PhD degrees emerging from CISMAC

Do Early Tests Tell the Full Story? New Findings Challenge Assumptions

Muneera A. Rasheed defended her doctoral thesis on May 29, 2026, at the University of Bergen. The dissertation is entitled: “Evaluating early childhood care interventions: Neurodevelopmental measures and middle childhood cognitive outcomes in rural Pakistan.”

Press release before the dissertation (translated from Norwegian):
Early developmental assessments are often used to evaluate the effects of interventions targeting young children. However, it remains uncertain how well such tests predict later cognitive development and academic performance, particularly in low-resource settings. This dissertation examines how accurately commonly used early developmental assessments predict later cognitive skills and school performance among children in rural areas of Pakistan.

The study is based on longitudinal data from a parenting intervention study conducted in Pakistan. Children’s development was assessed at the age of two using the Bayley Scales of Infant Development (BSID-III), a widely used tool in international research. Cognitive abilities at ages 4 and 7–8 were measured using the Wechsler scales, including IQ and the Fluid Reasoning Index (FRI). At ages 7–8, the study also assessed the children’s academic performance in mathematics and language, as well as characteristics of the home environment.

The findings show that developmental scores at age two have limited predictive value for later cognitive and academic skills. The tests explained only a small proportion of the variation in IQ at age 4, and almost none of the variation in problem-solving ability at ages 7–8. By contrast, the home environment showed a stronger association with later cognitive development. At school age, children’s cognitive abilities were also more closely linked to academic performance than to early childhood developmental measures.

The results suggest that early neurodevelopmental assessments should be interpreted with caution when used to infer long-term effects of early childhood interventions. At the same time, the study highlights the need for more research from different parts of the world to better understand how early life experiences influence child development, and to develop more valid assessment tools across cultural contexts.

Biography

Muneera A. Rasheed holds a Master’s degree in Psychology from the University of the Punjab in Lahore, Pakistan. Prior to her PhD studies, she worked at Aga Khan University in Pakistan, where she also served as project manager for the study that forms the basis of the dissertation data. The work has been supervised by Ingrid Kvestad, Tor Strand, Babar Hasan, and Sondre Aasen Nilsen.

The thesis is available for download in the Norwegian Research Information Repository: Evaluating early childhood care interventions : Neurodevelopmental measures and middle childhood cognitive outcomes in rural Pakistan

Simple Method Saves Babies and Protects Families Financially

Tarun Shankar Choudhary defended his PhD thesis on June 12, 2025, at the University of Bergen. His dissertation is titled “Assessing equity and poverty impact of health interventions in randomized controlled trials: a case study of Kangaroo Mother Care.”

Press release before the dissertation (translated from Norwegian):
A simple and cost-effective method known as Kangaroo Mother Care (KMC), which involves skin-to-skin contact between mother and child, has been shown to save thousands of newborn lives and protect poor families from financial hardship, according to new research.

The study, conducted as part of a doctoral thesis, shows that widespread implementation of KMC in India could reduce neonatal mortality—especially in the poorest communities—while also easing the financial burden of healthcare.

“KMC is a low-cost, high-impact solution that not only improves survival rates for babies but also helps families avoid catastrophic healthcare expenses. This is particularly important in countries like India, where out-of-pocket payments can drive families into poverty,” the researcher says.

The research combined a clinical trial with economic analysis. It found that KMC could save 26,000 newborns each year in India. Families practising KMC spent on average USD 5.50 less per child compared to those who did not. The risk of families falling below the poverty line due to medical bills was reduced by 44%.

The poorest households and vulnerable groups benefited the most. Importantly, the study also found that the introduction of KMC did not increase inequality in health outcomes—the greatest benefits were seen among babies from poor families, mothers without formal education, and minority groups.

“This research shows that we can and should design health programs that reduce inequality while saving lives. By looking beyond average outcomes, we can make smarter decisions that help those who need it most,” the researcher says.

The findings support scaling up KMC in India and in other low- and middle-income countries facing high neonatal mortality and limited access to healthcare. The study also urges researchers and policymakers to include equity and financial protection when evaluating health programs, especially for vulnerable populations.

Biography

Tarun Shankar Choudhary is a medical doctor with a specialisation in Public Health from the University of Delhi, India. The PhD work was carried out at the Department of Global Public Health and Primary Care, Faculty of Medicine, under Professor Kjell Arne Johansson (main supervisor), Ole Frithjof Norheim (co-supervisor), and Sarmila Mazumder (co-supervisor).

The thesis is available for download in the Norwegian Research Information Repository: Assessing equity and poverty impact of health interventions in randomized controlled trials: a case study of Kangaroo Mother Care

Vitamin B12 and Infant Growth and Development in Nepal

Manjeswori Ulak Chandyo defended her PhD thesis on February 20, 2025, at the University of Bergen. Her dissertation is titled “Vitamin B12, Neurodevelopment and Growth in Young Children in Bhaktapur, Nepal.”

Press release published before the dissertation (translated from Norwegian): 
Vitamin B12 is important for children’s growth and neurodevelopment. Deficiency in vitamin B12 is widespread, especially in low-income countries such as Nepal; however, it remains unclear whether supplementation leads to improved growth and development in young children.

This doctoral work investigates vitamin status among breastfed infants in Nepal and the effects of B12 supplementation on their growth and development throughout early childhood. The thesis comprises two studies.

The first, a cross-sectional study, analyzed vitamin status in 500 infants aged 2–12 months. The results showed that many of the children had at least one vitamin deficiency, with vitamin B12 deficiency being particularly common.

The second study was a double-blind, randomized controlled trial (RCT) in which 600 infants received daily vitamin B12 supplementation for 12 months. The dosage corresponded to 2 to 3 times the recommended daily intake. The objectives of the study were to measure the effects of vitamin B12 on neurodevelopment, growth, and hemoglobin levels, both immediately after the intervention and up to two years afterward.

Although supplementation led to a significant improvement in B12 status—especially among infants who initially had low levels—there was no measurable effect on the children’s neurodevelopment, growth, or hemoglobin concentrations immediately after the intervention. Nor was there any effect on cognitive development one and two years after the intervention had ended.

In summary, the findings show that many Nepali infants have poor vitamin B12 status, but supplementation during infancy does not necessarily lead to improved development. The study contributes to a more nuanced understanding of B12 deficiency and raises questions about whether general B12 supplementation should be recommended for this population group.

Biography
Manjeswori Ulak Chandyo (born 1969) is from Nepal and holds a medical degree from Saint Petersburg State Pediatric Medical University in Russia (1997), and a master’s degree in international health from the Faculty of Medicine at the University of Bergen (2012). The PhD work was conducted at the Faculty of Medicine, Department of Global Public Health and Primary Care at the University of Bergen, Innlandet Hospital Trust, and the Institute of Medicine at Tribhuvan University in Kathmandu. The work has been supervised by Ingrid Kvestad, Tor Strand, Catherine Schwinger, and Sudha Basnet. 

