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  • 1.
    Abrahamsson, Klara
    et al.
    Folkhälsomyndigheten.
    Jonzon, Robert
    Folkhälsomyndigheten.
    Goicolea, Isabel (Contributor)
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Baroudi, Mazen (Contributor)
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Hurtig, Anna-Karin (Contributor)
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Migration, sexuell hälsa och hiv/STI prevention: en sammanfattande rapport2020Report (Other academic)
  • 2.
    Baroudi, Mazen
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Beyond supply and demand: a new ecological framework for understanding the access of young migrants to sexual and reproductive health services in Sweden2023In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 16, no 1, article id 2251783Article in journal (Refereed)
    Abstract [en]

    Background: Although the sexual and reproductive health and rights (SRHR) of young people and migrants should be prioritised, young migrants’ sexual and reproductive health (SRH) is rarely studied in Sweden.

    Objectives: To explore young migrants’ understanding and experiences of sexual rights and examine their perceptions and experiences in accessing SRH services.

    Methods: This is a mixed method study including a national survey that recruited 1773 newly arrived young migrants; a youth clinic survey that recruited 1089 youths after visiting youth clinics; and a qualitative study that included 13 interviews with newly arrived Arabic-speaking migrant men. The results are synthesised using a new ecological framework of access to understand the factors influencing young migrant access to health care based on the levels of the ecological model and the five steps of access: approachability, acceptability, adequacy, affordability, and quality.

    Results: Young migrants understood SRH as both ‘essential’ and ‘a right.’ Their sexual rights were less fulfiled compared to other young people in Sweden, particularly for men, non-binary, LGBTQ+, those born in South Asia, without a residence permit, and those of low economic conditions. SRH services were largely unapproachable as almost half of those who needed them did not utilise them. Services were generally acceptable due to the ‘open environment,’ however, some young migrants faced cultural insensitivity, fear of exposure, low parental support, and long waiting times. SRH services’ quality was perceived as good, however, negative experiences were reported, particularly in the domains of respect, equity, privacy, non-prejudice, and consultation quality.

    Conclusion: The access of young migrants to SRH services is facilitated by an ‘open environment’ and available and good quality services; however, they faced serious barriers such as limited access to information about the health system, comprehensive sexual education, lack of cultural sensitivity, and cultural racism.

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  • 3.
    Baroudi, Mazen
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Leaving the door ajar: young migrants’ sexual and reproductive health in Sweden2022Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Young people and migrants are both prioritized groups regarding sexual and reproductive health and rights (SRHR), but studies about the sexual andreproductive health (SRH) of young migrants in Sweden are scarce. The aim of this thesis was to study the SRH of young migrants in Sweden, and specifically to: 1) explore how do young migrants understand SRH, and how do they experience their sexual rights; and 2) examine how do young migrants perceive and experience the process of accessing SRH services, including their approachability, acceptability, adequacy and quality.

    This thesis is built upon three studies, which collected quantitative data (a national survey – Papers 1 and 2, and a youth clinics survey – Paper 3) and qualitative data (a qualitative study – Paper 4). The national survey is a population-based cross sectional study, which recruited 1773 newly arrived young migrants aged 16 to 29 years through visits to schools and other venues, letters sent home, and via a web survey. The data was analysed through descriptive statistics (Paper 1) and multivariate multiple linear regression (Paper 2). The youth clinic survey is a clinic-based cross-sectional study whichrecruited 1089 youths (118 had at least one parent born outside Sweden/Scandinavia) aged 16 to 25 years after their visit to a youth clinic in the four most northern regions in Sweden. I used multi-level analysis to analyse the data. The qualitative study builds upon 13 semi-structured interviews with newly arrived Arabic-speaking migrant men, which were analysed through qualitative thematic analysis.

    Young migrants understood SRH as both “essential” and a “right”. The sexual rights of young migrants in Sweden were less fulfilled, compared to those of other young people in Sweden, and there were differences between the various groups of young migrants. The rights of men; people identifying as non-binary; people identifying as lesbian, gay, bisexual or asexual (LGBA); those born in South Asia; those without a residence permit; and people of low economic status were fulfilled to a lesser extent compared to their counterparts.

    Studying the process of accessing SRH services – including sexual education and information, and services related to sexual function, sexually transmitted diseases and gender-based violence, as well as infertility, pregnancy, delivery, contraceptives and abortion – showed barriers and facilitators. SRH serviceswere to a large extent non-approachable; almost half of those who needed these services in the national survey did not use them. SRH services were perceived, with some exceptions, as acceptable due to the “open environment” of Sweden; however, some young migrants faced a lack of cultural sensitivity in iv SRH services, low parental support, and fear of exposure, which decreased their acceptability of the services. Regarding adequacy, young migrants complained about long waiting times for receiving care particularly specialised care, and that SRH services did not take their problems seriously. Those who visited youth clinics, however, perceived them as providing convenient and timely services. The quality of SRH services was perceived as good in general; the majority of young migrants were satisfied with SRH services in the national survey and perceived youth clinics as very friendly. However, negative experiences were reported in the national survey, where almost half of those who visited SRH services had at least one negative experience in the five domains of respect, equity, quality of consultation, privacy and non-prejudice. Migrant youths also reported worse experiences in the youth clinic survey than Swedish/Scandinavian youths in the domains of respect, equity and quality of consultation. 

    Their legal entitlement to access most SRH services, the availability of good quality services and the “open environment” facilitate young migrants’ access to SRH services, however, their limited access to sexual education and to information about the health system, and cultural insensitivity and cultural racism when providing information and services, are serious barriers to young migrants’ access to SRH services. 

