health and Centre for Arctic and Global Health at UiT . The initiative to organize the workshop emerged from a recurrent need to discuss various topics related to global health in interdisciplinary fora. Global health is a field of study that is based on interdisciplinary and cross-sectorial collaboration in a public health perspective. Gathering PhD students from various disciplines to discuss issues related to sustainability is a useful way to increase interdisciplinary collaboration at UiT, both in a global health setting and beyond.


Visions and concrete initiatives

During four hours, the PhD researchers discussed why and how universities can play a significant role in sustainability questions. Both ideas for concrete initiatives and visions for the longer term were put forward in the conversations. Creating – or rather expanding – a sustainability network at UiT and beyond, encourage the university to reduce plastic waste and organize more workshops or symposia on sustainability were recommendations that may be implemented in a shorter timeframe. Creating a faculty for interdisciplinary research and to develop courses across faculties were among the more extensive suggestions.


An interdisciplinary sustainability forum

The workshop showed that there are multiple ways in which the university can engage in the SDGs. The participants did not know each other before the workshop but are now continuing their conversations through the Interdisciplinary PhD Forum for Sustainability. The network will make efforts to join forces with other initiatives at UiT and nationally and will follow up several of the ideas that emerged during the workshop. Stay tuned for more sustainability action!


“Who are you?” About experiences from a course in qualitative research

“You are you?” asked the professor. I sat there puzzled by the question. “I am Sara” I thought, “a researcher, a colleague, a friend, a…” But that was not the answer the professor was looking for. What was my epistemological position?  Was I a constructionist believing that everything is relative and that there are several realities all socially constructed? Or perhaps a positivist certain that the reality is static and directly measurable? During the course I have attended for the past two weeks titled “Advanced course in qualitative research in global public health” we as participants have been challenged to position ourselves within these theories. The course is organized in collaboration between the University of Copenhagen, the University of Bergen and the Norwegian Research School of Public Health. During the course we have learned that epistemology is the underlying assumption or belief about how knowledge is generated. Ontology is the study of the nature of being, becoming, or reality. It is grounded in the philosophical idea that everything around us is subjective and based on our individual reality. We have also learnt that as a qualitative researcher it is important to be transparent to our readers about who we are as researchers; our epistemological position and the theoretical approach we use to collect and analyze data. “But wait a minuteI thought “aren’t we as researchers supposed to generate some sort of objective truth completely separated from who we are as human beings and what we believe in?”

Later on in the course, during a group exercise about qualitative thematic analysis, participants were separated into groups at random and instructed to extract key features of a text and condense it into key words, a process called coding. These codes would eventually be developed into interpretative themes that would be presented to the class by each group at the end of the exercise. The text was about health-seeking behaviors of HIV positive men in Zimbabwe. Course participants were from multiple professional backgrounds such as medicine, anthropology and philosophy and came from various corners of the globe. Therefore, the multidisciplinary environment permitted rich discussions and interpretations from diverse perspectives. When each group presented their interpretative themes that they felt summed up the most important aspects of the text, it turned out we had all focused on different aspects of the text. The health professional had focused on issues such as adherence- the men´s ability to follow the treatment regimen, while the anthropologist had spent more time focusing on the experiences of the men and the context within which they lived their lives. The exercise was a lesson in how we all interpret the world around us from a unique position which influence who we are as researchers.

So who am I? I still need some more time on that one. But definitively not a positivist, I think…

Sara Rivenes Lafontan is a PhD student at the University of Oslo. Her PhD project is about adaptation of new technology among birth attendants and laboring women in Tanzania. She recently published a scientific article about laboring women´s experience using a newly developed electronic fetal heart rate monitor.