The thesis is available for download in the Norwegian Research Information Repository: Vitamin B12, Neurodevelopment and Growth in Young Children in Bhaktapur, Nepal 

Development and Evaluation of Targeted Client Communication
Jesmin Pervin defended her PhD thesis on September 9, 2024, at the University of Bergen. Her dissertation is titled “Targeted client communication to improve timely antenatal care utilization.”

Press release published before the dissertation (translated from Norwegian): 
The study observed low coverage of timely antenatal care visits in rural Matlab, Bangladesh. Targeted client communication using SMS was co-designed in consultation with clients, with the aim of developing an intervention tailored to the target population.

Theory-based targeted client communication delivered via SMS was evaluated in a cluster-randomized controlled trial. The intervention had no effect on timely attendance at antenatal care visits or on delivery in health facilities. However, an effect was observed—though with low certainty of evidence—on perinatal mortality and severe perinatal morbidity.

In her doctoral project, Jesmin Pervin aimed to develop targeted client communication and evaluate its effectiveness on service uptake, institutional deliveries, perinatal mortality, and severe perinatal morbidity, using a digital health registry in Matlab, Bangladesh.

The study found variation in antenatal care coverage and in the proportion of institutional deliveries across selected socio demographic variables. Maternal health programs should prioritize women with spouses who have low levels of education, low socioeconomic status, and young age in order to increase the use of healthcare services during pregnancy and childbirth.

The study represents an example of developing theory-based targeted client communication through a needs assessment of knowledge about antenatal care and pregnancy complications, with the goal of increasing uptake and use of maternal health services. Targeted client communication via SMS did not affect the timeliness of antenatal care visits or the proportion of facility-based deliveries.

Biography
Jesmin Pervin is a medical doctor with a Master’s degree in Public Health from the James P Grant School of Public Health, BRAC University.
The PhD project was carried out at the International Centre for Diarrhoeal Disease Research, Bangladesh, and the Cluster for Global Health, Division for Health Services, at the Norwegian Institute of Public Health in Oslo, under main supervisor Professor Jahn Frederik Frøen and co-supervisors Dr. Anisur Rahman, Dr. Ingrid Friberg, and Dr. Mahima Venkateswaran.
The candidate has been affiliated with the Centre for International Health at the Department of Global Public Health and Primary Care.

The thesis is available for download in the Norwegian Research Information Repository: Targeted client communication to improve timely antenatal care utilization : Assessment, development and evaluation

PhD completed at Faculty of Medicine and Health Technology of Tampere University, Finland

In his doctoral dissertation, Bireshwar Sinha estimated the effect of promoting and supporting kangaroo mother care in low birthweight infants on the outcomes of infant breastfeeding, biomarkers of infant gut function, and maternal postpartum depressive symptoms. Knowledge of the wide range of benefits of kangaroo mother care is lacking among heath care workers, mothers, and community members, which is often a barrier to its promotion and practice. The findings of the doctoral dissertation shed new light on this practice.

Low birthweight infants (LBW) with a birthweight of less than 2,500 grams have an increased risk of infections and deaths. LBW infants contribute to around half of overall infant deaths during the first 28 days of life.

Kangaroo mother care (KMC) is an intervention encompassing skin-to-skin-contact between the mother and the infant along with exclusive breastfeeding. The practice of KMC is recommended by the World Health Organization (WHO) for LBW infants during the first 28 days of life because it can prevent deaths.

“Despite WHO’s recommendations, KMC is not much practiced in low-income countries. Beyond the prevention of hypothermia in infants, the ways in which KMC works to prevent infant deaths is not clearly understood. Knowledge on the wide range of benefits of KMC is lacking among health care practitioners and communities. Moreover, the potential benefits of KMC to mothers is unclear, which is often a barrier to its promotion and practice,” says Bireshwar Sinha.

Research evidence aligns with WHO recommendations

In a previous scientific study, Bireshwar with colleagues in India have shown that the promotion and support of KMC in the community can reduce the deaths of LBW infants by 25% during the first four weeks of life. As a continuation of the previous research on KMC, he designed his doctoral dissertation to address the knowledge gaps related to the possible biological pathways through which KMC operates to improve survival in LBW infants.

In his dissertation, Sinha used a randomised controlled trial design in India. He reports that the promotion and support of KMC in LBW infants substantially improves effective breastfeeding and reduces the risk of maternal postpartum depressive symptoms at 28 days after birth. He has also reported no measurable effect of KMC on the biomarkers of infant gut function and has added that the area of infant gut function is still not fully understood and needs further research.

“The findings of my research align with the WHO’s 2022 recommendations and support the promotion of KMC among LBW infants in public health programmes in low- and middle-income settings in India and other South Asian countries,” Sinha says.

In low- and middle-income settings in India, the caregivers of LBW infants often visit primary health care centres or local physicians to seek medical help for difficulties in latching, sucking, nipple-related problems, and poor breastfeeding. In addition, in the low- and middle-income countries of the Indian subcontinent (South Asia), around 20% of mothers suffer from postpartum depression and need clinical attention.

“The evidence from my studies supports offering KMC as a potential solution to ameliorate the difficulties associated with breastfeeding in LBW infants and to prevent maternal depressive symptoms in the postpartum period,” Sinha explains.

Sinha is from India. He is a doctoral student at Tampere University and working as a Scientist at the Society for Applied Studies in New Delhi, India. He is also a Clinical and Public Health Research Fellowship awardee by the DBT Wellcome Trust India Alliance.

The thesis can be downloaded from Tampere University Repository: Effect of Kangaroo Mother Care in Low Birth Weight Infants on Breastfeeding Performance, Gut Function, and Maternal Depressive Symptoms in Low Middle Income Populations in the Indian Subcontinent

Bacterial Colonization of the Female Birth Canal and Infection

Josephine Tumuhamye defended her PhD degree on 26 October 2023 at the University of Bergen with the thesis “Vaginal Colonization and Neonatal Infections in Central Uganda.”

Press release before the dissertation (translated from Norwegian):
Bacteria in the female birth canal are often transmitted to newborns during delivery. Some of these bacteria can cause sepsis in newborns, for example through infection of the umbilical stump (omphalitis). As these bacteria are increasingly resistant to commonly used antibiotics, treatment can be challenging and sepsis may become life-threatening. It is therefore important to closely monitor the spread of these bacteria and their resistance patterns.

During the period 2016–2018, the research group of which Josephine is a member conducted studies at three clinics and one hospital in and around Kampala, the capital of Uganda. She isolated bacteria from vaginal samples from nearly 1,500 women in labour, and in a follow-up study involving about half of their newborns, she isolated bacteria from the umbilical stumps of those who developed omphalitis. In addition, she isolated bacteria from the blood of other newborns who had been admitted to hospital with sepsis.