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  • 4.
    Baroudi, Mazen
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Goicolea, Isabel
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Hurtig, Anna-Karin
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    The good, the bad, and the why: How do Arabic-speaking migrant men perceive and experience information and services related to sexual and reproductive health in Sweden?2023In: Journal of Migration and Health, E-ISSN 2666-6235, Vol. 7, article id 100153Article in journal (Refereed)
    Abstract [en]

    Although migrant men constitute a large and growing proportion of men in Sweden, literature exploring migrant men's experiences in sexual and reproductive health (SRH) services is scarce. We aimed to explore how Arabic-speaking migrant men perceive and experience information and services related to SRH in Sweden. We conducted 13 semi-structured interviews with Arabic-speaking migrant men and analysed the data using reflexive thematic analysis. We developed four themes: 1) SRH is ‘something essential in life’; 2) the good: a transition to a ‘new open society’; 3) the bad: barriers to sexual education and health services; and 4) the why: blaming oneself or the system. SRH services and sexual education/information were perceived as needs and rights, and the participants were content with the new possibilities and the ‘new open society’. However, sexual education was not provided to most migrants, and SRH services provided to men had shortcomings that deprived some migrant men from fulfilling their needs. Moreover, internalised and cultural racism created a challenge to receive adequate/acceptable SRH services. There is a need to provide comprehensive sexual education for all, strengthen SRH services provided to men, and develop an action plan to reinforce the anti-discrimination/racism policies in healthcare and society.

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  • 5.
    Baroudi, Mazen
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Goicolea, Isabel
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Hurtig, Anna-Karin
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    The good, the bad and the why; how do Arabic-speaking migrant men perceive and experience information and services related to sexual and reproductive health in SwedenManuscript (preprint) (Other (popular science, discussion, etc.))
  • 6.
    Baroudi, Mazen
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Goicolea, Isabel
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Hurtig, Anna-Karin
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    San Sebastian, Miguel
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Social factors associated with trust in the health system in northern Sweden: a cross-sectional study2022In: BMC Public Health, E-ISSN 1471-2458, Vol. 22, no 1, article id 881Article in journal (Refereed)
    Abstract [en]

    Background: Despite the importance of having trust in the health system, there is a paucity of research in this feldin Sweden. The aim of this study was to estimate the level of trust in the health system and to assess the factors asso‑ciated with it in northern Sweden.

    Methods: A cross-sectional survey was conducted in 2014 in the four northern regions of Sweden. A total of 24 795 participants (48% response rate) aged 18 to 84 years were involved in the study. A log-binomial regression was usedto measure the association between sociodemographic factors and trust in the health system.

    Results: Two thirds of the participants (68.5%) reported high trust in the health system i.e. had very much or quitea lot confdence in the health system. Women had lower prevalence of trust compared to men (PR=0.96; 95%CI=0.94–0.98) while older participants had a higher trust compared to youth (PR=1.11; 95% CI=1.06–1.16). Participants with lower level of education, those who experienced economic stress, those who were born outside Swedenand those living in small municipalities also had lower prevalence of trust in the health system. Conversely, lowerincome was associated with higher trust (PR=1.08; 95% CI=1.04–1.12). Finally, a strong relationship between highersocial capital (having emotional and instrumental support, horizontal trust, and higher social participation) and trustin the health system was also found.

    Conclusions: Trust in the health system was moderately high in northern Sweden and strongly associated withsociodemographic and social capital factors. Trust is a complex phenomenon and a deeper exploration of the relationbetween trust in the health system and sociodemographic factors is needed.

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  • 7.
    Baroudi, Mazen
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Hurtig, Anna-Karin
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Goicolea, Isabel
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    San Sebastian, Miguel
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Jonzon, Robert
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. The Public Health Agency of Sweden, Solna, Sweden.
    Nkulu Kalengayi, Faustine
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Young migrants' sexual rights in Sweden: a cross-sectional study2021In: BMC Public Health, E-ISSN 1471-2458, Vol. 21, no 1, article id 1618Article in journal (Refereed)
    Abstract [en]

    In national public health surveys including those assessing sexual and reproductive health, migrants generally tend to be underrepresented due to cultural, linguistic, structural and legal barriers, minimising the possibility to measure sexual rights' fulfilment in this group. This study aims to describe to what extent sexual rights of young migrants in Sweden are being fulfilled. A self-administered questionnaire was used to collect data from 1773 young (16 - 29 years) migrants by post, online, and at language schools and other venues. Sexual rights were operationalised and categorised into five domains adapted from the Guttmacher-Lancet Commission's definition. These domains included the right to: 1) access sexual and reproductive healthcare, 2) access information and education about sexuality and sexual and reproductive health and rights, 3) have bodily integrity, 4) make free informed decisions about sexuality and sexual relations and 5) have a satisfying and safe sexual life. Descriptive analysis was used to assess the extent of fulfilment for each right. There were wide variations in the fulfilment of sexual rights between subgroups and among the five domains. Most respondents rated their sexual health as good/fair, however, 6.3% rated their sexual health as bad/very bad. While most of those who visited related services were satisfied, 17.4% of respondents refrained from visiting the services despite their needs. Around four in ten respondents did not know where to get information about sexuality and sexual health. One-fourth of respondents reported sexual violence. Another 12.7% were limited by family members or fellow countrymen regarding with whom they can have an intimate relationship. Most respondents were satisfied with their sexual life, except for 11.9%. Men, non-binary respondents, lesbians, gays, bisexuals, asexuals, those who were awaiting a decision regarding residence permit and those born in South Asia reported poor sexual health to a greater extent and fulfilment of their sexual rights to a lesser extent than other groups. Timely and culturally adapted information about sexual rights, gender equalities, laws and available services in Sweden should be provided in appropriate languages and formats in order to raise awareness about sexual rights and improve access to available services. Tailored attention should be paid to specific vulnerable subgroups.

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  • 8.
    Baroudi, Mazen
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Nkulu Kalengayi, Faustine
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Goicolea, Isabel
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Jonzon, Robert
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. The Public Health Agency of Sweden, Solna, Sweden.
    San Sebastian, Miguel
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Hurtig, Anna-Karin
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Access of Migrant Youths in Sweden to Sexual and Reproductive Healthcare: A Cross-sectional Survey2022In: International Journal of Health Policy and Management, E-ISSN 2322-5939, Vol. 11, no 3, p. 287-298Article in journal (Refereed)
    Abstract [en]

    Background: This study aims to assess migrant youths’ access to sexual and reproductive healthcare (SRHC) in Sweden, to examine the socioeconomic differences in their access, and to explore the reasons behind not seeking SRHC. 

    Methods: A cross-sectional survey was conducted for 1739 migrant youths 16 to 29 years-old during 2018. The survey was self-administered through: ordinary post, web survey and visits to schools and other venues. We measured access as a 4-stage process including: healthcare needs, perception of needs, utilisation of services and met needs. 