About stereotypes, traditional practices and culture: Experiences from field work in Malawi

Written by Hanneke Pot, PhD candidate at Centre for Development and the Environment, University of Oslo 

To Malawi for fieldwork

During my first weeks in Malawi, I met with a staff member of an International Non-Governmental Organization (INGO). Over a cup of tea, we discussed a possible location for my fieldwork. I was interested in studying the dynamic relationships between NGOs and local communities and how this shaped the implementation of a project aiming to reduce teenage pregnancies and keep girls in school.  The Malawian INGO staff member was fascinated by Mangochi, a district which he described as having ‘bad’ indicators in the fields of health and education compared to the national average, but which on the other hand was quite developed in terms of economic activity. He mentioned that cultural values and practices were the main reason for these bad indicators. In other districts, he argued, people were more accepting towards programs. However, the ‘bad’ status of Mangochi was relative, as nationwide as much as 29 per cent of girls between the ages of 15 and 19 have begun child bearing and the median years of completed education for women aged 15-49 is 5.6 (for men 6.6) [1]. In Malawi, young motherhood was the norm.

Hanneke 4

Stereotypes at several levels

The more NGO staff and senior government officials I spoke to, the more I became aware of people’s strong stereotypical ideas about Mangochi: The dominant tribe in Mangochi – the Yao – did not value education because they were Muslims. They highly valued traditional practices such as initiation ceremonies and early marriages, aimed to protect their culture and therefore resisted development discourses. Having some prior knowledge of Islam, the logic of resisting western education out of religious conviction did not make sense to me. I knew Islam as a religion in which knowledge and education were highly valued. This puzzle fascinated me. How could elite Malawians’ perception of Islam be so different from mine? And why were traditional practices and culture so central in the explanation for the ‘bad’ indicators in Mangochi district?

A couple of weeks later I was on my way to Mangochi, a four-hour drive from the capital Lilongwe, crossing the mountains and fertile lands of Dedza district. The beautiful and peaceful scenery was somewhat in contrast with the immensely busy and vibrant atmosphere in Mangochi, located at the southern end of Lake Malawi. There were bicycles everywhere, transporting people, but also merchandise, between markets. On one side of the lake there were tourist lodges, the larger ones had conference halls, which were used for NGO-organized meetings. The population was ethnically mixed and residence to people from different parts of Malawi. The other side of the lake was calmer in terms of economic activity, and the population was more homogeneous Yao. I chose a village on the side with the mixed population as fieldwork location.

Conducting participant observation in the implementation of an INGO project with a behavior change approach and studying in-depth one rural area in which it was meant to make a difference, provided me with unique insights. I learned how the INGO staff ‘translated’ the content of the project to specificities of the district, how INGO staff and government stakeholders talked about the project and the target population during project meetings, but also how the project related to local realities in rural Malawi. One finding that stood out was the stereotypical portrayal of the Yao tribe, the overemphasis on a static uniform culture to explain bad indicators, and how this was in discordance with local realities shaped by poverty, daily uncertainties and lack of options to formal employment.

Hanneke 2

Emphasis on cultural and behavioral factors amongst INGO staff

Whereas the INGO staff attributed the Yao’s low educational attendance to a distant past in which they had resisted missionary education out of refusal to convert to Christianity, INGO staff completely passed over the influence of more recent events. The 1994 Free Primary Education policy had doubled the enrollment but deteriorated the quality of education. In the southern region of Malawi, this reinforced the idea that education was insignificant to secure livelihoods that were severely affected by the AIDS crisis [2]. There seemed to be no collective cultural or religious resistance towards education. Rather, to many villagers the importance of education was related to various notions of development. For some this meant a strong focus on tangibles, such as iron sheet houses, sleeping on a mattress, or having braided hair. To others, development meant envisioning getting an education and formal employment. Yet, achieving these dreams proved to be challenging.

When implementing interventions with a behavior change approach, discussions during INGO-community meetings were almost inevitably steered towards those factors that could be changed by the project: behavioral determinants. Although in private conversations INGO staff acknowledged the structural inequalities that characterized village life, they could not address these issues with the project. It was their job to convince local communities that education would lead to a better future, thereby constructing education and teenage pregnancies as oppositional. What therefore became the topic of discussion during INGO-community meetings were the behavioral and cultural factors that could be changed to achieve these aims. As such, poverty became a superficial factor, and culture the deeper layered problem, instead of the other way around.