Two-thirds of the women had potentially pathogenic bacteria in their birth canal. Nearly one in ten of the children developed omphalitis, and almost one-third of these had potentially pathogenic bacteria on their umbilical stump. Furthermore, such bacteria were isolated from the blood of 13% of the children hospitalized with sepsis, which is consistent with observations from similar studies, but likely represents a considerable underestimate of the true proportion.

Many of the isolated bacteria were resistant to a range of antibiotics used in the treatment of severe bacterial infections. Antibiotic resistance therefore appears to be a significant problem also in central parts of Uganda, and measures to limit its spread will be crucial for effective treatment of children with sepsis.

Biography

Josephine Tumuhamye holds a Master’s degree (“Master of Science in Immunology and Clinical Microbiology”) from Makerere University in Uganda. Her doctoral work is affiliated with the university’s School of Public Health, as well as the Department of Global Public Health and Primary Care / Centre for International Health and its Centre of Excellence for Intervention Science in Maternal and Child Health (CISMAC) at the University of Bergen, with Dr Victoria Nankabirwa as main supervisor and Professor Halvor Sommerfelt, Professor James Tumwine, and PhD Freddie Bwanga as co-supervisors.

The thesis is available for download in the Norwegian Research Information Repository: Vaginal Colonization and Neonatal Infections in Central Uganda : Etiology, Antimicrobial Resistance and Associated Factors

Nutrition, Growth, Stimulation, and Brain Development

Ravi Prakash Upadhyay defended his PhD degree on September 28, 2023, at the University of Bergen with the thesis “Nutrition, growth and neurodevelopment in children from low-resource settings in India.”

Press release before the dissertation (translated from Norwegian):
In many low- and middle-income countries (LMICs), a large number of children do not reach their full developmental potential due to factors such as poor nutrition and insufficient early developmental stimulation. This PhD project aimed to unravel parts of the complex interaction between critical factors such as nutrition, growth, and early stimulation on brain development.

The work used data from three different studies including more than 2,500 Indian children who were followed up to 8 years of age. In the first study, the effects of nutritional supplements containing micronutrients enriched with varying amounts of milk protein were assessed at 12 and 24 months of age. Results from this randomized trial involving more than 1,200 children indicated that moderate milk protein intake provided temporary benefits, particularly in relation to motor skills and behaviour at 12 months of age. However, no lasting effects of the intervention were observed. In contrast, higher intake of milk protein was associated with more challenging behaviour when assessed at 24 months of age.

The second study examined the association between linear growth during different phases of childhood and cognitive function at 6–9 years of age. Growth up to two years of age—but not thereafter—predicted cognitive outcomes at this stage.

In the final study, the interaction between early stimulation and growth in the development of children with low birth weight (LBW) was investigated. The results showed that early stimulation was particularly important for children with poor growth. Children with normal growth developed independently of the quality of stimulation.

The findings from this PhD project highlight that the first two years of life are critical for child development and that different risk factors interact. Interventions to improve child development should start early and be tailored to children's specific needs.

Biography

Ravi Prakash Upadhyay holds a medical degree (M.D.) from the All India Institute of Medical Sciences, New Delhi. He is also a DBT/Wellcome Trust India Alliance Early Career Fellow. He works as a researcher at the Society for Applied Studies, New Delhi.

The doctoral project is affiliated with the Centre for International Health, Department of Global Public Health and Primary Care, at the University of Bergen. The main supervisor was Tor A. Strand, with co-supervisors Mari Hysing, Sunita Taneja, and Nita Bhandari.

The thesis is available for download in the Norwegian Research Information Repository: Nutrition, growth and neurodevelopment in children from low resource settings in India

Is Childhood Cancer Treatment Cost-Effective in Ethiopia?

Mizan Kiros Mirutse defended his PhD degree on August 28, 2023, at the University of Bergen with the thesis “Childhood Cancer in Ethiopia: Treatment Abandonment Rate and the Cost and Cost-Effectiveness of Service Delivery.”

Press release before the dissertation (translated from Norwegian):
Overall survival for children with cancer is eight out of ten in high-income countries, while only two to three out of ten survive in lower-income countries. This stark disparity in survival rates can be explained by limited access to paediatric cancer services, late presentation of symptoms, and a low proportion of children who complete treatment.

In this thesis, Mizan Kiros Mirutse found that healthcare professionals working with childhood cancer in Ethiopia report that 34% of the few children who reach hospitals do not complete treatment (range: 29% to 39%). The main reasons include high out-of-pocket healthcare costs, families being unable to afford treatment, long travel distances to treatment centres, long waiting times for care, and a lack of awareness that childhood cancer is often curable.

Contrary to the common perception that childhood cancer treatment is expensive and not cost-effective, Mizan Kiros Mirutse showed that such treatment is, in most cases, affordable and cost-effective in Ethiopia. The annual cost of operating a dedicated paediatric oncology unit per treated child in 2019 was approximately NOK 6,000 (range: NOK 5,000 to NOK 11,000), which is within the government’s means given the relatively small number of patients requiring care (around 4,000 per year).

The treatment is also highly likely to be cost-effective, with a cost-effectiveness ratio of around NOK 3,600 per quality-adjusted life year gained. This can be considered cost-effective even under a strict threshold for cost per life year gained (50% of Ethiopia’s GDP per capita ≈ NOK 5,000).

These research findings may inform policymakers in Ethiopia and help elevate the priority of childhood cancer diagnosis and treatment. In addition, understanding the causes of treatment abandonment may contribute to improving the quality-of-care programs.

Biography

Mizan Kiros Mirutse trained as a medical doctor in Addis Ababa in 2012 and holds a master’s degree in Global Health from the University of Bergen. Through extensive academic training, ten years of professional experience in the Ethiopian healthcare system, and active participation in global health platforms, Dr. Mirutse has developed strong expertise in global health, health systems, health economics, and health financing.

The candidate is affiliated with the Centre for International Health at the Department of Global Public Health and Primary Care. The main supervisor was Professor Ole Frithjof Norheim, with co-supervisors Solomon Tessema Memirie and Mieraf Tadesse Tolla.

The thesis is available for download in the Norwegian Research Information Repository: Childhood Cancer in Ethiopia: Treatment Abandonment Rate and the Cost and Cost-Effectiveness of Service Delivery

Education as Medicine for Girls’ Sexual Health in Africa

Hanne Keyser Hegdahl defended her PhD degree on June 5, 2023, at the University of Bergen with the thesis “Young women’s sexual and reproductive health behaviour, beliefs and risks in a sub-Saharan African setting.”