    Results: Migrant youths faced difficulties in accessing SRHC services. Around 30% of the participants needed SRHC last year, but only one-third of them fulfilled their needs. Men and women had the same need (27.4% of men [95% CI: 24.2, 30.7] vs. 32.7% of women [95% CI: 28.2, 37.1]), but men faced more difficulties in access. Those who did not categorise themselves as men or women (50.9% [95% CI: 34.0, 67.9]), born in South Asia (SA) (39% [95% CI: 31.7, 46.4]), were waiting for residence permit (45.1% [95% CI: 36.2, 54.0]) or experienced economic stress (34.5% [95% CI: 30.7, 38.3]) had a greater need and found more difficulties in access. The main difficulties were in the step between the perception of needs and utilisation of services. The most commonly reported reasons for refraining from seeking SRHC were the lack of knowledge about the Swedish health system and available SRHC services (23%), long waiting times (7.8%), language difficulties (7.4%) and unable to afford the costs (6.4%). 

    Conclusion: There is an urgent need to improve migrant youths’ access to SRHC in Sweden. Interventions could include: increasing migrant youths’ knowledge about their rights and the available SRHC services; improving the acceptability and cultural responsiveness of available services, especially youth clinics; and improving the quality of language assistance services.

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  • 9.
    Baroudi, Mazen
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Petersen, Solveig
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Namatovu, Fredinah
    Umeå University, Faculty of Arts, Department of historical, philosophical and religious studies.
    Annelie, Carlsson
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Norström, Fredrik
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Preteen children’s health related quality of life in Sweden: changes over time and disparities between different sociodemographic groups2019In: BMC Public Health, E-ISSN 1471-2458, Vol. 19, article id 139Article in journal (Refereed)
    Abstract [en]

    Background: Assessing disparities in health-related quality of Life (HRQoL) is important as a part of health-related disparities in the society. The aim of this study was to explore HRQoL among 12-year-olds in Sweden in terms of differences between years 2005 and 2009 and disparities related to sociodemographic background.

    Methods: During the school years 2005 and 2009, a total of 18,325 sixth grade students in Sweden were invited to a celiac disease screening study; 13,279 agreed to participate. Jointly with the celiac screening, the children answered a questionnaire that included EuroQol 5 Dimensions-youth (EQ-5D-Y) and their parents responded to separate questionnaires about their own and their child’s country of birth, family structure, their employment status, occupation, and education. In total 11,009 child-parent questionnaires were collected. Logistic regression was used to study differences in HRQoL between 2005 and 2009, and between various sociodemographic subgroups.

    Results: Compared with 2005, children in 2009 reported more pain (OR: 1.20, 95% CI: 1.1–1.3) and more mood problems (OR: 1.35, 95% CI: 1.2–1.5). In general, girls reported more pain and mood problems and had more disparities than boys. There were no significant differences based on parents’ occupation, however, children of parents with low or medium education levels reported less “mood problems” than those of parents with high education levels (OR: 0.65, 95% CI: 0.46–0.92) and (OR: 0.84, 95% CI: 0.73–0.96), respectively. A slight variation was seen in HRQoL between children with different migration background. Girls living in small municipalities reported more pain (OR: 1.51, 95% CI: 1.14–2.01), and problems performing usual activities (OR: 3.77, 95% CI: 2.08–6.84), compared to girls living in large municipalities. In addition, children living with two parents had less mood problems than children living in other family constellations.

    Conclusion: More children reported pain and mood problems in 2009 compared with 2005. To study future trends, health outcomes among children in Sweden should continue to be reported periodically. More efforts should be invested to increase the awareness of health-related disparities as highlighted in this study especially for girls living in small municipalities and children of parents with high education level.

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  • 10.
    Baroudi, Mazen
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    San Sebastian, Miguel
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Hurtig, Anna-Karin
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Goicolea, Isabel
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    The perception of youth health centres' friendliness: does it differ between immigrant and Swedish-Scandinavian youths?2020In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 30, no 4, p. 780-785Article in journal (Refereed)
    Abstract [en]

    Background: Ensuring a good quality service and equal access according to need for all young people is a key objective of the Swedish health system. The aim of this study was to explore youths’ perception of youth health centres’ (YHCs’) friendliness and to assess the differences in perception between immigrant and Swedish-Scandinavian youths.

    Methods: All YHCs in the four northern counties in Sweden were invited (22 centres), and 20 agreed to participate. Overall, 1089 youths aged 16–25 years answered the youth-friendly health services-Sweden questionnaire between September 2016 and February 2017. Thirteen sub-domains of friendliness were identified and their scores were calculated. Multilevel analysis was used to examine the differences in perception between immigrant and Swedish-Scandinavian youths.

    Results: Our sample consisted of 971 Swedish-Scandinavian youths (89.2%) and 118 immigrants (10.8%). Generally, both groups perceived the services to be very friendly. All 13 sub-domains were rated more than three in a four-point scale except for fear of exposure and parental support of psychosocial services. However, immigrant youths perceived YHCs less friendly than their counterparts, particularly regarding the domains of equity, respect, quality and parental support.

    Conclusions: Our study suggests that even though youths perceived YHCs as highly friendly, there is a space for improvement regarding access to health care. Our findings highlight the importance of an open and culturally sensitive attitude of the staff and the need to engage parents and community as a key to improve immigrant youths’ accessibility to health care.

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  • 11.
    Baroudi, Mazen
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Stoor, Jon Petter
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Centre for Sami Health Research, Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
    Blåhed, Hanna
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Edin, Kerstin
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Hurtig, Anna-Karin
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Men and sexual and reproductive healthcare in the Nordic countries: a scoping review2021In: BMJ Open, E-ISSN 2044-6055, Vol. 11, no 9, article id e052600Article, review/survey (Refereed)
    Abstract [en]

    Context: Men generally seek healthcare less often than women and, other than traditional gender norms, less is known about the explanation. The aim was to identify knowledge gaps and factors influencing men regarding sexual and reproductive healthcare (SRHC) in the Nordic countries.

    Methods: We searched PubMed and SveMed+ for peer-reviewed articles published between January 2010 and May 2020. The analyses identified factors influencing men’s experiences of and access to SRHC.