Hanneke 1

Hanneke 3

Focus on culture reflects dichotomies

Through such meetings, INGO staff talked about tradition and culture as something static, as an entity in itself, uninfluenced over time. The fuss about ‘harmful cultural practices’ in Malawi seemed to reflect dichotomies between elites and villagers, modernity and tradition, urban and rural, educated and ignorant. As such, a project about reducing teenage pregnancies and keeping girls in school that appeared to be morally neutral due to its scientific underpinnings, played out as a moral discourse for rural girls and communities to abandon their traditional practices and become modern educated Malawians, blaming culture in its course.

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Hanneke Pot with research assistants Gertrude Finyiza and Beatrice Chibayo

  1. NSO and ICF, Malawi Demographic and Health Survey 2015-16. 2017, National Statistical Office [NSO] Malawi and ICF: Zomba, Malawi and Rockville, Maryland, USA.
  2. Kendall, N., Education for All Meets Political Democratization: Free Primary Education and the Neoliberalization of the Malawian School and State. Comparative Education Review, 2007. 51(3): p. 281-305.

Improving the quality of reproductive healthcare in Georgia – About the creation of a Georgian birth registry

Written by Ingvild Hersoug Nedberg (MPH), Natia Skhvitaridze (MD, MBA) and Tinatin Manjavidze (DD, MPH) from UiT The Arctic University of Norway  

Maternal and perinatal mortality and morbidity are frequently referred to as the most important indicators related to the health of a nation and is used as a measure of quality of the reproductive health care system. One of the major challenges to improve a health care system is unreliable patient-data and methods of collecting data. A country can improve the quality and efficiency of their reproductive health care system with the use of a medical birth registry with high quality and accurate data, as has been done in Georgia.   


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Health data in Georgia

Georgia is a developing country with several problems related to their healthcare system. Among the challenges are how to improve the quality of care and its effectiveness. Reduction of maternal and children morbidity and mortality has been an important goal for the United Nations Millennium Development Goals (MDG) and is now the priority for the Sustainable Development Goals (SDG). Maternal and newborns deaths are crucial to report accurately. However, Georgia has been lacking precise and longitudinal data dealing with maternal and newborns mortality and morbidity. Until 2016, data on reproductive health services came from sporadic on-demand surveys. Routine info on mortality and morbidity was available as aggregated data with a lack of epidemiological analysis.


Using data for research and education

The Georgian Birth Registry (GBR) was implemented 1January 2016 with the aim of collecting reliable information and ensuring accurate reporting of data with high quality and completeness. It is the first developing country to implement a national, digital medical birth registry, and it was made possible by the initiative and great enthusiasm from the involved actors.

The introduction of the GBR in Georgia has made it possible to create a database, which can be used for epidemiological analysis and recommend evidence-based findings. We are three PhD-students (two Georgians living in Georgia and one Norwegian) accepted at UiT The Arctic University of Norway in the Department of Community Medicine to work and develop our studies. We are all using data from the GBR and our projects deal with maternal and perinatal mortality and morbidity, and cesareans sections.

The supervising team consists of main supervisors in Norway and co-supervisors in Georgia from different scientific backgrounds and clinical experience.


How it works

We started our PhD in January 2017 and we all study full-time. We attend relevant PhD-courses together in Norway and gather for common supervision either in Norway or in Georgia at least four times a year. We also have weekly communication by Skype. We arranged a writing gathering in February 2018 where supervisors and PhD-students came together for a week in the mountains of Georgia to write the outline of our first paper, a highly effective way of working and something we would recommend for other PhD-students working on common data material. The Norwegian and Georgian partners in the project also organize annual conferences to review progress and challenges with the birth registry and other parts of the project.

