Gunnar Aksel Bjune

• Noory, Bandar; Hassanain, Sara A.; Lindskog, Benedikte Victoria; Elsony, Asma & Bjune, Gunnar Aksel (2020). Exploring the consequences of decentralization: has privatization of health services been the perceived effect of decentralization in Khartoum locality, Sudan? BMC Health Services Research. ISSN 1472-6963. doi: 10.1186/s12913-020-05511-z. Full text in Research Archive
• Riaz, Syeda Mariam; Bjune, Gunnar Aksel; Wiker, Harald G; Sviland, Lisbeth & Mustafa, Tehmina (2020). Mycobacterial antigens accumulation in foamy macrophages in murine pulmonary tuberculosis lesions: Association with necrosis and making of cavities. Scandinavian Journal of Immunology. ISSN 0300-9475. 91:e12866(4), p. 1–13. doi: 10.1111/sji.12866. Full text in Research Archive
• Sima, Bezawit Temesgen; Belachew, Tefera; Bjune, Gunnar Aksel & Abebe, Fekadu (2019). Traditional healers`role in the detection of active tuberculosis cases in a pastoralist community in Ethiopia: a pilot intervention study. BMC Public Health. ISSN 1471-2458. 19(1). doi: 10.1186/s12889-019-7074-9. Full text in Research Archive Show summary

  Abstract Background: Pastoralists rely on traditional healers (THs) for general health problems. However, some studies indicate that such practices result in delays in the diagnosis and treatment of tuberculosis (TB) cases. This study aims to assess the role of traditional healers in the detection and referral of active TB cases in a pastoralist community. Methods: We identified 22 traditional healers from 7 villages of Kereyu pastoralist community in the Fentale district in Ethiopia in January 2015. We trained these THs in identifying presumptive TB symptoms and early referral to the nearby healthcare facilities. The training was held during a 1 week period that included a visit to their villages and follow-up. A 1 day meeting was held with the traditional healers, the district TB care and prevention coordinator and health extension workers from the selected sub-district to discuss the referral link between THs and the nearby healthcare facilities. Health providers working at the TB units in the selected healthcare facilities were oriented about the training given and planned involvement of THs in referring presumptive TB case. In addition, documentation of the presumptive TB cases was discussed. Results: We succeeded in tracing and interviewing 8 of the 22 THs. The rest were on seasonal migration. According to the THs report for the 1 year period, these 8 THs had referred 24 TB suspects to the healthcare facilities. Sputum smear microscopy confirmed 13 of the 24 suspects as having TB cases. Among those confirmed, 10 completed treatment and three were on treatment. Five presumptive TB cases were confirmed non TB cases through further evaluation at the healthcare facilities and six of the presumptive TB cases were lost to follow up by the THs. Whereas, four of the presumptive TB cases were lost to follow up to the healthcare facility. Conclusions: Results of the present study indicate that THs can contribute to the detection of undiagnosed active TB cases in a pastoralist community, provided they are given appropriate training and support.

• Wu, Tsung-Shu Joseph; Kagoli, Matthew; Kaasbøll, Jens Johan & Bjune, Gunnar Aksel (2018). Integrated Disease Surveillance and Response (IDSR) in Malawi: Implementation gaps and challenges for timely alert. PLOS ONE. ISSN 1932-6203. 13(11), p. 1–19. doi: 10.1371/journal.pone.0200858. Show summary

  Objective: The emerging and recent 2014 Ebola Virus Disease (EVD) outbreaks rang the bell to call upon efforts from globe to assist resource-constrained countries to strengthen public health surveillance system for early response. Malawi adopted the Integrated Disease Surveillance and Response (IDSR) strategy to develop its national surveillance system since 2002 and revised its guideline to fulfill the International Health Regulation (IHR) requirements in 2014. This study aimed to understand the state of IDSR implementation and differences between guideline and practice for future disease surveillance system strengthening. Methods: This was a mixed-method observational study. Quantitative data were to analyze completeness and timeliness of surveillance system performance from national District Health Information System 2 (DHIS2). Qualitative data were collected through interviews with 29 frontline health service providers from the selected district and key informants of the IDSR system implementation and administration at district and national levels. Findings: The current IDSR system showed relatively good completeness (76.4%) but poor timeliness (41.5%) of total expected monthly reports nationwide and zero weekly reports. The challenges of IDSR implementation revealed through qualitative data included lack of supervision, inadequate resources for training and difficulty to implement weekly report due to overwhelming paperwork at frontline health services. Conclusions: The differences between IDSR technical guideline and actual practice were huge. The developing information technology infrastructure in Malawi and emerging mobile health (mHealth) technology can be opportunities for the country to overcome these challenges and improve surveillance system to have better timeliness for the outbreaks and unusual events detection.

• Hasle, Arne Gunnar; Raastad, Ragnhild; Bjune, Gunnar Aksel; Jenum, Pål & Heier, Lise (2017). Can a galacto-oligosaccharide reduce the risk of traveller's diarrhoea? A placebo-controlled, randomized, double-blind study. Journal of Travel Medicine (JTM). ISSN 1195-1982. 24(5). doi: 10.1093/jtm/tax057.
• Gebreegziabher, Senedu Bekele; Bjune, Gunnar Aksel & Solomon, Abebe Yimer (2017). Applying tuberculosis management time to measure the tuberculosis infectious pool at a local level in Ethiopia. Infectious Diseases of Poverty. ISSN 2049-9957. 6. doi: 10.1186/s40249-017-0371-6. Full text in Research Archive
• Workneh, Mahteme Haile; Bjune, Gunnar Aksel & Solomon, Abebe Yimer (2017). Prevalence and associated factors of tuberculosis and diabetes mellitus comorbidity: A systematic review. PLOS ONE. ISSN 1932-6203. 12(4). doi: 10.1371/journal.pone.0175925. Full text in Research Archive
• Osman, R.K.; Mortimer, K.; Bjune, Gunnar Aksel & El Sony, Sony (2016). Chronic respiratory disease in adults treated for tuberculosis in khartoum, Sudan. Public Health Action. ISSN 2220-8372. 6(3), p. 199–204. doi: 10.5588/pha.16.0030.
• Gebreegziabher, Senedu Bekele; Bjune, Gunnar Aksel & Yimer, Solomon Abebe (2016). Patients' and health system's delays in the diagnosis and treatment of new pulmonary tuberculosis patients in West Gojjam Zone, Northwest Ethiopia: a cross-sectional study. BMC Infectious Diseases. ISSN 1471-2334. 16. doi: 10.1186/s12879-016-1995-z. Full text in Research Archive Show summary