Press release before the dissertation (translated from Norwegian):
In sub-Saharan Africa, the prevalence of teenage pregnancies is high, and the proportion of new HIV cases is greater among young women than among men of the same age. The risk of such outcomes makes young women in this region particularly vulnerable in terms of their sexual and reproductive health. Key contributing factors to these health challenges include poverty, school dropout, and child marriage.

Through her work, Hegdahl found that young women continue to be disproportionately affected by HIV. However, providing adolescent girls with financial support to attend school can reduce their risk of HIV and teenage pregnancy by lowering sexual activity. She also found that combining such financial support with sexuality education can further reduce this risk through increased contraceptive use and improved knowledge about contraception. Sexuality education may also strengthen the effects of financial support on sexual behaviour.

Findings related to child marriage were less conclusive, with only a moderate reduction observed among girls who received financial support.

The thesis is based on data from large Demographic and Health Surveys conducted across 18 sub-Saharan African countries, as well as data from the RISE study, an intervention study among adolescent girls in Zambia. In the intervention study, which included 4,922 girls, researchers examined the effects of providing monthly cash transfers and covering school fees on the risk of marriage and pregnancy. The study also investigated whether the effects of such financial support were greater among those who additionally received sexuality education for adolescents and community meetings for parents.

The findings highlight the importance of addressing poverty in order to improve girls’ sexual and reproductive health.

Biography

Hanne Keyser Hegdahl (b. 1987), from Bergen, earned her medical degree from the University of Bergen (UiB) in 2017. She began her doctoral work as a student in the medical research program at UiB and later continued as a PhD candidate (2018–2022) at the Centre for International Health and CISMAC, Department of Global Public Health and Primary Care.

Her main supervisor was Professor Ingvild Fossgard Sandøy (UiB), with Professor Patrick Musonda (University of Zambia) as co-supervisor. 

When the Law Falls Short: Abortion and Abortion Policy in Zambia

Marte Haaland defended her PhD degree on June 18, 2021, at the University of Bergen with the thesis “Beyond the Law – An Ethnography of Zambian Abortion Politics.”

Press release before the dissertation (translated from Norwegian):
Every year, around 25 million women worldwide resort to unsafe abortions. Many of these result in serious complications and deaths. Laws that permit abortion on both health and socioeconomic grounds are an important prerequisite for ensuring women’s access to safe abortion services. Zambia appears to have a liberal abortion law. Nevertheless, many illegal and unsafe abortions are carried out, contributing to the country’s high maternal mortality rate. There is limited knowledge about why Zambia’s abortion law does not ensure women access to safe abortion. This thesis examines what happens when adopted abortion policy is translated into actual health services.

The study shows that the Zambian abortion law allows for widely differing interpretations. This creates ambiguity around the issue of abortion among both healthcare providers and the general population. Furthermore, the study reveals how a lack of political will to implement the law, as well as underlying power structures within the Zambian healthcare system, make access to safe abortion difficult.

Health bureaucrats in key positions have a significant influence on whether and how the Zambian abortion law is implemented. The thesis demonstrates how the role of these bureaucrats is shaped by conflicting signals and instructions, creating confusion as to whether abortion is in fact legal. The study also explores how abortion is part of everyday life at the community level. Abortions that remain within the private sphere are largely tolerated, whereas cases that become publicly known are met with strong condemnation.

The thesis sheds light on how the issue of abortion in Zambia is part of a political process that operates across social and bureaucratic levels, and which obstructs the implementation of adopted abortion policies. It thus shows that a law permitting abortion on broad grounds is only the first of several necessary steps to ensure that girls and women have access to legal and safe abortion services.

Biography

Marte E. S. Haaland (b. 1986) holds a master’s degree in Social Anthropology from the University of Bergen (2015). She has been a PhD candidate at the Centre for International Health and CISMAC at the Department of Global Public Health and Primary Care, University of Bergen. She has also been a visiting researcher at the University of Zambia and the University of Sussex.

Her supervisors were Professor Astrid Blystad, Professor Karen Marie Moland, Professor Haldis Haukanes, and Professor Joseph Zulu.

The thesis is available for download in the Norwegian Research Information Repository: Beyond the Law - An Ethnography of Zambian Abortion Politics

Targeted Personalized Text Messages to Pregnant Women in Palestine

Binyam Bogale Bungudo defended his PhD thesis on June 16, 2021, at the University of Bergen. The title of his dissertation is "Digital Targeted Client Communication for Effective Coverage of Antenatal Care."

Press release before the dissertation (translated from Norwegian):
The design and implementation of digital health interventions (DHIs) for maternal and child health is a rapidly growing field. However, there is limited literature describing how DHIs are developed, and the process is therefore often referred to as a “black box.” There is also limited research on the potential unintended consequences of DHIs.

Binyam Bogale Bungudo examines the frequency and timing of antenatal care visits in Palestine. He finds that women attend an average of four or more antenatal visits per pregnancy, but only 13% of these visits take place during the recommended gestational weeks. Furthermore, through interviews with women who do not attend antenatal care at the recommended times, he finds that they perceive their own risk of developing pregnancy-related hypertension, diabetes, and anaemia as low. They also consider the severity of these conditions to be low, even if left untreated. As a result, they do not see the value of following the recommended antenatal care schedule.

To address this, Binyam has developed a DHI consisting of targeted, personalized text messages for pregnant women. These messages are based on various theoretical frameworks and have been developed with user involvement. They aim to inform women about their risk of developing pregnancy-related hypertension, diabetes, and anaemia, the seriousness of these conditions if left untreated, and to present the available antenatal services and the benefits of attending visits during the recommended gestational weeks. Binyam has also tested the text messages and found that providing women with information about pregnancy risks does not increase anxiety during pregnancy nor reduce their satisfaction with the services.

Biography

Binyam Bogale Bungudo holds a Master’s degree in International Health from Uppsala University, Sweden, and a Master’s degree in Public Health from Jimma University, Ethiopia. His doctoral work was conducted at the Norwegian Institute of Public Health and the Centre for International Health at the University of Bergen. His research is part of the eRegistries project. Professor J. Frederik Frøen (Norwegian Institute of Public Health, University of Bergen) and researcher Kjersti Mørkrid Blom-Bakke (Norwegian Institute of Public Health) have been his supervisors.

The thesis is available for download in the Norwegian Research Information Repository: Digital Targeted Client Communication for Effective Coverage of Antenatal Care: Assessment, Development, and Evaluation

Innovations for Newborns in Low-Income Countries

Susanna Myrnerts Höök defended her PhD thesis on May 12, 2021, at the University of Bergen. The title of her dissertation is “Supporting neonatal resuscitation in low-resource settings – Innovations and new strategies.”