    Results: The majority of the 68 articles included focused on pregnancy, birth, infertility and sexually transmitted infections including HIV. During pregnancy and childbirth, men were treated as accompanying partners rather than individuals with their own needs. The knowledge and attitudes of healthcare providers were crucial for their ability to provide SRHC and for the experiences of men. Organisational obstacles, such as women-centred SRHC and no assigned healthcare profession for men’s sexual and reproductive health issues, hindered men’s access to SRHC. Lastly, the literature rarely discussed the impact of health policies on men’s access to SRHC.

    Conclusions: The literature lacked the perspectives of specific groups of men such as migrants, men who have sex with men and transmen, as well as the experiences of men in SRHC related to sexual function, contraceptive use and gender-based violence. These knowledge gaps, taken together with the lack of a clear entry point for men into SRHC, indicate the necessity of an improved health and medical education of healthcare providers, as well as of health system interventions.

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  • 12.
    Baroudi, Mazen
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Waenerlund, Anna-Karin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    San Sebastian, Miguel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Goicolea, Isabel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Assessing the dimensionality of YFHS-Swe; a new questionnaire to assess youth friendliness2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no suppl_3, p. 343-Article in journal (Other academic)
    Abstract [en]

    Background: Ensuring the youth friendliness of health services can increase the utilization of these services and contribute to improve youth’s health. Few validated instruments to assess youth-friendliness exist worldwide and none in Sweden. To assess the youth-friendliness of Swedish youth clinics (differentiated services for youth that exist since the 70s), an adapted version of YFHS WHO+ questionnaire called (YFHS-Swe) was developed. YFHS-Swe proved to have good internal homogeneity and consistency over time. The aim of our study was to perform a psychometric analysis to assure the quality and reliability of the questionnaire, and to assess the dimensionality of YFHS-Swe to identify possible subdomains that might be of importance for policy making.

    Methods: YFHS-Swe was answered by 1,110 youths aged 16 to 25 years visiting 20 youth clinics in Northern Sweden between September 2016 and February 2017. YFHS-Swe was assessed using exploratory and confirmatory factor analysis.

    Results: Thirteen factors could be identified; ability to get contact; access to sexual and reproductive health (SRH) service; access to psychosocial health services; parental support of SRH services; parental support of psychosocial health services; equity with diverse concerns; equity with legal concerns; fear of exposure; respect; privacy and confidentiality; no judgement; quality of consultation and quality of facility. Except for “quality of facility”, all other twelve factors recorded good α reliability ranging from 0.76 to 0.97, good ρ reliability ranging from 0.77 to 0.97 and acceptable measure of fit (SRMR<0.08).

    Conclusions: The YFHS-Swe proved to be credible and suitable for assessing youths-friendliness of the Swedish youth clinics. The identified factors might be of an importance to capture different dimensions of youth friendliness. With some cultural and linguistic adaptations, this instrument can be used in other differentiated youth health services internationally.

    Key messages:

    • YFHS-Swe is credible and suitable instrument in the Swedish context and it can be used as a basis for validating other instruments to assess youth-friendliness in other contexts.
    • The dimensions identified of this novel instrument might be of importance in assessing distinct aspects of friendliness in differentiated health services and might be of importance for policy making.
  • 13.
    Baroudi, Mazen
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Waenerlund, Anna-Karin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    San Sebastián, Miguel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Goicolea, Isabel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Assessing the dimensionality of YFHS-Swe: a questionnaire to assess youth-friendliness in differentiated health services2017In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, no 1, article id 1380399Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to assess the dimensionality of YFHS-Swe and identify possible unique factors in the evaluation of youth-friendliness. YFHS-Swe was answered by 1110 youths aged 16 to 25 years visiting youth clinics in Northern Sweden. Thirteen factors were identified by exploratory factor analysis and except for one factor they all proved to fit well and have good reliability when assessed by the confirmatory factor analysis. The YFHS-Swe proved to be credible and suitable for assessing youth-friendliness of differentiated health services in Sweden. With cultural and linguistic adaptations, it can be used in similar settings internationally.

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  • 14.
    Birabwa, Catherine
    et al.
    Department of Health Policy, Planning and Management, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda.
    Chemonges, Dennis
    Department of Programs, Population Services International Uganda, Kampala, Uganda; Department of Epidemiology and Biostatistics, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda.
    Tetui, Moses
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Department of Health Policy, Planning and Management, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda; School of Pharmacy, Waterloo University, Waterloo, ON, Canada.
    Baroudi, Mazen
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Namatovu, Fredinah
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Akuze, Joseph
    Department of Health Policy, Planning and Management, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
    Makumbi, Fredrick
    Department of Epidemiology and Biostatistics, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda.
    Ssekamatte, Tonny
    Department of Disease Control and Environmental Health, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda.
    Atuyambe, Lynn
    Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda.
    Hernandez, Alison
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Sewe, Maquins Odhiambo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Knowledge and information exposure about family planning among women of reproductive age in informal settlements of Kira municipality, Wakiso district, Uganda2021In: Epidemiologic Methods, ISSN 2194-9263, E-ISSN 2161-962X, Vol. 2, article id 650538Article in journal (Refereed)
    Abstract [en]

    Introduction: A high unmet need for family planning (FP) prevails in sub-Saharan Africa. Knowledge, awareness creation, and ensuring accessibility are frequently used to increase FP uptake. However, evidence on knowledge or information dissemination about FP among marginalized populations in urban settings in Africa is limited. This study explored the knowledge of FP methods, media exposure, and contact with FP providers among women from an informal settlement in Uganda.

    Methods: Using a cross-sectional study design, we interviewed 626 women aged 15–49 years living in informal settlements of Kira municipality, selected through multistage sampling. Using a standard questionnaire, data was collected on socioeconomic characteristics, knowledge of FP methods, and access to media FP messages among others. Binomial log-linear regression was used to assess disparities in exposure to media FP messages or provider information. Data were analyzed using STATA version 14, at a 5% level of statistical significance.