  Background Tuberculosis (TB) is a major public health concern in the developing world. Early diagnosis and prompt initiation of treatment is essential for effective TB control. The aim of this study was to determine the length and analyze associated factors of patients’ and health system’s delays in the diagnosis and treatment of new pulmonary TB (PTB) patients. Methods A cross-sectional study was conducted in 30 randomly selected public health facilities in West Gojjam Zone, Amhara Region, Ethiopia. Newly diagnosed PTB patients who were ≥15 years of age were consecutively enrolled in the study. Patients’ delay (the time period from onset of TB symptoms to first presentation to a formal health provider) and health system’s delay (the time period from first presentation to a formal health provider to first start of TB treatment) were measured. Median patients’ and health system’s delays were calculated. Mixed effect logistic regression was used to analyze predictors of patients’ and health system’s delays. Results Seven hundred six patients were enrolled in the study. The median patients’ delay was 18 days (interquartile range [IQR]: 8–34 days) and the median health system’s delay was 22 days (IQR: 4–88 days). Poor knowledge of TB (adjusted odds ratio [AOR], 2.33; 95 % confidence interval [CI], 1.34–4.05), first visit to non-formal health provider (AOR, 47.56; 95 % CI, 26.31–85.99), self-treatment (AOR, 10.11; 95 % CI, 4.53–22.56) and patients’ age (≥45 years) (AOR, 2.99; 95 % CI, 1.14–7.81) were independent predictors of patients’ delay. Smear-negative TB (AOR, 1.88; 95 % CI, 1.32–2.68) and first visit to public health centers (AOR, 2.22; 95 % CI, 1.52–3.25) and health posts (AOR, 5.86; 95 % CI, 1.40–24.39) were found to be independent predictors of health system’s delay. Conclusions The health system’s delay in this study was long and contributed more than 50 % of the total delay. Better TB diagnostic tools to complement sputum smear microscopy are needed to early diagnose PTB cases at peripheral health facilities. In addition, due emphasis should be given to increase public awareness about symptoms and consequences of TB disease.

• Mengesha, Mulugeta Belay; Legesse, Mengistu; Ottenhoff, Tom H.M.; Mihret, Adane; Franken, Kees L & Bjune, Gunnar Aksel [Show all 7 contributors for this article] (2016). IFN-γ and IgA against non-methylated heparin-binding hemagglutinin as markers of protective immunity and latent tuberculosis: Results of a longitudinal study from an endemic setting. Journal of Infection. ISSN 0163-4453. 72(2), p. 189–200. doi: 10.1016/j.jinf.2015.09.040.
• Gebreegziabher, Senedu Bekele; Yimer, Solomon Abebe & Bjune, Gunnar Aksel (2016). Qualitative Assessment of Challenges in Tuberculosis Control in West Gojjam Zone, Northwest Ethiopia: Health Workers’ and Tuberculosis Control Program Coordinators’ Perspectives. Tuberculosis Research and Treatment. ISSN 2090-150X. 2016. doi: 10.1155/2016/2036234. Full text in Research Archive
• Workneh, Mahteme Haile; Bjune, Gunnar Aksel & Yimer, Solomon Abebe (2016). Diabetes mellitus is associated with increased mortality during tuberculosis treatment: a prospective cohort study among tuberculosis patients in South-Eastern Amahra Region, Ethiopia. Infectious Diseases of Poverty. ISSN 2049-9957. 5(1). doi: 10.1186/s40249-016-0115-z.
• Gebreegziabher, Senedu Bekele; Bjune, Gunnar Aksel & Yimer, Solomon Abebe (2016). Total delay is associated with unfavorable treatment outcome among pulmonary tuberculosis patients in West Gojjam Zone, Northwest Ethiopia: A prospective cohort study. PLOS ONE. ISSN 1932-6203. 11(7). doi: 10.1371/journal.pone.0159579. Full text in Research Archive Show summary

  Background delay in diagnosis and treatment of tuberculosis (TB) may worsen the disease, increase mortality and enhance transmission in the community. This study aimed at assessing the association between total delay and unfavorable treatment outcome among newly diagnosed pulmonary TB (PTB) patients. Methods A prospective cohort study was conducted in West Gojjam Zone, Amhara Region of Ethiopia from October 2013 to May 2015. Newly diagnosed PTB patients who were ≥15 years of age were consecutively enrolled in the study from 30 randomly selected public health facilities. Total delay (the time period from onset of TB symptoms to first start of anti-TB treatment) was measured. Median total delay was calculated. Mixed effect logistics regression was used to analyze factors associated with unfavorable treatment outcome. Results Seven hundred six patients were enrolled in the study. The median total delay was 60 days. Patients with total delay of > 60 days were more likely to have unfavorable TB treatment outcome than patients with total delay of ≤ 60 days (adjusted odds ratio [AOR], 2.33; 95% confidence interval [CI], 1.04–5.26). Human immunodeficiency virus (HIV) positive TB patients were 8.46 times more likely to experience unfavorable treatment outcome than HIV negative TB patients (AOR, 8.46; 95% CI, 3.14–22.79). Conclusions Long total delay and TB/HIV coinfection were associated with unfavorable treatment outcome. Targeted interventions that can reduce delay in diagnosis and treatment of TB, and early comprehensive management of TB/HIV coinfection are needed to reduce increased risk of unfavorable treatment outcome.