Due to the recent implementation of the GBR, we have spent much time reviewing the quality of the variables in the registry, trying to find out why some are poorly filled out while others seem to be misunderstood. It is also important to make a detailed and up-to-date codebook of all the 470 variables with detailed explanations of coding and meaning, to avoid misunderstandings and provide a working tool for all those involved in using the GBR data. This work is not directly related to our projects, but is valuable to understand how a national registry is set up, what it takes to make it work and not the least how much time it takes to clean a dataset before it is ready for analyses!



We believe that our studies, through our PhD-projects, can contribute to the improvement of the Georgian reproductive health system by providing descriptions and analyses of data never published before and suggestions for improving maternal and newborn health.


For more information contact:

Ingvild Hersoug Nedberg – ingvild.h.nedberg@uit.no

Natia Skhvitaridze – natia.skhvitaridze@uit.no

Tinatin Manjavidze – tinatin.manjavidze@uit.no


The Norwegian Center for International Cooperation in Education (SIU) funded the project ”Georgian-Norwegian Collaborative in Public Health (GeNoC-PH)” in 2016 with the following participants:

  • UiT The Arctic University of Norway (UiT)
  • University of Georgia (UG)
  • Ivane Javakhishvili Tbilisi State University (TSU)
  • National Center for Disease Control and Public Health of Georgia (NCDC)
  • United Nations Children’s Fund (UNICEF)
  • Consulting & IT Innovations (CiTi)

Country of focus: Malawi

Written by Maria Lisa Odland, PhD Candidate, Norwegian University of Science and Technology (NTNU)


About research, medical training and other experiences from Malawi


First time in Malawi

People´s knowledge on Malawi varies a lot. Some people don’t know the difference between Mali and Malawi, some people know it’s one of the poorest countries in the world, some people don’t know it exists, and some people know it is a popular place to do research and aid work, and some people even know it as a tourist destination. For me I didn’t have a clue before the first time I travelled down there, but now I can safely say that Blantyre is my second hometown and Malawi will always have a special place in my heart.

I went to Malawi for the first time as a medical student and did rotations in Obstetrics and Gynecology, Pediatrics and Nephrology. There was a lot of impressions, both good and bad. Doing rounds at the ward for malnourished children and participating in a data collection on underfed children was probably one of the most difficult things I have ever done. I more or less saw children die from lack of food. Additionally, seeing patients with chronic kidney disease without money to buy drugs or the possibility to get a transplant or dialysis also made a very big impression on me and is something I will never forget. The bright side were seeing all these talented and dedicated doctors doing everything they could with very little resources. It made me a little bit hopeful that some of these patients could be saved, and maybe get better lives.



Unsafe abortions, complications and maternal mortality

Personally, my interest was always in Gynecology and naturally my further work went in this direction. It was devastating seeing girls even younger than me that had done horrible things to induce an abortion. An abortion is not legal in Malawi unless to save a pregnant woman’s life. Still, there is estimated around 140 000 induced abortions in the country every year. Considering the abortion law most of these are unsafe which leads to many complications that have to be treated.  Retained products of conception in the uterus, referred to as incomplete abortions, consists of more than 50% of the patients in a gynecological or female ward in Malawi, and takes up a lot time and resources. If incomplete abortions are left untreated it can lead to hemorrhage, sepsis and in worst case scenario death. One thing I noticed as a medical student was that they were treating all these patients with sharp curettage, while in Norway we mostly use medical treatment with misoprostol or electrical vacuum if surgical treatment is necessary. Treatment with curettage requires more resources like general anesthetics, a doctor or clinical officers, and electricity. Also, it is known to lead to more complications such as bleeding, uterine perforation and Asherman Syndrom. Potentially complications after this treatment can make women infertile in the future which can be devastating for a 16-year-old girl who maybe would have wanted a child later in life. In Malawi, they prefer to treat patients surgically for different reasons. If medical treatment is given out it can be used to induce abortions illegally. Additionally, medical treatment is not as efficient as surgical treatment and patients are supposed to return for follow up to ensure the uterus is empty. In Malawi, this is difficult due to lack of transport and money, and the woman can end up with more dangerous septic abortions. Manual vacuum aspiration (MVA) is therefore the preferred surgical method of treatment in Malawi, and recommended by the WHO, FIGO and the Ministry of Health in Malawi. The method is cheap, safe and can be done without electricity by nurses/midwives in addition to doctors.