Press release before the dissertation (translated from Norwegian):
In the womb, the foetus receives oxygen through the placenta. After birth, the newborn must supply its own lungs with oxygen—a dramatic transition in which every minute counts. Within one minute, the newborn should either be breathing independently or have received assistance with breathing. This transition does not always go well; more than 700,000 newborn deaths each year are caused by a lack of oxygen during or after birth. Nearly all these deaths occur in low-income countries, where healthcare workers may have limited training in airway management and heart rate assessment in newborns. In addition, maternity clinics in these settings often lack reliable monitoring equipment.

This doctoral research has investigated the effect of two new innovations designed to improve airway management and heart rate assessment in newborns. One intervention is the use of a laryngeal mask, a new device for newborns that is inserted into the throat to create a stable airway passage to the trachea. In pilot studies, this method has been shown to be more effective than conventional face-mask ventilation with a bag. According to international guidelines, healthcare personnel should simultaneously assess the newborn’s heart rate/pulse; however, this is not strongly emphasised in midwives’ training. For this PhD project, in addition to training in mask use, a free app (NeoTapLS, tap4life.org) was developed to simplify pulse assessment.

Both innovations are intended for use by midwives. The effect of the training program for the laryngeal mask and face mask, as well as the new app, was tested in a clinical trial at Uganda’s largest hospital, Mulago Hospital in Kampala. A total of 1,163 newborns who required breathing assistance at birth were included, randomised to receive either laryngeal mask or face mask ventilation, and recorded. Heart rate assessment was performed with support from the NeoTapLS app. The results showed that midwives can safely use the laryngeal mask. However, the laryngeal mask did not reduce mortality or brain injury, as reported in The New England Journal of Medicine. The NeoTapLS app can be used by midwives following extended training.

Biography

Susanna Myrnerts Höök (born 1975) is a medical doctor, educated at the University of Gothenburg in 2002 and a specialist in paediatrics since 2015. She works at the Emergency Care Unit, Sachsska Children and Youth Hospital in Stockholm. She is a co-founder of the organisation Tap4Life.org. The PhD degree is awarded through the Centre for International Health, Department of Global Public Health and Primary Care, at the University of Bergen. Her supervisors have been Professor Thorkild Tylleskär (University of Bergen), Associate Professor Tobias Alfvén and Professor Mats Blennow (Karolinska Institute), and PhD Anna Bergström (Uppsala University).

The thesis is available for download in the Norwegian Research Information Repository: Supporting neonatal resuscitation in low-resource settings : Innovations and new strategies

Vitamin D, Respiratory Infections, Anemia, Growth, and Development in Young Children from New Delhi

Dr. Ranadip Chowdhury defended his PhD degree on August 12, 2020, at the University of Bergen. His dissertation is titled “Vitamin D status and child health, growth, and neurodevelopment.”

Press release before the dissertation (translated from Norwegian):
Vitamin D deficiency is one of the most overlooked forms of under-nutrition in the world. Animal studies have shown that vitamin D is important for the immune system, blood health, growth, and neurological development, in addition to its more well-known effects on bone health. In fact, most of the functions of vitamin D occur outside the skeleton: vitamin D receptors are found in many other parts of the human body, including the intestines, kidneys, respiratory epithelium, and the brain.

Dr. Chowdhury used data from a randomised, placebo-controlled trial involving 1,000 North Indian children aged 6 to 30 months, along with a follow-up study conducted when the children were 6 to 9 years old. Detailed information on the children’s health, home environment, nutritional status, infectious diseases, growth, and brain development—measured at several points during childhood—provided an excellent opportunity to test various hypotheses about the consequences of vitamin D deficiency.

Approximately 35% of the children had vitamin D deficiency (<10 ng/ml) in early childhood, and this was associated with an increased risk of lower respiratory tract infections and moderate anaemia (haemoglobin 7 to 9.9 g/dl). However, vitamin D deficiency was not associated with neurological development or growth in early childhood (6–30 months) or at school age (6 to 9 years).

These findings suggest that vitamin D may play a role in infections and anaemia. However, it does not appear to have a significant impact on neurological development and growth in this population. The role of vitamin D in infections and anaemia should be confirmed in randomised controlled trials targeting children with vitamin D deficiency before implementing interventions to improve vitamin D status.

Biography

Dr. Ranadip Chowdhury is a medical doctor and works at the Centre for Health Research and Development, Society for Applied Studies in New Delhi, India. He graduated from Nil Ratan Sircar Medical College in Kolkata, India, in 2008 and completed his specialisation in community medicine (public health) at R.G. Kar Medical College, Kolkata, in 2013. His doctoral work was carried out at the Centre for International Health, part of the Department of Global Public Health and Primary Care at the Faculty of Medicine, University of Bergen. His main supervisor was Dr. Tor A. Strand, with Dr. Sunita Taneja and Dr. Ingrid Kvestad as co-supervisors.

The thesis is available for download in the Norwegian Research Information Repository: Vitamin D status and child health, growth, and neurodevelopment

Breathing Support for Newborns Using Laryngeal Mask Airway in Low-Income Countries

Nicolas J. Pejovic defended his PhD degree on March 27, 2020, at the University of Bergen with the thesis “No Cry at Birth.”

Press release before the dissertation (translated from Norwegian): 
Around one in ten newborns requires breathing assistance to successfully transition to independent breathing after birth. In many cases globally, only a midwife is present to provide this support. Each year, more than 700,000 newborns die shortly after birth due to lack of oxygen, almost all in low- and middle-income countries.

Immediate and effective ventilation using a face mask and bag can reduce these deaths by up to 30%. However, this method is technically demanding and requires trained healthcare personnel. The aim of our research has been to investigate whether midwives working without access to advanced medical services can safely and effectively assist newborns using a laryngeal mask airway (LMA) instead of a face mask.

The LMA is a relatively new device for newborns. It is inserted into the throat and creates a secure airway to the trachea. We began with a pilot study in Uganda, which demonstrated that midwives were able to use the LMA on manikins after a short training program. We then conducted two randomised trials at Mulago National Referral Hospital in Uganda, where midwives used either LMA or a face mask to assist newborns.

The studies showed that the LMA reduced the time to spontaneous breathing compared to the conventional face mask and that it caused no harm. Heart rates in newborns treated with LMA increased more rapidly, likely due to improved oxygen delivery.

The LMA may be a valuable alternative for preventing death or brain injury caused by oxygen deprivation when ventilation with a face mask is unsuccessful.

Biography

Nicolas Pejovic (born 1964) obtained his medical degree from Uppsala University and completed his specialisation in paediatrics and neonatology at Sachsska Children’s Hospital in Stockholm. He is co-founder of the organisation Tap4Life.org.