• Workneh, Mahteme Haile; Bjune, Gunnar Aksel & Yimer, Solomon Abebe (2016). Assessment of health system challenges and opportunities for possible integration of diabetes mellitus and tuberculosis services in South-Eastern Amhara Region, Ethiopia: A qualitative study. BMC Health Services Research. ISSN 1472-6963. 16(135). doi: 10.1186/s12913-016-1378-6.
• Workneh, Mahteme Haile; Bjune, Gunnar Aksel & Yimer, Solomon Abebe (2016). Prevalence and Associated Factors of Diabetes Mellitus among Tuberculosis Patients in South-Eastern Amhara Region, Ethiopia: A Cross Sectional Study. PLOS ONE. ISSN 1932-6203. 11(1). doi: 10.1371/journal.pone.0147621. Full text in Research Archive
• Mengesha, Mulugeta Belay; Bjune, Gunnar Aksel & Abebe, Fekadu (2015). Prevalence of tuberculosis, HIV, and TB-HIV co-infection among pulmonary tuberculosis suspects in a predominantly pastoralist area, northeast Ethiopia. Global health action. ISSN 1654-9716. 8:27949(1), p. 1–8. doi: 10.3402/gha.v8.27949.
• Larsson, Geir; Shenoy, Kotacherry Thrivikrama; Ramasubramanian, Ramalingom; Thayumanavan, Lakshmikanthan; Balakumaran, Leena Kondarappassery & Bjune, Gunnar Aksel [Show all 7 contributors for this article] (2015). High faecal calprotectin levels in intestinal tuberculosis are associated with granulomas in intestinal biopsies. Infectious Diseases. ISSN 2374-4235. 47(3), p. 137–143. doi: 10.3109/00365548.2014.974206.
• Larsson, Geir; Bjune, Gunnar Aksel; Moum, Bjørn; Shenoy, K.T. & Småstuen, Milada Cvancarova (2015). A Risk Matrix Model for the Prediction of Intestinal Tuberculosis and Differentiation from Crohn’s Disease. Austin Journal of Gastroenterology. ISSN 2381-9219. 2(5).
• Mengesha, Mulugeta Belay; Bjune, Gunnar Aksel & Abebe, Fekadu (2015). Tuberculosis and HIV infection among pulmonary tuberculosis suspects in a predominantly pastoralist area, Northeast Ethiopia. Global health action. ISSN 1654-9716. 8(27949), p. 1–7. doi: 10.3402/gha.v8.27949. Full text in Research Archive
• Yimer, Solomon Abebe; Norheim, Gunnstein; Namouchi, Amine; Zegeye, Ephrem Debebe; Kinander, Wibeke & Tonjum, Tone [Show all 11 contributors for this article] (2015). Mycobacterium tuberculosis lineage 7 strains are associated with prolonged patient delay in seeking treatment for pulmonary tuberculosis in Amhara region, Ethiopia. Journal of Clinical Microbiology. ISSN 0095-1137. 53(4), p. 1301–1309. doi: 10.1128/JCM.03566-14.
• Mengesha, Mulugeta Belay; Legesse, Mengistu; Mihret, Adane; Bekele, Yonas; Bjune, Gunnar Aksel & Abebe, Fekadu (2015). Lipoarabinomannan-specific TNF-alpha and IFN-gamma as markers of protective immunity against tuberculosis: a cohort study in an endemic setting. APMIS - Journal of Pathologiy, Microbiology and Immunology. ISSN 0903-4641. 123(10), p. 851–857. doi: 10.1111/apm.12423.
• Mengesha, Mulugeta Belay; Legesse, Mengistu; Mihret, Adane; Ottenhoff, Tom HM; Franken, Kees Lumc & Bjune, Gunnar Aksel [Show all 7 contributors for this article] (2015). Pro-and-anti-inflammatory cytokines against Rv2031 are elevated during latent tuberculosis: a study in cohorts of tuberculosis patients, household contacts and community Controls in an endemic setting. PLOS ONE. ISSN 1932-6203. p. 1–13. doi: 10.1371/journal.pone.0124134. Full text in Research Archive
• Larsson, Geir; Shenoy, Thrivikrama; Ramasubramanian, Ramalingom; Balakumaran, Leena Kondarappassery; Småstuen, Milada Cvancarova & Bjune, Gunnar Aksel [Show all 7 contributors for this article] (2014). Routine diagnosis of intestinal tuberculosis and Crohn´s disease in Southern India. World Journal of Gastroenterology (WJG). ISSN 1007-9327. 20(17), p. 5017–5024. doi: 10.3748/wjg.v20.i17.5017.
• Larsson, Geir; Koticherry Thrivikrama, Shenoy; Ramasubramanian, Ramalingom; Lakshmikanthan, Thayumanavan; Leena Kondarappassery, Balakumaran & Bjune, Gunnar Aksel [Show all 7 contributors for this article] (2014). Faecal calprotectin levels differentiate intestinal from pulmonary tuberculosis: An observational study from Southern India. United European Gastroenterology Journal (UEG Journal). ISSN 2050-6406. doi: 10.1177/2050640614546947.
• Belay, Mulugeta ; Dagne, Daniel; Legesse, Mengistu; Mihret, Adane; Bekele, Yonas & Medhin, Girmay [Show all 8 contributors for this article] (2014). QuantiFERON-TB-Gold In-Tube test conversions and reversions among Tuberculosis patients and their household contacts in Addis Ababa: a one year follow-up study. BMC Infectious Diseases. ISSN 1471-2334. 14:654. doi: 10.1186/s12879-014-0654-5.
• Kuznetsov, Vladimir; Grjibovski, Andrej; Mariandyshev, Andreyi O; Johansson, Eva & Bjune, Gunnar Aksel (2014). Two vicious circles contributing to a diagnostic delay for tuberculosis patients in Arkhangelsk. Emerging Health Threats Jour. ISSN 1752-8550. 7. doi: 10.3402/ehtj.v7.24909. Full text in Research Archive
• Kuznetsov, Vladimir; Grjibovski, Andrej; Mariandyshev, Andrey O.; Johansson, Eva & Bjune, Gunnar Aksel (2014). A comparison between passive and active case finding in TB control in the Arkhangelsk region. International Journal of Circumpolar Health. ISSN 1239-9736. 73. doi: 10.3402/ijch.v73.23515. Full text in Research Archive
• Yimer, Solomon Abebe; Holm-Hansen, Carol J C; Storla, Dag Gustav Gundersen & Bjune, Gunnar Aksel (2014). Tuberculosis management time: an alternative parameter for measuring the tuberculosis infectious pool. Tropical medicine & international health. ISSN 1360-2276. 19(3), p. 313–320. doi: 10.1111/tmi.12246.
• Yimer, Solomon Abebe; Bjune, Gunnar Aksel & Holm-Hansen, Carol J. C. (2014). Time to first consultation, diagnosis and treatment of TB among patients attending a referral hospital in Northwest, Ethiopia. BMC Infectious Diseases. ISSN 1471-2334. 14. doi: 10.1186/1471-2334-14-19. Full text in Research Archive
• Belay, Mulugeta ; Ameni, Gobena; Bjune, Gunnar Aksel; Couvin, David; Rastogi, Nalin & Abebe, Fekadu (2014). Strain diversity of Mycobacterium tuberculosis isolates from pulmonary tuberculosis patients in Afar pastoral Region of Ethiopia. BioMed Research International. ISSN 2314-6133. 2014. doi: 10.1155/2014/238532.
• Yimer, Solomon Abebe; Hailu, Elena; Derese, Yohannes; Bjune, Gunnar Aksel & Holm-Hansen, Carol J. C. (2013). Spoligotyping of Mycobacterium tuberculosis isolates among pulmonary tuberculosis patients in Amhara Region, Ethiopia. APMIS - Journal of Pathologiy, Microbiology and Immunology. ISSN 0903-4641. 121(9), p. 878–885. doi: 10.1111/apm.12046.
• Kuznetsov, Vladimir; Grjibovski, Andrej; Mariandyshev, A.O.; Johansson, Eva; Enarson, Donald Arthus & Bjune, Gunnar Aksel (2013). Hopelessness as a basis for tuberculosis diagnostic delay in the Arkhangelsk region: a grounded theory study. BMC Public Health. ISSN 1471-2458. 13. doi: 10.1186/1471-2458-13-712. Full text in Research Archive
• Sagbakken, Mette; Frich, Jan C; Bjune, Gunnar Aksel & Porter, John DH (2013). Ethical aspects of directly observed treatment for tuberculosis: a cross-cultural comparison. BMC Medical Ethics. ISSN 1472-6939. 14. doi: 10.1186/1472-6939-14-25. Full text in Research Archive
• Kumbani, Lily C; Bjune, Gunnar Aksel; Chirwa, Ellen; Malata, Address & Odland, Jon Øyvind (2013). Why some women fail to give birth at health facilities: a qualitative study of women's perceptions of perinatal care from rural Southern Malawi. Reproductive Health. ISSN 1742-4755. 10. doi: 10.1186/1742-4755-10-9. Full text in Research Archive
• Dadi, Mengistu Legesse; Ameni, Gobena; Medhin, Girmay; Franken, Kees LMC; Kassa, Gezahegne Mamo & Ottenhoff, Tom HM [Show all 8 contributors for this article] (2013). IgA response to ESAT-6/CFP-10 and Rv2031 antigens varies in culture-confirmed pulmonary tuberculosis patients, healthy Mycobacterium tuberculosis infected and non-infected individuals in a tuberculosis endemic setting, Ethiopia". Scandinavian Journal of Immunology. ISSN 0300-9475. 78(3), p. 266–274. doi: 10.1111/sji.12080.
• Yimer, Solomon Abebe; Agonafir, Mulualem; Derese, Yohannes; Sani, Yusuf; Bjune, Gunnar Aksel & Holm-Hansen, Carol J. C. (2012). Primary drug resistance to anti-tuberculosis drugs in major towns of Amhara region, Ethiopia. APMIS - Journal of Pathologiy, Microbiology and Immunology. ISSN 0903-4641. 120(6), p. 503–509. doi: 10.1111/j.1600-0463.2011.02861.x.
• Yimer, Solomon Abebe; Holm-Hansen, Carol J. C. & Bjune, Gunnar Aksel (2012). Assessment of knowledge and practice of private practitioners regarding tuberculosis control in Ethiopia. Journal of Infection in Developing Countries. ISSN 2036-6590. 6(1), p. 13–19. doi: 10.3855/jidc.1927.
• Mengesha, Mulugeta Belay; Bjune, Gunnar Aksel; Ameni, Gobena & Abebe, Fekadu (2012). Diagnostic and treatment delay among tuberculosis patients in Afar Region, Ethiopia: a cross-sectional study. BMC Public Health. ISSN 1471-2458. 12. doi: 10.1186/1471-2458-12-369.
• Kassa, Gezahegne Mamo; Abebe, Fekadu; Worku, Yalelet; Legesse, Mengistu; Medhin, Girmay & Bjune, Gunnar Aksel [Show all 7 contributors for this article] (2012). Tuberculosis in goats and sheep in Afar pastoral region of Ethiopia and isolation of Mycobacterium tuberculosis from goat. Veterinary Medicine International. ISSN 2090-8113. doi: 10.1155/2012/869146.
• Dadi, Mengistu Legesse; Ameni, Gobena; Kassa, Gezahegne Mamo; Medhin, Girmay; Bjune, Gunnar Aksel & Abebe, Fekadu (2012). Association of the level of IFN-gamma produced by T cells in response to Mycobacterium tuberculosis-specific antigens with the size of skin test indurations among individuals with latent tuberculosis in a highly tuberculosis-endemic setting. International Immunology. ISSN 0953-8178. 24(2), p. 71–78. doi: 10.1093/intimm/dxr102. Show summary

