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  • 101.
    George, Asha
    et al.
    Univ Western Cape, Sch Publ Hlth, Bellville, South Africa.
    Tetui, Moses
    Makerere Univ, Makerere Univ Sch Publ Hlth MakSPH, New Mulago Complex, Kampala, Uganda; Umea Univ, Dept Publ Hlth & Clin Med, Epidemiol & Global Hlth Unit, Umea, Sweden.
    Pariyo, George W
    Johns Hopkins Univ, Johns Hopkins Bloomberg Sch Publ Hlth, Dept Int Hlth, Baltimore, MD USA.
    Peterson, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Maternal and newborn health implementation research: programme outcomes, pathways of change and partnerships for equitable health systems in Uganda.2017In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, no sup4, article id 1359924Article in journal (Refereed)
  • 102. George, Asha
    et al.
    Tetui, Moses
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Makerere University School of Public Health (MakSPH), Makerere University, Kampala, Uganda.
    Pariyo, George W.
    Peterson, Stefan S.
    Maternal and newborn health implementation research: programme outcomes, pathways of change and partnerships for equitable health systems in Uganda2017In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, article id 1359924Article in journal (Other academic)
  • 103. Gerritsen, Annette
    et al.
    Bocquier, Philippe
    White, Michael
    Mbacke, Cheikh
    Alam, Nurul
    Beguy, Donatien
    Odhiambo, Frank
    Sacoor, Charfudin
    Phuc, Ho Dang
    Punpuing, Sureeporn
    Collinson, Mark A
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Health and demographic surveillance systems: contributing to an understanding of the dynamics in migration and health2013In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 6, p. 1-6Article in journal (Refereed)
    Abstract [en]

    Background: Migration is difficult to measure because it is highly repeatable. Health and Demographic Surveillance Systems (HDSSs) provide a unique opportunity to study migration as multiple episodes of migration are captured over time. A conceptual framework is needed to show the public health implications of migration.

    Objective/design: Research conducted in seven HDSS centres [International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH) Network], published in a peer-reviewed volume in 2009, is summarised focussing on the age-sex profile of migrants, the relation between migration and livelihoods, and the impact of migration on health. This illustrates the conceptual structure of the implications of migration. The next phase is described, the Multi-centre Analysis of the Dynamics In Migration And Health (MADIMAH) project, consisting of workshops focussed on preparing data and conducting the analyses for comparative studies amongst HDSS centres in Africa and Asia. The focus here is on the (standardisation of) determinants of migration and the impact of migration on adult mortality.

    Results: The findings in the volume showed a relatively regular age structure for migration among all HDSS centres. Furthermore, migration generally contributes to improved living conditions at the place of origin. However, there are potential negative consequences of migration on health. It was concluded that there is a need to compare results from multiple centres using uniform covariate definitions as well as longitudinal analysis techniques. This was the starting point for the on-going MADIMAH initiative, which has increased capacity at the participating HDSS centres to produce the required datasets and conduct the analyses.

    Conclusions: HDSS centres brought together within INDEPTH Network have already provided strong evidence of the potential negative consequences of migration on health, which contrast with the beneficial impacts of migration on livelihoods. Future comparative evidence using standardised tools will help design policies for mitigating the negative effects, and enhancing the positive effects, of migration on health.

  • 104.
    Ghanean, Helia
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Nojomi, M.
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Public awareness and attitudes towards epilepsy in Tehran, Iran2013In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 6, p. 1-5Article in journal (Refereed)
    Abstract [en]

    Background: Epilepsy is a prototypical, stigmatised disorder. Numerous studies have been conducted regarding the public perception of epilepsy, but they are primarily from high-income western countries; few studies have taken place in low-to middle-income countries with a traditional culture and a religious orientation. Objective: The public knowledge and attitudes towards epilepsy in Tehran, Iran, is studied. Design: A survey of 800 subjects ranging from 18 to 85 years was randomly chosen from households in Tehran in 2009. The questionnaire used was based on the Caveness and Gallup's studies conducted in the United States in 1949 and it has been used in numerous similar studies all over the world. The mean age of the participants was 37.5 years and 46.7% were female. Pearson's Chi-squared test was used for subgroup analyses. Results: The majority of subjects cited brain disorders as a cause of epilepsy, while 17% indicated the will of God as the cause. Most individuals were willing to work with a person with epilepsy, allow their children to play with a child with epilepsy, and allow people with epilepsy to use public transportation (78-82%). However, only 28% were willing to accept the marriage of a family member to someone with epilepsy. Conclusion: The knowledge and attitudes towards epilepsy are similar to those in Europe, with the exception of a much lower acceptance regarding marriage to a person with epilepsy. However, the low acceptance for marrying someone with epilepsy reveals the remaining misconceptions about the nature of epilepsy in Iran, despite the high educational level in the studied population. Therefore, informational efforts must be employed to change the perception of epilepsy.