His doctoral work was carried out at the Centre for International Health (University of Bergen) from 2016 to 2019 in collaboration with Karolinska Institutet. His supervisors were Professor Thorkild Tylleskär (UiB), Professor Hege Ersdal (UiS), Professor Mats Blennow, and Dr. Tobias Alvén (Karolinska Institutet, Stockholm).

The thesis is available for download in the Norwegian Research Information Repository: No cry at birth: Neonatal resuscitation in low-resource settings: role of the laryngeal mask airway 

Breastfeeding and Newborn Health in Northern Uganda

David Mukunya defended his PhD degree on February 13, 2020, at the University of Bergen with the thesis “Newborn Care Practices in Northern Uganda.”

Press release before the dissertation (translated from Norwegian):
In sub-Saharan Africa, most women breastfeed their babies, but few follow current recommendations: initiating breastfeeding within the first hour after birth, exclusively breastfeeding for the first six months, and continuing breastfeeding alongside complementary foods until the child is two years old.

The PhD thesis includes two studies from Northern Uganda, a region previously affected by civil war. Breastfeeding practices and low body temperature (hypothermia) were investigated. The first study included 930 mothers with children under the age of two. The second study was a follow-up study of more than 1,400 mother–child pairs, in which pregnant women were enrolled and followed through childbirth and shortly thereafter.

The studies found that only half of newborns were put to the breast within the first hour after birth. Mothers who had undergone a caesarean section were less likely to initiate breastfeeding early, and newborns who were not breastfed early were more likely to develop low body temperature. Hypothermia was a surprisingly common problem in these studies conducted in a tropical environment; around half of all newborns experienced low body temperature at some point.

Counselling provided by lay workers—similar to breastfeeding support groups in Norway—improved exclusive breastfeeding rates but did not increase early initiation of breastfeeding.

Based on our findings, we emphasise the importance of skin-to-skin contact to prevent low body temperature in newborns. It is also crucial to highlight the importance of initiating breastfeeding early. Furthermore, including individuals other than the mother—such as fathers, grandparents, and healthcare workers—in interventions is recommended to improve newborn care.

Biography

David Mukunya (born 1988) from Uganda obtained his medical degree from Makerere University (2014). His doctoral research was conducted between 2016 and 2019 at the Centre for International Health, University of Bergen, in collaboration with Makerere University.

His supervisors were Professor Thorkild Tylleskär and Karen Marie Moland (UiB), and Professor James K. Tumwine and Victoria Nankabirwa (Makerere). He currently works as Programme Manager at Sanyu Africa Research Institute in Mbale, Uganda, and as a lecturer at Makerere University.

The thesis is available for download in the Norwegian Research Information Repository: Newborn Care Practices in Northern Uganda: Studies on breastfeeding, decision-making and hypothermia

Health Information on Pregnant Women in the West Bank, Palestine

Mahima Venkateswaran defended her PhD degree on November 5, 2019, at the University of Bergen with the thesis “Attributes and Consequences of Health Information Systems Data for Antenatal Care: Health Status, Health Systems Performance and Policy.”

Press release before the dissertation (translated from Norwegian):
Many countries make decisions about healthcare priorities based on collected data, making the quality of the data crucial. To gain an overview of a health field, complex health outcomes are quantified and simplified into health indicators. These indicators rely on collected data and are an important source for health monitoring, helping to reveal both positive and negative health trends, inequalities, and serving as key predictors of development.

The health sector is undergoing digitalisation. Many low- and middle-income countries have electronic health information systems where health workers record large amounts of patient data. Despite this, only a limited number of health indicators are available.

Mahima Venkateswaran’s research follows the implementation of a national electronic health information system for pregnant women, newborns, and postpartum women in the West Bank, Palestine. Her work demonstrates how the use of individual-level data in such systems can improve monitoring of maternal health.

Venkateswaran finds that priority-setting results from the modelling tool Lives Saved Tool (LiST) change when individual-level data are used, compared to aggregated data. For example, Palestinian women attend more than four antenatal care visits on average per pregnancy, yet individual-level data reveal that only 13% of these visits occur at the recommended stages of pregnancy.

Digital solutions within health information systems can make health indicators more accessible. An increasing number of people in low- and middle-income countries are utilising healthcare services. Data collected during healthcare visits constitute an important source of information on their own, as well as in combination with other sources.

Mahima Venkateswaran emphasises the importance of understanding the data that are collected. Only then is it possible to properly assess the quality of healthcare services.

Biography

Mahima Venkateswaran is a medical doctor from India. She completed her master’s degree in Global Health at Maastricht University in 2013. Her doctoral research was conducted at the Norwegian Institute of Public Health and the Centre for Intervention Science in Maternal and Child Health at the University of Bergen. Her work is part of the eRegistries project.

Her supervisors were Professor J. Frederik Frøen (Norwegian Institute of Public Health) and Professor Ole Frithjof Norheim (University of Bergen).

The thesis is available for download in the Norwegian Research Information Repository: Attributes and consequences of health information systems data for antenatal care: Health status, health system performance and policy

Rotavirus Vaccines: Efficacy and Predictors of Immune Response

Temsunaro Rongsen-Chandola defended her PhD degree on February 5, 2019, at the University of Bergen with the thesis “Rotavirus Vaccines in India.”

Press release before the dissertation (translated from Norwegian):
A live oral rotavirus vaccine developed in India was tested in infants to determine whether it protects against diarrhoea caused by rotavirus. The vaccine was administered orally in a three-dose schedule at 6, 10, and 14 weeks of age, corresponding to the timing of routine vaccinations in the national immunisation program.

A total of 6,800 infants participated in the study: two-thirds were randomly assigned to receive the vaccine, while one-third received a placebo. All children were followed weekly until the age of two. During these weekly home visits, information was collected on whether the child had diarrhoea or other illnesses. Stool samples were collected whenever a child had diarrhoea, and detailed daily information was gathered to assess disease severity.

The study showed that approximately 56% of vaccinated children were protected against rotavirus diarrhoea for up to two years. The vaccine was safe and did not cause any adverse effects.

In a separate study, a licensed rotavirus vaccine was tested in children of the same age group to investigate whether antibodies in breast milk interfere with the infant’s immune response to the vaccine. This vaccine was administered orally in a two-dose schedule at 6 and 10 weeks of age.

Four hundred mother–infant pairs were included in this study. Half of the mothers were encouraged to breastfeed their child during the hour surrounding vaccination, while the other half were asked to refrain from breastfeeding during that period. The study found that breastfeeding had no impact on the immune response to the vaccine, indicating that there is no need to withhold breast milk to improve vaccine effectiveness.

Biography

Temsunaro Rongsen-Chandola is a senior researcher at the Centre for Health Research and Development, Society for Applied Studies, New Delhi, India. She is a medical doctor and holds a master’s degree in Epidemiology from the London School of Hygiene and Tropical Medicine. Her main area of expertise is large field-based clinical trials.