    Results: Nearly all women in the survey were aware of FP methods (99.7%). On average, each woman was aware of 10 FP methods. The most commonly known methods were male condoms (98.2%), injectables (97.4%), and the oral contraceptive pill (95.2%). Use of any contraceptive was found among 42.7% of respondents. Exposure to media was found in 70.6% of the respondents, mostly through television (58.5%) and radio (58.3%). Discussing FP with a provider was significantly associated with media exposure (aPR 1.4, 95% CI: 1.24–1.56). Less than 50% of women who were not using FP had contact with an FP provider. Women in union (aPR 1.6, 95% CI: 1.01–2.68) and those with access to media messages (aPR 2.5, 95% CI: 1.37–4.54) were more likely to have contact with a provider to discuss FP.

    Conclusion: There is high general awareness about FP methods and media exposure, but method use was low. Further exploration of women's understanding of FP methods and the fit between existing education programs and FP knowledge needs in this urban setting should be conducted. The potential for mobile health solutions in this urban population should be explored. Future studies should focus on the knowledge and understanding of FP among unmarried and nulliparous women and those with no access to media information.

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  • 15.
    Hintermeier, M.
    et al.
    General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany; Population Medicine and Health Research, Bielefeld University, Bielefeld, Germany.
    Pernitez-Agan, S.
    International Organization of Migration, United Nations, Manila, Philippines.
    Lopez, J.
    International Organization of Migration, United Nations, Manila, Philippines.
    Wickramage, K.
    International Organization of Migration, United Nations, Manila, Philippines.
    Gottlieb, N.
    Population Medicine and Health Research, Bielefeld University, Bielefeld, Germany.
    Baroudi, Mazen
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Rohleder, S.
    Population Medicine and Health Research, Bielefeld University, Bielefeld, Germany.
    Flores, S.
    Department of Public Health and Caring Sciences, Stockholm University, Stockholm, Sweden.
    Mohsenpour, A.
    Population Medicine and Health Research, Bielefeld University, Bielefeld, Germany.
    Bozorgmehr, K.
    General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany; Population Medicine and Health Research, Bielefeld University, Bielefeld, Germany.
    Covid-19 among migrants, refugees, and internally displaced persons: systematic review and synthesis of the global empirical literature2023In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 33, no Supplement_2, article id ckad160.550Article in journal (Refereed)
    Abstract [en]

    National pandemic response and preparedness plans aim at mitigating the spread of infectious diseases and protecting public health. Yet, they often fail to consider migrants. Evidence from the pandemic's early phase indicates that migrants are disproportionally affected by the Covid-19 pandemic and its consequences. Yet, synthesized evidence quantifying the magnitude of inequalities in infection risk, consequences of disease, or consequences of public health measures is lacking. We conducted a systematic review of the literature from 12/2019 to 11/2021 to synthesise the empirical evidence in this field. We considered all types of articles and study designs. The synthesis of evidence was divided into qualitative and quantitative analysis. Out of 6961 studies we included 243 to describe the heterogenous research landscape in terms of design, population, country context, and outcomes reported. The qualitative synthesis (n = 44) highlights the complex interplay of social and Covid-19 related factors at macro-, meso- and micro-level, resulting in high exposure, risk of infection, impacts of public health measures, and health impacts for migrants. The meta-analysis of n = 45 quantitative studies shows that migrants have an elevated risk of infection (RR: 2.46 (95%CI: 1.96-3.07)) compared to non-migrants, but a similar risk of hospitalization (RR: 1.05 (95%CI: 0.80-1.37)). Among those hospitalized, migrants have a lower risk of mortality (RR: 0.57 (95%CI: 0.32-1.03)). Yet, population-based excess mortality tends to be higher among migrants compared to non-migrants (RR: 1.30 (95%CI: 0.90-1.89)). Overall, high heterogeneity in reporting and quality of primary studies hampered the comparability of data. The qualitative results highlight the syndemic nature of the crisis, with cascading effects and interactions among socio-economic and health inequalities. They also illustrate the lack of evidence on some migrant categories, e.g., labor migrants, undocumented migrants, and returnees.

  • 16.
    Hintermeier, Maren
    et al.
    Section Health Equity Studies & Migration, Department of Primary Care and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany; Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany.
    Gottlieb, Nora
    Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany.
    Rohleder, Sven
    Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany.
    Oppenberg, Jan
    Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany.
    Baroudi, Mazen
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Pernitez-Agan, Sweetmavourneen
    Migration Health Division, International Organization for Migration, Paseo de Roxas, Makati City, Philippines.
    Lopez, Janice
    Migration Health Division, International Organization for Migration, Paseo de Roxas, Makati City, Philippines.
    Flores, Sergio
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Mohsenpour, Amir
    Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany.
    Wickramage, Kolitha
    UN Migration Agency, Global Data Institute, Migration Health Division, International Organization for Migration, Berlin, Germany.
    Bozorgmehr, Kayvan
    Section Health Equity Studies & Migration, Department of Primary Care and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany; Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany.
    COVID-19 among migrants, refugees, and internally displaced persons: systematic review, meta-analysis and qualitative synthesis of the global empirical literature2024In: eClinicalMedicine, E-ISSN 2589-5370Article in journal (Refereed)
    Abstract [en]

    Background: Evidence amounted early that migrants, who are often side-lined in pandemic response or preparedness plans, are disproportionately affected by the COVID-19 pandemic and its consequences. However, synthesised evidence that quantifies the magnitude of inequalities in infection risk, disease outcomes, consequences of pandemic measures or that explains the underlying mechanisms is lacking.

    Methods: We conducted a systematic review searching 25 databases and grey literature (12/2019 to 09/2023) and considered empirical articles covering migrants, refugees, asylum-seekers, and internally displaced persons reporting COVID-19 cases, hospitalisation, ICU admission, mortality, COVID-19 vaccination rates or health consequences of pandemic measures. Random-effects meta-analysis of observational studies and qualitative analysis were performed for evidence synthesis. A protocol was registered with PROSPERO (CRD42021296952).

    Findings: Out of 17,088 records, we included 370 reports in the review. For the quantitative studies (n = 65; mainly from high income countries), meta-analysis with over 53 million participants studied showed that, compared to non-migrants, migrants have an elevated risk of infection (RR = 1.84; 95%-CI: 1.44–2.35) but similar risk for hospitalisation (RR = 1.10; 0.91–1.33), while the probability of ICU admission was higher (RR = 1.23; 0.99–1.52). Among those hospitalised, migrants had a lower risk of mortality (RR = 0.56; 0.42–0.76), while their population-based mortality tended to be higher (RR = 1.46; 0.95–2.26). The qualitative synthesis (n = 75) highlighted the complex interplay of social and COVID-19-related factors at different levels. This involved increased exposure, risk, and impact of pandemic measures that compromised the health of migrants.