  There is growing evidence showing the potential of T-cell-based gamma interferon (IFN-g) release assays (IGRAs) for predicting the risk of progression of Mycobacterium tuberculosis (Mtb) infection, though there is little information from tuberculosis (TB)-endemic settings. In this study, we assessed the association between the level of IFN-g produced by T cells in response to Mtb-specific antigens and the size of skin test indurations in 505 adult individuals who were screened for latent tuberculosis infection (LTBI) using the QuantiFERON-TB Gold In Tube (QFTGIT) assay and tuberculin skin test (TST). There was a strong positive correlation between the level of IFN-g induced by the specific antigens and the diameter of the skin indurations (Spearman’s rho 5 0.6, P < 0.001). Body mass index and parasitic infection were not associated with the level of IFN-g production or the TST reaction. In linear regression analysis, the size of the skin test indurations was significantly associated with the mean level of IFN-g [coefficient, 0.65; 95% confidence interval (CI), 0.47 to 0.82, P < 0.001]. Similarly, results from logistic regression analysis demonstrated that individuals who had skin test indurations ‡ 10 mm were 6.82 times more likely than individuals who had skin test indurations < 10 mm to have high levels of IFN-g (i.e. positive QFTGIT result) (adjusted odd ratio 5 6.82; 95% CI, 3.67 to 12.69, P < 0.001). In conclusion, the results of this study could provide indirect evidence for the prognostic use of the QFTGIT assay for progression of Mtb infection, though prospective follow-up studies are needed to provide direct evidence.