Priority to the Newborn? Health Priority Setting in Ethiopia

Kristine Husøy Onarheim defended her PhD degree on Friday, April 13, 2018, at the University of Bergen with the thesis “Priority to the Newborn? Real-Life Priority Setting and Intra-Household Resource Allocation for Newborn Health in Ethiopia.”

Press release before the dissertation (translated from Norwegian):
The first month of life—the neonatal period—is a vulnerable time, especially among the poor in low- and middle-income countries. Despite the availability of effective health interventions, 2.6 million newborns die each year. In Ethiopia, neonatal mortality remains high, while the use of healthcare services is low. The health system is underfunded, and limited resources lead to difficult priority-setting dilemmas. The aim of this doctoral research was to analyse how newborn health is prioritised in Ethiopia from a micro-level perspective.

The thesis consists of two qualitative studies and an ethical analysis. The findings show how family decision-making and intra-household priorities influence whether care is sought when newborns fall ill. Healthcare services in Ethiopia are often paid for out-of-pocket by patients and their families. In a resource-constrained setting, the financial costs of seeking care have serious consequences both for the sick newborn and for the household economy.

Families reported high expenses for treatment and diagnostics, often requiring them to borrow money or sell assets to afford care. The tension between acting in the child’s best interest and protecting the family’s financial stability was central to decisions about seeking healthcare. The ethical analysis discusses whether it is acceptable to limit treatment for a sick newborn to avoid financial catastrophe for the family. It considers principles such as health maximisation, lifetime health loss, and financial risk protection, and concludes that limiting treatment is not ethically acceptable. The study argues that decision-makers at the household level have limited freedom of choice, and that the conditions shaping their decisions are unjust and unacceptable.

The findings highlight that newborn health is closely linked to poverty and illustrate how decisions to seek care are shaped by socio-cultural and structural factors. To achieve Ethiopian and global goals of improved newborn survival and universal health coverage, local conditions and financial protection must be prioritised in health planning and implementation.

Biography

Kristine Husøy Onarheim (born 1987) obtained her medical degree from the University of Bergen (2014). She is currently a resident physician at Ålesund Hospital. She was part of the medical student research program (2009–2013) and later a PhD candidate (2015–2018) in the Global Health Priority Setting research group at the Department of Global Public Health and Primary Care, University of Bergen. She has also held visiting positions at Harvard University and the World Health Organization.

Her supervisors were Associate Professor Ingrid Miljeteig, Professor Ole F. Norheim, Professor Karen M. Moland, and Associate Professor Mitike M. Sisay.

The thesis is available for download in the Norwegian Research Information Repository: Priority to the newborn? Real-life priority setting and intra-household resource allocation for newborn health in Ethiopia

Growth Velocity Among Undernourished Children in Low-Income Countries

Catherine Schwinger defended her PhD degree on Tuesday, December 12, 2017, at the University of Bergen with the thesis “Growth Velocity of Young Children in Two Low-Resource Settings: Patterns and Ability to Predict Negative Health Outcomes.”

Press release before the dissertation (translated from Norwegian):
Undernourished children face a higher risk of illness and death than well-nourished children. In the long term, under-nutrition can lead to impaired development, resulting in poorer school performance and lower income in adulthood.

A child is typically classified as undernourished if their weight or height is below what is expected for their age and sex. But what if a child has always been small? Does that child carry the same risk as a child who was initially larger but begins to grow more slowly?

In 2009, the World Health Organization published an international standard for growth velocity. This standard was intended to evaluate growth over time but has so far been underutilised. In our studies, we applied this standard. We examined children under five years of age living in a remote area of the Democratic Republic of the Congo, far from major urban centres. The study showed that growth velocity measured over a three-month period was a better predictor of mortality risk than weight and height measured at a single point in time.

Regarding seasonal variation, children experienced lower growth velocity during seasons typically characterised by food shortages and more frequent infections. This pattern was difficult to detect using conventional growth charts.

When scarce resources must be allocated in the most effective way, it is crucial to understand how children’s growth is influenced by seasonal variation. We also studied a group of children in Nepal. In this work, we found that weight and height measured at a single point in time were better predictors than growth velocity of which children would become undernourished by the age of two.

To understand and study under-nutrition, our results suggest that the advantage of measuring growth over time versus at a single point depends on the intended use. Growth velocity is somewhat more complex to calculate and interpret. However, in light of our findings, such measurements may have substantial value in assessing the risk of severe health outcomes and in understanding the relationship between growth and different aspects of health.

Biography

Catherine Schwinger (born 1982) is from Germany. She studied sports science and completed a master’s thesis on overweight and obesity among preschool children. Her academic interests include malnutrition, physical activity, epidemiology, reproductive health, and public health. Her doctoral research was conducted at the Centre for International Health.

The thesis is available for download in the Norwegian Research Information Repository: Growth velocity of young children in two low-resource settings. Patterns and abilities to predict negative health outcomes

Challenges in Measuring Maternal Mortality in Zambia

Richard Banda defended his PhD degree on September 23, 2016, at the University of Bergen with the thesis “Measuring Maternal Mortality in a Context of Deficient Vital Registration Systems: Use of Population Census in Zambia.”

Press release before the dissertation (translated from Norwegian):
The starting point of this thesis is that pregnancy and childbirth remain dangerous events for women in many low- and middle-income countries. In Zambia, the risk of dying during this period is 200 times higher than for women in Norway.

Investments in maternal health programs have increased in many low-income countries over the past two decades. However, it is difficult to assess whether these interventions have had an impact because many countries lack functioning civil registration and vital statistics systems, including reliable records of births and causes of death. As a result, many maternal deaths are never recorded.

To compensate for the absence of civil registration systems, many low-income countries conduct population censuses every ten years. The United Nations and the World Health Organization (WHO) recommend that countries without reliable population registers include questions about pregnancy-related deaths in these censuses to estimate maternal mortality. However, little has been done to evaluate whether census data are a reliable source for measuring such deaths.

In his doctoral research, Richard Banda examined the quality and reliability of data on pregnancy-related deaths from the 2010 population census in Zambia. He identified several weaknesses in the data; nevertheless, the mortality estimates appear plausible. The census data confirm that pregnancy-related mortality in Zambia is very high and reveal significant regional differences, which can be explained by variations in access to and quality of healthcare services.

In the future, more detailed questions about causes of death should be included in censuses to improve data reliability. To reduce pregnancy-related mortality, Zambian authorities should prioritise more equitable access to high-quality healthcare services, particularly in rural areas and in districts with especially high mortality rates.

Biography

Richard Banda was born in 1974 in Zambia. He holds a Bachelor’s degree in Demography from the University of Zambia and a Master’s degree in International Health from the University of Bergen. He began his PhD studies in 2012.