    Interpretation: Even in the advanced stages of the pandemic, migrants faced higher infection risks and disproportionately suffered from the consequences of COVID-19 disease, including deaths. Population-level interventions in future health emergencies must better consider socio-economic, structural and community-level exposures to mitigate risks among migrants. Enhancing health information systems is crucial, as the lack of migration variables makes it difficult to close coverage gaps, leaving migrants largely ‘invisible’ in official data.

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  • 17. Hintermeier, Maren
    et al.
    Gottlieb, Nora
    Rohleder, Sven
    Oppenberg, Jan
    Baroudi, Mazen
    Pernitez-Agan, Sweetmavourneen
    Lopez, Janice
    Flores, Sergio
    Mohsenpour, Amir
    Wickramage, Kolitha
    Bozorgmehr, Kayvan
    COVID-19 among migrants, refugees, and internally displaced persons: systematic review, meta-analysis and qualitative synthesis of the global empirical literature2024In: eClinicalMedicine, ISSN 2589-5370, p. 102698-102698, article id 102698Article in journal (Refereed)
  • 18.
    Lukyamuzi, Zubair
    et al.
    Makerere University–Johns Hopkins University Research Collaboration, Kampala, Uganda; School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
    Nabisere, Ruth Mirembe
    Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.
    Nakalega, Rita
    Makerere University–Johns Hopkins University Research Collaboration, Kampala, Uganda.
    Atuhaire, Patience
    Makerere University–Johns Hopkins University Research Collaboration, Kampala, Uganda.
    Kataike, Hajira
    Makerere University–Johns Hopkins University Research Collaboration, Kampala, Uganda.
    Ssuna, Bashir
    Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda; Department of Clinical Epidemiology and Biostatistics, College of Health Sciences, Makerere University, Kampala, Uganda.
    Baroudi, Mazen
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Kiweewa, Flavia Matovu
    Makerere University–Johns Hopkins University Research Collaboration, Kampala, Uganda.
    Musoke, Philippa
    Makerere University–Johns Hopkins University Research Collaboration, Kampala, Uganda.
    Butler, Lisa M.
    Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA.
    Community health workers improve HIV disclosure among HIV-affected sexual partners in rural Uganda: a quasi-experimental study2022In: Global Health: Science and Practice (GHSP), ISSN 2169-575X , Vol. 10, no 5, article id e2100631Article in journal (Refereed)
    Abstract [en]

    Background: We evaluated the efficacy of a community health worker (CHW)–led intervention in supporting disclosure among adults living with HIV in heterosexual relationships.

    Methods: We conducted a quasi-experimental study with 2 arms allocated by geographically determined clusters and adjusted for between-group differences among adults living with HIV in the greater Luwero region of Uganda who had never disclosed their status to their current primary sexual partners. Clusters were allocated to either a CHW-led intervention or a control arm. In both arms, participants were consecutively recruited. As opposed to receiving routine care for the control arm, participants in the intervention arm received additional CHW disclosure support. The overall follow-up was 6 months, and the primary outcome was disclosure to the sexual partner. Data were analyzed using a clustered modified Poisson regression model with robust standard errors to determine independent factors associated with disclosure.

    Results: Of the 245 participants who enrolled, 230 (93.9%) completed the study, and 112 (48.7%) of those were in the intervention arm. The median age was 30 (interquartile range=25–37) years, the majority were women (76.5%), and most (80%) did not know their partners’ HIV status at study entry. At the end of follow-up, the overall disclosure prevalence was 74.4% (95% confidence interval [CI]=68.2, 79.9) and participants in the intervention arm were 51% more likely to disclose compared to those in the control (adjusted relative ratio [aRR]=1.51; 95% CI=1.28, 1.77). Men were 24% (aRR=1.24; 95% CI=1.07, 1.44) more likely to disclose compared to women, and membership in an HIV/AIDS association increased disclosure by 18% (aRR=1.18; 95% CI=1.01, 1.39).

    Conclusion: CHW support improved disclosure among adults living with HIV in heterosexual relationships when compared to routine care. Therefore, CHW-led mechanisms may be utilized in increasing disclosure among adults living with HIV in heterosexual relationships in rural settings.

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  • 19.
    Lukyamuzi, Zubair
    et al.
    Makerere University, Johns Hopkins University Collaboration (MU-JHU), Kampala, Uganda.
    Tetui, Moses
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. School of Pharmacy, Waterloo University, Waterloo, ON, Canada; Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda.
    Fonseca Rodriguez, Osvaldo
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Atuyambe, Lynn
    Department of Community Health and Behavioural Sciences Makerere University School of Public Health, Kampala, Uganda.
    Makumbi, Fredrick Edward
    Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda.
    Baroudi, Mazen
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Quality of care in family planning services: differences between formal and informal settlements of Kira municipality, Uganda2021In: Epidemiologic Methods, ISSN 2194-9263, E-ISSN 2161-962X, Vol. 2, article id 656616Article in journal (Refereed)
    Abstract [en]

    Background: Quality of care (QoC) of family planning (FP) affects contraceptive use, and it varies across types of urban settlement. This study assesses the difference in service delivery point (SDP) structural and process factors between formal and informal urban settlements, and the opinion of the client on the QoC in informal settlements. This is useful in creating an evidence base to advocate for better quality services for the most vulnerable in society.

    Methods: This was a cross-sectional survey that included SDPs of Kira municipality in Wakiso district, Uganda. Data were collected from all the service points in Kira municipality with the caretakers consented. In addition, using multi-stage sampling, 626 women of reproductive age (15–49 years) who lived in the informal settlements of Kira municipality were interviewed. Data were collected using structured questionnaires, descriptive analysis was carried out in Stata version 14.0, and Chi-square and t-tests were used to compare the informal with the formal settlements.