• Sagbakken, Mette; Bjune, Gunnar Aksel & Frich, Jan C (2012). Humiliation or care? A qualitative study of patients' and health professionals' experiences with tuberculosis treatment in Norway. Scandinavian Journal of Caring Sciences. ISSN 0283-9318. 26(2), p. 313–323. doi: 10.1111/j.1471-6712.2011.00935.x.
• Kumbani, Lily C; Chirwa, Ellen; Malata, Address; Odland, Jon Øyvind & Bjune, Gunnar Aksel (2012). Do Malawian women critically assess the quality of care? A qualitative study on women’s perceptions of perinatal care at a district hospital in Malawi. Reproductive Health. ISSN 1742-4755. 9(30). doi: 10.1186/1742-4755-9-30. Full text in Research Archive
• Kuznetsov, Vladimir; Grjibovski, Andrej; Maryandyshev, A O; Johansson, E & Bjune, Gunnar Aksel (2011). "I never go to doctors, as long as I can move": a narrative analysis of interview with a patient having Tuberculosis diagnostic delay experience. Human Ecology. ISSN 0300-7839. p. 54–58.
• Belay, Mulugeta ; Bjune, Gunnar Aksel & Abebe, Fekadu (2011). Serodiagnosis performance of R-ESAT-6-CFP-10 in the diagnosis of pulmonary tuberculosis in Ethiopia. Mycobacterial Diseases. ISSN 2161-1068. 1(2). doi: 10.4172/2161-1068.1000103.
• Farah, Sameir Kamal Sayyed; Bjune, Gunnar Aksel; Damtew, Zufan Abera & Abdelaziz, Ali Omer (2011). Challenges and Opportunities of Integrating Primary Health Care Information System: Northern State, Sudan. Sudanese Journal of Public Health. ISSN 1990-7567. 6(3), p. 105–109. Show summary

  This paper discusses outcome of studying challenges and opportunities of integrating Health Information System. The study was conducted in the settings of Primary Health Care programs in Northern State, Sudan. Qualitative case study was employed and data were collected through interviews, analysis of relevant documents, and observation of the settings. The results were analyzed using interpretive approach. The study findings indicated that fragmentation of Primary Health Care programs’ Information System is a major problem affecting system performance. Our study also showed that efforts to integrate Primary Health Care programs’ Information System might be challenged by the existing structural, socio-cultural and political contexts of the organization. On the other hand, opportunities for integration of the programs’ Information System lie in the existence of Health Information Center, which receives collected health data from all parts of the state and formulate common reports. Besides, most of the study participants were expressing optimism at outcomes of Information System integration. The need of considering structural, socio-cultural and political contexts of the organization is emphasised in order to address the identified challenges related to integrating Health Information Systems.

• Yimer, Solomon Abebe; Holm-Hansen, Carol J C & Bjune, Gunnar Aksel (2011). The perspective of private practitioners regarding tuberculosis case detection and treatment delay in Amhara Region, Ethiopia: a cross-sectional study. BMC Research Notes. ISSN 1756-0500. 4. doi: 10.1186/1756-0500-4-285.
• Gebremariam, Mekdes; Bjune, Gunnar Aksel & Frich, Jan C (2011). Lay beliefs of TB and TB/HIV co-infection in Addis Ababa, Ethiopia: a qualitative study. BMC Research Notes. ISSN 1756-0500. 4. doi: 10.1186/1756-0500-4-277.
• Hasle, Gunnar; Bjune, Gunnar Aksel; Midthjell, Liv; Røed, Knut H. & Leinaas, Hans Petter (2011). Transport of Ixodes ricinus infected with Borrelia species to Norway by northward-migrating passerine birds. Ticks and Tick-borne Diseases. ISSN 1877-959X. 2(1), p. 37–43. doi: 10.1016/j.ttbdis.2010.10.004.
• Abebe, Dawit Shawel; Bjune, Gunnar Aksel; Ameni, Gobena; Biffa, Demelash & Abebe, Fekadu (2011). Prevalence of pulmonary tuberculosis and associated risk factors in Eastern Ethiopian prisons. The International Journal of Tuberculosis and Lung Disease. ISSN 1027-3719. 15(5), p. 668–673. doi: 10.5588/ijtld.10.0363.
• Dadi, Mengistu Legesse; Ameni, Gobena; Kassa, Gezahegne Mamo; Medhin, Girmay; Bjune, Gunnar Aksel & Abebe, Fekadu (2011). Community-based cross-sectional survey of latent tuberculosis infection in Afar pastoralists, Ethiopia, using QuantiFERON-TB Gold In-Tube and tuberculin skin test. BMC Infectious Diseases. ISSN 1471-2334. 11. doi: 10.1186/1471-2334-11-89.
• Dadi, Mengistu Legesse; Ameni, Gobena; Kassa, Gezahegne Mamo; Medhin, Girmay; Bjune, Gunnar Aksel & Abebe, Fekadu (2011). Knowledge of cervical tuberculosis lymphadenitis and its treatment in pastoral communities of the Afar region, Ethiopia. BMC Public Health. ISSN 1471-2458. 11(157). doi: 10.1186/1471-2458-11-157.
• Kassa, Gezahegne Mamo; Bayleyegn, Gizachew; Tessema, Tesfaye Sisay; Dadi, Mengistu Legesse; Medhin, Girmay & Bjune, Gunnar Aksel [Show all 8 contributors for this article] (2011). Pathology of Camel Tuberculosis and Molecular Characterization of Its Causative Agents in Pastoral Regions of Ethiopia. PLOS ONE. ISSN 1932-6203. 6(1). doi: 10.1371/journal.pone.0015862.
• Abebe, Dawit Shawel; Biffa, Demelash; Bjune, Gunnar Aksel; Ameni, Gobena & Abebe, Fekadu (2011). Assessment of knowledge and practice about tuberculosis among eastern Ethiopian prisoners. The International Journal of Tuberculosis and Lung Disease. ISSN 1027-3719. 15(2), p. 228–233.
• Legesse, Mengistu; Ameni, Gobena; Mamo, Gezahegne; Medhin, Girmay; Abebe, Dawit Shawel & Bjune, Gunnar Aksel [Show all 7 contributors for this article] (2010). Knowledge and perception of pulmonary tuberculosis in pastoral communities in the middle and Lower Awash Valley of Afar region, Ethiopia. BMC Public Health. ISSN 1471-2458. 10(187). doi: 10.1186/1471-2458-10-187.
• Gele, Abdi Ali & Bjune, Gunnar Aksel (2010). Armed conflicts have an impact on the spread of tuberculosis: the case of the Somali Regional State of Ethiopia. Conflict and Health. ISSN 1752-1505. 4(1).
• Storla, Dag Gustav Gundersen; Yimer, Solomon Abebe & Bjune, Gunnar Aksel (2010). Can treatment delay be utilized as a key variable for monitoring the pool of infectious tuberculosis in a population? Journal of Infection in Developing Countries. ISSN 2036-6590. 4(2), p. 083–090.
• Hasle, Gunnar; Bjune, Gunnar Aksel; Christensson, Dan; Røed, Knut H.; Whist, Anne Cathrine & Leinaas, Hans Petter (2010). Detection of Babesia divergens in southern Norway by using an immunofluorescence antibody test in cow sera. Acta Veterinaria Scandinavica (AVS). ISSN 0044-605X. 52. doi: 10.1186/1751-0147-52-55.
• Dadi, Mengistu Legesse; Ameni, Gobena; Kassa, Gezahegne Mamo; Medhin, G; Bjune, Gunnar Aksel & Abebe, Fekadu (2010). Performance of QuantiFERON-TB Gold In-Tube (QFTGIT) for the diagnosis of Mycobacterium tuberculosis (Mtb) infection in Afar Pastoralists, Ethiopia. BMC Infectious Diseases. ISSN 1471-2334. 10. doi: 10.1186/1471-2334-10-354.
• Gebremariam, Mekdes; Bjune, Gunnar Aksel & Frich, Jan C (2010). Barriers and facilitators of adherence to TB treatment in patients on concomitant TB and HIV treatment: a qualitative study. BMC Public Health. ISSN 1471-2458. 10. doi: 10.1186/1471-2458-10-651.
• Wiker, Harald G; Mustafa, Tehmina; Bjune, Gunnar & Harboe, Morten (2010). Evidence for waning of latency in a cohort study of tuberculosis. BMC Infectious Diseases. ISSN 1471-2334. 10. doi: 10.1186/1471-2334-10-37. Show summary