Over the past 16 years, he has worked for the Ministry of Health in Zambia and the Central Statistical Office in Lusaka. He currently serves as Chief Statistician responsible for research at the Central Statistical Office of Zambia. He is married and has five children.

 Kjersti S. Bakken defended her PhD degree on September 2, 2016, at University of Oslo with the thesis “Obstetric outcomes of immigrants in a low-risk maternity ward in Norway.”

Press release from University of Oslo before the dissertation (translated from Norwegian):
Midwife and researcher Kjersti S. Bakken’s dissertation, “Obstetric Outcomes of Immigrants in a Low-Risk Maternity Ward in Norway,” shows that certain groups of immigrant women are at higher risk of complications during childbirth compared to Norwegian women.

Women from Africa—and particularly those from Somalia—were found to be the most vulnerable to complications. Somali women, for example, had twice the risk of undergoing an emergency caesarean section compared to Norwegian women. They also had nearly double the risk of delivering post-term and almost four times the risk of giving birth to a baby with a birthweight lower than expected for gestational age.

The dissertation presents a theory suggesting that Somali women may experience increased stress during pregnancy. The combined findings for this group indicate that the fetuses may not have had optimal conditions during pregnancy and appeared to be under stress during labour.

Bakken emphasises that greater efforts should begin already during pregnancy. Current antenatal care services need to be adapted to reduce disparities in the risk of complications. This includes significant investment in developing well-functioning interpreter services and strengthening midwifery services in antenatal care in order to provide more individualised, high-quality care.

Maternity services should also increase their use of interpreter services. Language barriers may lead to insecurity and anxiety, and it is important that all women feel safe during such a significant life event.

The dissertation is based on an observational study in which Bakken examined the association between country of origin and the risk of adverse birth outcomes among women who gave birth at Bærum Hospital between 2006 and 2010/2013. The hospital does not have a neonatal unit, and therefore the population consists of a selected group of women with pregnancies beyond 35 weeks’ gestation, where a healthy outcome is expected. For this reason, the maternity ward at Bærum Hospital is referred to as a low-risk unit in this dissertation.

The thesis is available for download in the Norwegian Research Information Repository: Obstetric outcomes of immigrants in a low-risk maternity ward in Norway

Zinc for Children with Pneumonia: Will They Recover Faster?

On Tuesday, April 19, 2016, Sudha Basnet defended her PhD thesis, “Severe Pneumonia in Hospitalized Young Nepalese Children – Studies on the Efficacy of Oral Zinc, Respiratory Viruses and Prognostic Determinants.”

Press release before the dissertation (translated from Norwegian): 
Pneumonia is a major cause of illness and death among children under five years of age in low- and middle-income countries. Zinc is essential for cell division and the normal functioning of the immune system. In Nepal, zinc deficiency is common due to low dietary intake and the presence of compounds in food that inhibit zinc absorption in the intestines.

Previous studies have shown that zinc supplementation reduces the risk of pneumonia and diarrhoea in children. Zinc is also recommended by the World Health Organization for the treatment of childhood diarrhoea, as it shortens disease duration. However, studies investigating zinc as a treatment for pneumonia have shown conflicting results. The study forming part of this PhD was conducted at a children’s hospital in Nepal and is the largest randomised clinical trial of therapeutic zinc in hospitalised children with pneumonia.

The main finding of the study is that young children hospitalised with severe pneumonia do not recover faster when given zinc in addition to standard treatment. The study also found that viruses may play an important role in causing pneumonia. Respiratory viruses were detected in 30% of the children, and among the seven viruses tested, respiratory syncytial virus (RSV) was the most common.

This finding is particularly important in a country where viral pneumonia is still not widely recognised as a cause of hospitalisation. Younger age, the need for oxygen therapy, and chest X-ray findings consistent with pneumonia were predictors of longer disease duration. These findings may be useful for classification and treatment of children with pneumonia.

The study included more than 600 children aged 2 to 35 months and was conducted over a period of 30 months. Funding was provided by the European Union, the Research Council of Norway, the Meltzer Foundation, and the University of Bergen.

Biography

Sudha Basnet is a paediatrician from Nepal with many years of experience in both clinical practice and research. From 2011 to 2015, she was a PhD candidate at the University of Bergen.

The thesis is available for download in the Norwegian Research Information Repository: Severe pneumonia in hospitalized young Nepalese children. Studies on the efficacy of oral zinc, respiratory viruses and prognostic determinants

Vitamin B12 Improves Development in Young Children in Low-Income Countries

Ingrid Kvestad defended her PhD degree on Tuesday, January 26, 2016, at the University of Bergen with the thesis “Biological Risks and Neurodevelopment in North Indian Children: Results from a Randomized Controlled Trial on Vitamin B12 and Folic Acid.”

Press release before the dissertation (translated from Norwegian):
Daily supplementation with vitamin B12 and folic acid for six months improved development among infants and young children in India. The areas showing the greatest improvement were gross motor skills and problem-solving abilities. These are the main findings of the thesis, which is based on data from a randomised controlled trial examining the effects of vitamin B12 and folic acid in infants and young children in New Delhi, India.

The children were randomly assigned to one of four groups receiving either a placebo, folic acid, vitamin B12, or both vitamins daily, and were closely followed for six months. At the end of the intervention period, the children’s development was assessed.

Children who initially showed poor growth and had low vitamin B12 status benefited the most from the supplementation. When examining other factors influencing development, the study found that growth was closely associated with developmental outcomes—larger children achieved higher scores. Increased episodes of diarrhoea and pneumonia during the study period were associated with lower developmental scores. At the same time, access to stimulation and learning opportunities showed the strongest association with children’s developmental outcomes.

Vitamin B12 deficiency is widespread globally, particularly among populations with low meat consumption.

Poor nutrition and a high burden of infections in early life are common in low-income countries and represent important risk factors for impaired development.

Our findings suggest that improving the situation of children in low-income settings requires a broad and integrated approach. Ensuring adequate nutrition and preventing infections early in life are essential. At the same time, efforts must be made to strengthen children’s psychosocial environments. Such measures can have a wide range of positive effects in both the short and long term. They can help children reach their full developmental potential, improve educational outcomes, and, in the longer term, contribute to breaking cycles of poverty.

Biography

Ingrid Kvestad holds a Cand.Psychol. degree from the University of Bergen and is a specialist in clinical child and adolescent psychology. Since 2011, she has been a PhD candidate at the Faculty of Psychology, University of Bergen, and affiliated with the Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU West), Uni Research Health.

Her doctoral work is based on data from a project at the Centre for International Health, University of Bergen, conducted in collaboration with the Center for Applied Studies in New Delhi, India.

The thesis is available for download in the Norwegian Research Information Repository: Biological Risks and Neurodevelopment in Young North Indian Children