    Results: Formal settlements generally had more higher-level SDPs compared to informal settlements (value of p < 0.001). SDPs in the formal settlements provided more FP methods and had more community health workers (CHW) to support their work. Also, SDPs in the formal settlements were more likely to have long-term FP methods available and more likely to have trained personnel to insert and remove implants and IUDs compared to those in informal settlements. Additionally, more SDPs in the formal settlements provided counseling for permanent, long-term, and short-term FP methods. Of the 626 interviewed women, most of the women (68.6%) reported that they would not return to the previous FP provider or refer a friend to the same provider (72.7%).

    Conclusions: There is a lower quality FP services in the informal settlements with a commensurable effect on the client satisfaction with the services. Therefore, improving the quality of FP services in informal settlements should be a top priority. Improved quality of services could act as a motivation to increase the uptake of modern contraceptives in such settings.

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  • 20. Mengesha, Zelalem
    et al.
    Hawkey, Alexandra J.
    Baroudi, Mazen
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Ussher, Jane M.
    Perz, Janette
    Men of refugee and migrant backgrounds in Australia: a scoping review of sexual and reproductive health research2023In: Sexual Health, ISSN 1448-5028, E-ISSN 1449-8987, Vol. 20, no 1, p. 20-34Article, review/survey (Refereed)
    Abstract [en]

    Australia’s National Men’s Health Strategy 2020–2030 identifies refugee and migrant men from culturally and lingustically diverse backgrounds as priority groups for sexual and reproductive health (SRH) interventions. The paucity of SRH research focusing on refugee and migrant men is a significant gap to advance men’s health and policy. Hence, this review aimed to synthesise the available evidence on refugee and migrant men’s SRH needs, understandings and experiences of accessing services after resettlement in Australia. A systematic search of peer reviewed literature in PubMed, Scopus, and PsyInfo was made. A World Health Organization framework for operationalising sexual health and its relationship with reproductive health was used to map the identified studies. The socio-ecological framework was applied to thematically synthesise data extracted from individual studies and identify factors that influence the SRH of refugee and migrant men. We included 38 papers in the review. The majority of sexual health studies (16) were about sexually transmitted infections (STIs), mainly HIV (12), followed by sexual health education and information (5) and sexual functioning (3). Reproductive health studies focused on contraceptive counselling and provision (3), antenatal, intrapartum and postnatal care (1) and safe abortion care (1). Several factors influenced refugee and migrant men’s SRH, including a lack of access to SRH information, language barriers and stigma. We found that SRH literature on refugee and migrant men focuses on STIs, meaning other areas of SRH are poorly understood. We identified key gaps in research on experiences of, and access to, comprehensive SRH care.

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  • 21.
    Nkulu Kalengayi, Faustine
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Goicolea, Isabel
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Baroudi, Mazen
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Hurtig, Anna-Karin
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Migration, sexuell hälsa och hiv- och STI-prevention: en kartläggning av unga migranters sexuella och reproduktiva hälsa och rättigheter i Sverige2020Report (Other academic)
  • 22.
    Nkulu Kalengayi, Faustine Kyungu
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Baroudi, Mazen
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Hurtig, Anna-Karin
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Prevalence of perceived discrimination, determinants and associations with self-rated general and sexual health, healthcare utilization and self-perceived integration: a cross-sectional survey of migrants in Sweden2024In: BMC Public Health, E-ISSN 1471-2458, Vol. 24, article id 699Article in journal (Refereed)
    Abstract [en]

    Background: Sweden has welcomed migrants, but attitudes have shifted, becoming hostile due to populism and the growing number of migrants. This has left migrants feeling unwelcome and marginalized. Few studies have examined the extent to which migrants perceive discrimination, who, why, where and its relationships with different outcomes. This study has two aims: to assess the prevalence, reasons, and determinants of perceived discrimination among migrants (1) and its associations with self-rated health, sexual health, healthcare use, and integration (2).

    Methods: We analysed data from a 2018 survey on migrants' sexual and reproductive health and rights. The survey included 1740 migrants aged 16 or older. We used descriptive and log-binomial regression analyses to estimate prevalence, crude and adjusted prevalence ratios (APR) with 95% confidence interval (CI).

    Results: About 36% of participants perceived discrimination in Sweden, with ethnic origin (62%) and religion (35%) as main reasons. Perceived discrimination occurred in public spaces (47%), schools (33%), internet (20%), work (19%), public services (18%), residential areas (16%), and healthcare settings (10%). Migrant men (APR: 1.26, CI:1.07–1.49), born in Middle East and North Africa (APR: 1.57, CI:1.26–1.95) and South Asia (APR: 1.61, CI:1.27–2.04) regions, with more than 12 years of education (APR: 1.33, CI:1.10–1.60), a non-heterosexual orientation (APR: 1.21, CI: 1.02–1.43), a non-Christian religion (APR: 1.41, CI: 1.10–1.80), economic stress (APR:1.67, CI: 1.44–1.93) or Swedish language skills (APR: 1.24, CI:1.07–1.43) perceived discrimination more than their counterparts. In contrast, the oldest participants (46 years or more) perceived less discrimination (APR:0.55, CI: 0.37–0.80) than the youngest ones (16–25 years). Moreover, perceived discrimination was associated with poor self-rated general (APR:1.72, CI: 1.45–2.04) and sexual health (APR:1.40, CI:1.2–1.64), integration (APR:1.25, CI:1.14–1.37), and healthcare access (APR: 1.48, 1.16–1.89).

    Conclusions: This study shows that migrants in Sweden face widespread perceived discrimination based on ethnicity and religion. This can affect their health, healthcare use, and social integration. The study calls for policies and interventions that tackle systemic perceived discrimination, foster inclusion, and guarantee equal opportunities in accessing healthcare and resources for migrants. It also urges support for vulnerable groups who perceive more discrimination, such as migrants from certain regions or under economic stress.

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  • 23.
    Pettersson, Johanna
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Baroudi, Mazen
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Exploring barriers and strategies for improving sexual and reproductive health access for young men in Sweden: insights from healthcare providers in youth clinics2023In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 39, article id 100942Article in journal (Refereed)
    Abstract [en]

    Methods: Youth clinics in Sweden are not reaching young men to the same extent as young women. We conducted a qualitative study to explore healthcare providers’ (HCPs) perspectives on the barriers to young men’s access to sexual and reproductive health (SRH) services and how youth clinics can better accommodate the needs of young men. We used thematic analysis to analyze eight interviews with nine HCPs (three men and six women).