  Background: To investigate how the risk of active tuberculosis disease is influenced by time since original infection and to determine whether the risk of reactivation of tuberculosis increases or decreases with age. Methods: Cohort analysis of data for the separate ten year birth cohorts of 1876-1885 to 1959-1968 obtained from Statistics Norway and the National Tuberculosis Registry. These data were used to calculate the rates and the changes in the rates of bacillary (or active) tuberculosis. Data on bacillary tuberculosis for adult (20+) age groups were obtained from the National Tuberculosis Registry and Statistics Norway from 1946 to 1974. Most cases during this period arose due to reactivation of remote infection. Participants in this part of the analysis were all reported active tuberculosis cases in Norway from 1946 to 1974 as recorded in the National Tuberculosis Registry. Results: Tuberculosis decreased at a relatively steady rate when following individual birth cohorts, but with a tendency of slower decline as time passed since infection. A mean estimate of this rate of decline was 57 % in a 10 year period. Conclusions: The risk of reactivation of latent tuberculosis decreases with age. This decline may reflect the rate at which latent tuberculosis is eliminated from a population with minimal transmission of tubercle bacilli. A model for risk of developing active tuberculosis as a function of time since infection shows that the rate at which tuberculosis can be eliminated from a society can be quite substantial if new infections are effectively prevented. The findings clearly indicate that preventative measures against transmission of tuberculosis will be the most effective. These results also suggest that the total population harbouring live tubercle bacilli and consequently the future projection for increased incidence of tuberculosis in the world is probably overestimated.

• Sagbakken, Mette; Bjune, Gunnar Aksel & Frich, Jan C (2010). Experiences of being diagnosed with tuberculosis among immigrants in Norway - Factors associated with diagnostic delay: A qualitative study. Scandinavian Journal of Public Health. ISSN 1403-4948. 38(3), p. 283–290. doi: 10.1177/1403494809357101. Show summary

  Aims: The aim of this paper is to explore experiences of being diagnosed with tuberculosis (TB) among immigrants in Norway, with a view to factors associated with diagnostic delay. Methods: A qualitative study was conducted among 22 participants diagnosed with TB who originated from Somalia or Ethiopia. Results: One-third of the participants reported less than 2 months from onset of symptoms to treatment were initiated. The factors associated with little delay included a medical history that gave suspicion of TB, presenting with typical TB symptoms, or being screened for TB at arrival. Two-thirds of the participants told about extensive diagnostic processes. Persistent cough not accompanied by symptoms such as: weight loss and weakness; mild, diffuse, atypical, and/or intermittent symptoms; and a sense of not being a likely victim of TB could delay patients’ first initiative to seek help. Participants experienced that the diagnostic process in the health services could endure for months, even years. The diagnosis could be difficult to confirm, but health professionals appeared to have difficulties with associating their symptoms with TB. This resulted in delays in initiating diagnostic tests for TB, especially in cases of extra-pulmonary TB. Conclusions: Public health efforts to increase awareness about TB transmission, its diversity in manifestations, and its progression from latent to active disease, may decrease patient delay. An increased awareness among health professionals about typical and atypical symptoms of TB, aspects of the patient’s history, and being aware and sensitive to patients’ own interpretation of symptoms may reduce diagnostic delay in the health services.