Research on the treatment of incomplete abortions – My PhD

A fellow medical student, Hanne Rasmussen, had made similar observations with curettage in Ecuador, and came up with the idea to investigate this further. Since I had previous experiences from Malawi we travelled down together in early 2013 to go through all the hospital files on women treated for incomplete abortions the last 4 years in three public hospitals in Malawi. The findings were striking. Even though, the recommendations from WHO and the Ministry of Health was to increase the use of MVA, they were using less and less MVA, and more curettage. This development was in contrast to the guidelines, and curettage is a more costly and dangerous procedure. Malawi already has a high maternal mortality ratio, and a health system that is very low on resources and personnel, and this development would only make things worse, or at least not better. So, we decided to do something about it. Over the last few years I have with my collaborators conducted trainings at three public hospitals in Malawi to increase the use of MVA. We achieved a 21.3% increase in the use of MVA at the intervention hospitals, while there was only a 3% increase at the control hospitals during the same time period. This indicates that simple trainings should be done on a regular basis to sustain the use of MVA rather than curettage. However, it is essential that donors and policy makers make the equipment available and this is something that has to be dealt with.

More trips to Malawi in the future?

So, after living in Malawi three times already I still don’t feel it’s over. When you identify a problem, you can’t just leave it and expect someone else to sort things out. I therefore think my research in Malawi will continue to try and make things better for young women in the country. At the same time, Malawi is captivating and it sucks you in. First of all, it’s a beautiful place, and most importantly the people are amazing. So, you push through the power cuts, lack of water, the broken-down cars, the fear of malaria and different parasites. If you have a rough day you soon forget everything when you are going for run or having a gin and tonic with your friends in the amazing African sunset. To conclude, Malawi is maybe not for everyone, but it’s definitely for me.



Facts about Malawi

Population 18.09 millions
Gross Domestic Product 5.43 billions
Human Development Index 0.476, Place 170
Life Expectancy at birth 63
Mortality rate (under 5) per 1000 55
Maternal Mortality Ratio per 100 000 births 439
Prevalence of HIV, total (% of population ages 15-49) 9.2

Resource: The World Bank 2016 and Malawi Demographic and Health Survey 2015-2016.

A personal experience from Nepal Earthquake in 2015: Lesson learned from a local hospital

Written by Samita Giri, PhD candidate at NTNU, the Norwegian University of Science and Technology

This is a story about how a collaborative project between Dhulikhel hospital (DH) in Nepal, the Norwegian University of Science and Technology (NTNU) and St. Olav’s Hospital, University Hospital Trondheim, Norway, showed fruitful and life-saving result during the Nepal earthquake in 2015.

On 25 April 2015, middle of the day at 11:56, I felt a very high intensity shake. I was inside the house with my husband. My husband told me that it is an earthquake and he immediately ran out of the house and asked me to run with him. I was unable to move for a few seconds, I rather tried to hide under the bed instead of running out. I was seven months pregnant expecting our first baby in July.  My husband came back to take me out. I could hear people screaming and running to the safest place that they would think of. My family and I was safe and our house was still standing. Within an hour after this first quake, the ambulances, motorbikes, trucks, cars or any kind of transport system that were available started rushing towards the hospital. Some of the victims were even carried by their family members & neighbors with some heavy bleeding. I was living in a few minutes distance from the Dhulikhel Hospital (DH). DH is one of the tertiary level hospital for the Kavrepalanchok district and for few other neighboring districts.