    Results: We developed three themes: 1) It’s about the youth clinics and those working in them—the clinics suffered from low organizational support, which affected their ability to accommodate young men’s needs and were perceived as “girls’ clinics”. Midwifery, which is the main profession of HCPs working with SRH in the clinics, was perceived as a women’s profession for women’s SRH; 2) It’s not all about the youth clinics—young men were perceived as lacking essential knowledge about SRH and gender norms were preventing young men from visiting youth clinics; 3) Organizational strategies for improving access—the participants discussed strategies to attract young men, including separate reception for young men, hiring more male staff, having higher age limits for young men, and digital solutions to address privacy concerns.

    Conclusion: There is a need for societal efforts to increase young men’s knowledge about SRH and improve their access to SRH services. Several strategies can be adapted by youth clinics to attract more young men but there is need for further research to design and evaluate such interventions.

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  • 24.
    Teferi, Henok Mulatu
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    San Sebastian, Miguel
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Baroudi, Mazen
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Factors associated with home delivery preference among pregnant women in Ethiopia: a cross-sectional study2022In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 15, article id 2080934Article in journal (Refereed)
    Abstract [en]

    Background: Home delivery is associated with a high risk of maternal and neonatal mortality. The prevalence and factors associated with home delivery have been studied retrospectively among women in Ethiopia. However, no national studies have assessed pregnant women’s preferences for home delivery.

    Objective: To assess factors associated with preferences for home delivery among pregnant women in Ethiopia.

    Methods: We analysed a sample of 678 pregnant women derived from the 2019 performance monitoring for action cross-sectional survey. The association between pregnant women’s preferences for home delivery and several individual, household, healthcare, and community factors were explored through log-Poisson regression with robust variance.

    Results: The weighted prevalence of pregnant women’s preferences for home delivery in Ethiopia was 33%. Pregnant women between the ages of 15–19 years (PR = 2.3; 95% CI: 1.43–4.00) had a higher preference for home delivery compared to those above 34 years. Those who had no Antenatal care (ANC) visit in the current pregnancy (PR = 1.5; 95% CI: 1.11–2.11), multipara women (PR = 1.8; 95% CI: 1.19–2.92) those who did not discuss place of delivery with their partners (PR = 1.5; 95% CI: 1.18–2.10), did not participate in a community-based program called ‘1 to 5’ network meetings (PR = 4.5; 95% CI: 1.09–18.95), and those who perceived low community support for facility delivery (PR = 2.2; 95% CI: 1.53–3.20) had a higher prevalence of home delivery preference compared to their references.

    Conclusions: A significant proportion of pregnant women preferred home deliveries in Ethiopia. Household and community supporting factors such as not discussing place of delivery with a partner, not participating in women developmental army meetings, and perceived low community support were associated with preference for home delivery. Interventions should address these factors to increase facility deliveries in Ethiopia.

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  • 25.
    Tetui, Moses
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. School of Pharmacy, Waterloo University, Waterloo, ON, Canada; Department of Health Policy, Planning and Management, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda.
    Baroudi, Mazen
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Ssekamatte, Tonny
    Department of Disease Control and Environmental Health, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda.
    Birabwa, Catherine
    Department of Health Policy, Planning and Management, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda.
    Kibira, Simon Peter
    Department of Community Health and Behavioral Sciences, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda.
    Atuyambe, Lynn
    Department of Community Health and Behavioral Sciences, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda.
    Delamou, Alexandre
    Africa Center of Excellence for Prevention and Control of Communicable Diseases (CEA-PCMT), Faculty of Science and Health Techniques, Gamal Abdel Nasser University of Conakry, Conakry, Guinea; National Training and Research Center in Rural Health of Maferinyah, Forecariah, Guinea.
    Makumbi, Fredrick Edward
    Department of Epidemiology and Biostatistics, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda.
    Total Demand, Use and Unmet Need for Modern Contraceptives Among Women Living in Informal Settlements in Kira Municipality, Wakiso District, Uganda: Implications for Urban Health2021In: Epidemiologic Methods, ISSN 2194-9263, E-ISSN 2161-962X, Vol. 2, article id 655413Article in journal (Refereed)
    Abstract [en]

    Background: Update and utilization of modern contraceptives has public health benefits including reduction of unintended pregnancies, unsafe abortions, and related maternal mortality. However, paucity of evidence on key indicators of family planning in the informal settlements abounds. Data are usually collapsed within the larger urban communities that tend to mask peculiarities of informal settlements. This study determined the proportion of women using modern contraceptives, the unmet need for modern contraceptives and the total demand in informal settlements of an urban municipality.

    Methods: A cross-sectional study conducted among 626 women in the reproductive age (15–49 years)  in the informal settlements of Kira municipality (part of metropolitan Kampala). Multi-stage sampling was applied in the selection of the respondents. Descriptive and log-binomial regression analysis were conducted to determine percentage of women using modern contraceptives, unmet need, and total demand with their associated factors. All analyses were conducted using STATA version 15.0.

    Results: The total demand for modern contraceptives was 84.9%, modern contraceptive prevalence was 47.4% nearly meeting the national target of 50%, however the unmet need was 37.3%, which much higher than the national target of 10%. Lower total demand for contraceptives was associated with higher women’s education status and preference to have another child, while higher total demand was associated with having at least one living child. Higher modern contraceptives use was associated with older age, having at least one living child and high decision-making power, while lower modern contraceptives use was associated with higher education and undetermined fertility preference. Lower unmet need for modern contraceptives was associated with older age (PR 0.68, 95% CI: 0.48–0.97) and high decision-making power (PR 0.64, 95% CI: 0.50–0.81), while higher unmet need was found among those who having at least one living child (PR 1.40, 95% CI: 1.01–1.93) and undetermined fertility preference (PR 1.70, 95% CI: 1.24–2.34).

    Conclusions: Total demand and contraceptive use were found to be higher in the informal settlements of Kira municipality, however, the unmet need was much higher among this population as compared to the national urban estimates. This indicates a much higher demand for contraceptives and the need to consider the diverse socio-demographic characteristics of urban spaces. Development of Interventions need to critically consider the diverse urban space, associated explanatory variables and a collaborative systems lens to achieve sustained improvements.

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