• Gele, Abdikadir Ali; Sagbakken, Mette; Abebe, Fekadu & Bjune, Gunnar Aksel (2010). Barriers to tuberculosis care: a qualitative study among Somali pastoralists in Ethiopia. BMC Research Notes. ISSN 1756-0500. 3(86). Full text in Research Archive
• Sandberg, Kristin Ingstad; Andresen, Steinar & Bjune, Gunnar Aksel (2010). A new approach to global health institutions? A case study of new vaccine introduction and the formation of the GAVI Alliance. Social Science and Medicine. ISSN 0277-9536. 71(7), p. 1349–1356. doi: 10.1016/j.socscimed.2010.06.017.
• Dadi, Mengistu Legesse; Ameni, Gobena; Medhin, G.; Shawel, Dawit; Bjune, Gunnar Aksel & Abebe, Fekadu (2010). Knowledge and perception of pulmonary tuberculosis in pastoral communities in the middle and Lower Awash Valley of Afar region, Ethiopia. BMC Public Health. ISSN 1471-2458. 10. doi: 10.1186/1471-2458-10-187.
• Abebe, Fekadu & Bjune, Gunnar Aksel (2009). The protective role of antibody responses during Mycobacterium tuberculosis infection. Clinical and Experimental Immunology. ISSN 0009-9104. 157(2), p. 235–243. doi: 10.1111/j.1365-2249.2009.03967.x.
• Gele, Abdikadir Ali; Bjune, Gunnar Aksel & Abebe, Fekadu (2009). Pastoralism and delay in diagnosis of TB in Ethiopia. BMC Public Health. ISSN 1471-2458. 9. doi: 10.1186/1471-2458-9-5.
• Baranov, AA; Mariandyshev, AO; Mannsåker, Turid; Dahle, Ulf R & Bjune, GA (2009). Molecular epidemiology and drug resistance of widespread genotypes of Mycobacterium tuberculosis in northwestern Russia. The International Journal of Tuberculosis and Lung Disease. ISSN 1027-3719. 13(10), p. 1288–1293.
• Storla, Dag Gundersen; Kristiansen, Ingun; Oftung, Fredrik; Korsvold, Gro Ellen; Gaupset, Monica & Gran, Gerd [Show all 10 contributors for this article] (2009). Use of interferon gamma-based assay to diagnose tuberculosis infection in health care workers after short term exposure. BMC Infectious Diseases. ISSN 1471-2334. 9. doi: 10.1186/1471-2334-9-60.
• Eick, Frode; Maleta, K; Govasmark, Espen; Duttaroy, Asim K. & Bjune, Gunnar Aksel (2009). Food intake of selenium and sulphur amino acids in tuberculosis patients and healthy adults in Malawi. The International Journal of Tuberculosis and Lung Disease. ISSN 1027-3719. 13(10), p. 1313–1315.
• Yimer, S; Holm-Hansen, Carol ; Yimaldu, T & Bjune, G (2009). Evaluating an active case-finding strategy to identify smear-positive tuberculosis in rural Ethiopia. The International Journal of Tuberculosis and Lung Disease. ISSN 1027-3719. 13(11), p. 1399–1404.
• Yimer, Solomon; Holm-Hansen, Carol ; Yimaldu, Tilahun & Bjune, Gunnar (2009). Health care seeking among pulmonary tuberculosis suspects and patients in rural Ethiopia: a community-based study. BMC Public Health. ISSN 1471-2458. 9. doi: 10.1186/1471-2458-9-454.
• Hasle, Gunnar; Bjune, Gunnar Aksel; Edvardsen, Erik; Jakobsen, Christer; Linnehol, Bjørn & Røer, Jan Erik [Show all 10 contributors for this article] (2009). Transport of ticks by migratory passerine birds to Norway. Journal of Parasitology. ISSN 0022-3395. 95(6), p. 1342–1351. doi: 10.1645/GE-2146.1.
• Storla, Dag Gustav Gundersen; Yimer, Solomon Abebe & Bjune, Gunnar Aksel (2008). A systematic review of delay in the diagnosis and treatment of tuberculosis. BMC Public Health. ISSN 1471-2458. 8. doi: 10.1186/1471-2458-8-15.
• Bjune, Gunnar Aksel (2008). Tuberkulose - en sosialpolitisk sjukdom. In Larsen, Øivind; Alvik, Anne; Hagestad, Kristian & Nylenna, Magne (Ed.), Samfunnsmedisin. Gyldendal Akademisk. ISSN 978-82-05-34459-4. p. 300–309. Show summary

  Lærebok i samfunnsmedisin for legestudenter, medisinske kandidater med eksamen fra utlandet og oppslagsbok for alle som arbeider med samfunnsmedisin. Totalt omarbeidet ny-utgave av de samme redaktørers "Helse for de mange" (2003).

• Nyombi, Balthazar M; Kristiansen, Knut I; Bjune, Gunnar; Muller, Fredrik & Holm-Hansen, Carol (2008). Diversity of human immunodeficiency virus type 1 subtypes in Kagera and Kilimanjaro regions, Tanzania. AIDS Research and Human Retroviruses. ISSN 0889-2229. 24(6), p. 761–769. doi: 10.1089/aid.2007.0311.
• Nyombi, Balthazar M; Nkya, Watoky; Barongo, Longin; Bjune, Gunnar; Kristiansen, Knut I & Muller, Fredrik [Show all 7 contributors for this article] (2008). Evolution of human immunodeficiency virus type 1 serotypes in northern Tanzania: a retrospective study. APMIS - Journal of Pathologiy, Microbiology and Immunology. ISSN 0903-4641. 116(6), p. 507–514. doi: 10.1089/088922200415054.
• Nyombi, Balthazar; Holm-Hansen, Carol ; Kristiansen, Knut I; Bjune, Gunnar & Müller, Fredrik (2008). Prevalence of reverse transcriptase and protease mutations associated with antiretroviral drug resistance among drug-naïve HIV-1 infected pregnant women in Kagera and Kilimanjaro regions, Tanzania. AIDS research and therapy. ISSN 1742-6405. 5. doi: 10.1186/1742-6405-5-13.
• Jani-Bølstad, Jagrati; De Schacht, C; Jani, IV & Bjune, Gunnar Aksel (2008). Risk factors for incomplete vaccination and missed opportunity for immunization in rural Mozambique. BMC Public Health. ISSN 1471-2458. 8. doi: 10.1186/1471-2458-8-161.
• Nyombi, Balthazar Melchior; Holm-Hansen, Carol; Kristiansen, Knut Ivan; Bjune, Gunnar Aksel & Muller, Fredrik (2008). Prevalence of reverse transcriptase and protease mutations associated with antiretroviral drug resistance among drug-naive HIV-1 infected pregnant women in Kagera and Kilimanjaro regions, Tanzania. AIDS research and therapy. ISSN 1742-6405. 5(13).