Most of the regular health facilities were closed because of the weekend. My husband decided to go to the hospital the first day. After a while, I received a phone call and it was my supervisor (Prof. Erik Solligård) who was asking if we were safe. I was very happy to hear him. We were outside the whole day. I was very scared to go back to the house and the same feeling was with my family members and my neighbors. We bought some dry foods from the local shops and spend that night in a public bus that was parked in the bus station. We spend our nights outside under the tents and sometimes inside the bus for almost a month after the first earthquake. I started to go to the hospital from the second day to help in the areas that I could. Personally, I also felt more safe being in the hospital and making myself busy. I usually started my work from 8:00 in the morning until 20:00.

I still remember, the second day after the earthquake when I was in the hospital, the number of earthquake injuries escalated in the hospital, all the beds and almost all the space in the courtyard was occupied. The working conditions were continuously demanding. No one was prepared to deal with such a large number of injured patients. This was Nepal’s first experience in responding to a major disaster almost after eight decades and DH had never been the first-line health care provider after an earthquake. However, the hospital was in the process of improving emergency health care through the “Dhulikhel Hospital Patient Care (DHPCARE)” project, a collaborative project initiated in 2013 between DH, the Norwegian University of Science and Technology (NTNU) and St. Olav’s Hospital, University Hospital Trondheim, Norway [1]. The main interventions in this project were the introduction of a systematic emergency registry, a systematic triage system, and simulator training among health personnel in the emergency department (ED). As part of the project, the ED was reorganized to separate patients into three treatment zones (red, orange/yellow, and green) according to four triage categories (red, orange, yellow and green), with separate staff attending each zone since Feb 2015. I was the coordinator from the DH in implementing the project.

DH located in one of the most earthquake-affected districts of Nepal started providing 24 hours health services from day one to the earthquake victims. The hospital set up immediate medical direction, 24-hour surgical services, infection control teams, and logistical management teams, who had a vital role in managing unexpected workloads and providing efficient and quality health care. One of the major task force was the establishment of triage zone at the main entrance of the hospital consisting of medical team and volunteers. We started a systematic screening of patients arriving at the hospital using a simplified triage system, and prioritized patients for effective surgical services. We used color ribbons (red, orange, yellow and green) to distinguish the patient according to the severity and were treated in respective treatment zones. This was evaluated as a useful tool by the staffs at the hospital. I believe this is a great example of teamwork in a local hospital with dedicated staffs working 24 hours prioritizing their profession and humanity rather than their family. On the other hand, collaborations between the two institutions could deliver the quality of health service to the people on right time. At the same time, I was collecting the patient information from the triage zone and the treatment area. I thought this would be useful to report for the future preparedness in similar disasters. I find very challenging to have patients’ information during this emergency phase because the situation was very emotional, hospital had large number of caseloads, and in the first few days the hospital was not able to establish the systematic patient registry system. My two dedicated and hardworking research nurses helped me to accomplish this tremendous work.

DH provided emergency health services to more than 2,000 patients. The caseload was unexpected and was almost five times higher during the first five days than the pre-incident daily average. The majority of injuries were lower limb fractures and over 100 severely injured patients were treated. The proportion of severely injured and in-hospital deaths were relatively low indicating that the most severely injured did not reach the hospital. Most earthquake-affected regions in Nepal were rural and mountainous and there were continuous landslides, which affect transportation and prevent timely access to health facilities. The burden of emergency cases was high before the international field hospitals could be established. The international medical teams need some days after a disaster to initiate their services in the disaster affected areas. Until they arrive, patients are often treated by the poorly developed local health system, and many severely injured likely die prior to receiving medical treatment. Our study result and the local hospital experience underline the importance of developing own consistent and robust local health services capable of managing natural disasters such as an earthquake.

I am a PhD student at the Medical Faculty at NTNU under the supervision of Erik Solligård and Kari Risnes who are the project leaders in the DHECARE project. We had presented the experiences from DH including follow-up of earthquake victims in the article “Impact of 2015 Earthquakes on a local hospital in Nepal: A Prospective Hospital-based Study” in “PLOS ONE”, 2 February 2018.

Samita Giri, NTNU