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• Yimer, Solomon Abebe; Norheim, Gunnstein; Namouchi, Amine; Zegeye, Efrem; Kinander, Wibeke & Bekele, Shiferaw [Show all 10 contributors for this article] (2015). Mycobacterium tuberculosis lineage 7 strains are associated with prolonged patient delay in pulmonary tuberculosis patients in Amhara Region, Ethiopia. Oral presentation at the World TB Summit to be held in London, UK 24th-26th March/2015.
• Yimer, Solomon Abebe; Norheim, Gunnstein; Namouchi, Amine; Zegeye, Ephrem Debebe; Kinander, Wibeke & Tonjum, Tone [Show all 9 contributors for this article] (2015). Lineage 7 Mycobacterium tuberculosis strains are associated with longer patient delay in pulmonary TB patients.
• Yimer, Solomon; Holm-Hansen, Carol J C; Storla, Dag Gustav Gundersen & Bjune, Gunnar Aksel (2014). Tuberculosis management time: an alternative parameter for measuring the tuberculosis infectious pool.
• Mustafa, Tehmina; Wiker, Harald G; Harboe, Morten & Bjune, Gunnar Aksel (2014). Mycobacterial antigens disappear from host tissue during latent Mycobacterium tuberculosis infection.
• Shero, Kebede Chimdessa; Legesse, Mengistu; Medhin, Girmay; Belay, Mulugeta; Bjune, Gunnar Aksel & Abebe, Fekadu (2014). Re-assessing tuberculin skin test (TST) for the diagnosis of tuberculosis (TB) among African migrants in Western Europe and USA. Journal of Tuberculosis Research. ISSN 2329-8448. 2(1), p. 4–15. doi: 10.4236/jtr.2014.21002.
• Legesse, Mengistu; Mamo, Gezahegne; Ameni, Gobena; Medhin, Girmay; Bjune, Gunnar Aksel & Abebe, Fekadu (2013). Community-based prevalence of undiagnosed mycobacterial diseases in the Afar Region, north-east Ethiopia. International Journal of mycobacteriology. ISSN 2212-5531. 2(2), p. 94–102. doi: 10.1016/j.imyco.2013.04.001.
• Sagbakken, Mette; Bjune, Gunnar Aksel & Frich, Jan C (2013). En sammenligning av DOT-behandling i Etiopia og Norge.
• Vogt, Yngve; Jani-Bølstad, Jagrati & Bjune, Gunnar Aksel (2012). Manglende tillit til vaksinering i U-land.
• Sagbakken, Mette; Bjune, Gunnar Aksel & Frich, Jan C (2011). Tuberculosis - from the patients' perspective.
• Larsson, Geir; Shenoy, K.; Røseth, Arne; Bjune, Gunnar Aksel & Moum, Bjørn (2011). Diagnosis and differentiation of intestinal tuberculosis and Crohn's disease by use of faecal and serum calprotectin. Inflammatory Bowel Diseases. ISSN 1078-0998. 17, p. S35–S35.
• Jani-Bølstad, Jagrati; Christie, Vibeke & Bjune, Gunnar Aksel (2011). Transformasjon av vitenskapelig tanke,arbeids og-vurderingsformer i master utdanning: MPhil i samfunnsmedisin.
• Sagbakken, Mette; Bjune, Gunnar Aksel & Frich, Jan C (2011). Patients’ and health professionals’ views and experiences with tuberculosis treatment in Norway among immigrants from Ethiopia. Tropical medicine & international health. ISSN 1360-2276. 16, p. 52–52.
• Arntsen, A.; Sakhi, Amrit Kaur; Kalfoss, Torill; Maleta, Kenneth M.; Blomhoff, Rune & Duttaroy, Asim K. [Show all 7 contributors for this article] (2011). Lower plasma levels of selenium and glutathione in smear-positive tuberculosis patients in Malawi. Ethiopian Journal of Health Development. ISSN 1021-6790. 25(3), p. 230–232.
• Larsson, Geir; Shenoy, K.T.; Røseth, Arne; Bjune, Gunnar Aksel & Moum, Bjørn (2010). Evaluation of faecal and serum calprotectin in patients with intestinal tuberculosis. Scandinavian Journal of Gastroenterology. ISSN 0036-5521. 45, p. 72–72.
• Sagbakken, Mette; Frich, Jan C & Bjune, Gunnar Aksel (2010). Kampen mot tuberkulose. Tidsskrift for Den norske legeforening. ISSN 0029-2001. 130, p. 646–648.
• Yimer, Solomon Abebe; Holm-Hansen, C & Bjune, G (2009). Measuring the prevalence of sputum smear-positive tuberculosis in a rural district of Ethiopia: an active case finding.
• Sagbakken, Mette; Bjune, Gunnar Aksel & Frich, Jan C (2009). Diagnostic delay among immigrants with tuberculosis in a low-endemic context.
• Sagbakken, Mette; Bjune, Gunnar Aksel & Frich, Jan C (2009). Patients' and health professionals views and experiences with tuberculosis treatment in a low-endemic setting: a qualitative study.
• Rahim, Z; Storla, D; Khan, M Shahzada; Mannsåker, Turid; Myrvang, B & Bjune, G [Show all 11 contributors for this article] (2008). Prevalence of different phylogenetic clades of Mycobaterium tuberculosis in urban and rural areas Bangladesh. International Journal of Infectious Diseases. ISSN 1201-9712. 12. doi: 10.1016/j.ijid.2008.05.910.
• Mamo, Gezahegne; Abebe, Fekadu; Worku, Yalelet; Hussein, Nesredin; Legesse, Mengistu & Tilahun, Getachew [Show all 9 contributors for this article] (2013). Bovine tuberculosis and its associated risk factors in pastoral and agro-pastoral cattle herds of Afar Region. northeast Ethiopia. Academic journals.
• Yimer, Solomon & Bjune, Gunnar (2010). Millennium development goal six and the lost indicator for case detection in tuberculosis control: Investigating diagnostic delay and the infectious pool in Ethiopia. Unipub forlag. ISSN 978-82-8072-505-9. 2010(987).

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