  • 105. Giang, Kim Bao
    et al.
    Dzung, Truong Viet
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Allebeck, Peter
    Prevalence of mental distress and use of health services in a rural district in Vietnam2010In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 3, p. 2025-Article in journal (Refereed)
    Abstract [en]

    Although there was a low prevalence of mental distress, the low use of mental health services indicated that there was a treatment gap in mental health care. Since many people used private services, intervention programs should include private providers to strengthen their capacity to provide mental health care for the community.

  • 106. Giang, Kim Bao
    et al.
    Oh, Juhwan
    Kien, Vu Duy
    Center for Population Health Sciences, Hanoi School of Public Health, Hanoi, Vietnam;.
    Hoat, Luu Ngoc
    Choi, Sugy
    Lee, Chul Ou
    Van Minh, Hoang
    Changes and inequalities in early birth registration and childhood care and education in Vietnam: findings from the Multiple Indicator Cluster Surveys, 2006 and 20112016In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 9, no 1, article id 29470Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Early birth registration, childhood care, and education are essential rights for children and are important for their development and education. This study investigates changes and socioeconomic inequalities in early birth registration and indicators of care and education in children aged under 5 years in Vietnam.

    DESIGN: The analyses reported here used data from the Vietnam Multiple Indicator Cluster Surveys (MICS) in 2006 and 2011. The sample sizes in 2006 and 2011 were 2,680 and 3,678 for children under 5 years of age. Four indicators of childcare and preschool education were measured: birth registration, possession of books, preschool education attendance, and parental support for early childhood education. The concentration index (CI) was used to measure inequalities in gender, maternal education, geographical area, place of residence, ethnicity, and household wealth.

    RESULTS: There were some improvements in birth registration (86.4% in 2006; 93.8% in 2011), preschool education attendance (57.1% in 2006; 71.9% in 2011), and parental support for early childhood education (68.9 and 76.8%, respectively). However, the possession of books was lower (24.7% in 2006; 19.6% in 2011) and became more unequal over time (i.e. CI=0.370 in 2006; CI=0.443 in 2011 in wealth inequality). Inequalities in the care and education of children were still persistent. The largest inequalities were for household wealth and rural versus urban areas.

    CONCLUSION: Although there have been some improvements in this area, inequalities still exist. Policy efforts in Vietnam should be directed towards closing the gap between different socioeconomic groups for the care and education of children under 5 years old.

  • 107. Giang, Pham Ngan
    et al.
    Dung, Do Van
    Bao Giang, Kim
    Vinhc, Hac Van
    Rocklöv, Joacim
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    The effect of temperature on cardiovascular disease hospital admissions among elderly people in Thai Nguyen Province, Vietnam2014In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, article id 23649Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Projected increases in weather variability due to climate change will have severe consequences on human health, increasing mortality, and disease rates. Among these, cardiovascular diseases (CVD), highly prevalent among the elderly, have been shown to be sensitive to extreme temperatures and heat waves. OBJECTIVES: This study aimed to find out the relationship between daily temperature (and other weather parameters) and daily CVD hospital admissions among the elderly population in Thai Nguyen province, a northern province of Vietnam. METHODS: Retrospective data of CVD cases were obtained from a data base of four hospitals in Thai Nguyen province for a period of 5 years from 2008 to 2012. CVD hospital admissions were aggregated by day and merged with daily weather data from this period. Distributed lag non-linear model (DLNM) was used to derive specific estimates of the effect of weather parameters on CVD hospital admissions of up to 30 days, adjusted for time trends using b-splines, day of the week, and public holidays. RESULTS: This study shows that the average point of minimum CVD admissions was at 26°C. Above and below this threshold, the cumulative CVD admission risk over 30 lag days tended to increase with both lower and higher temperatures. The cold effect was found to occur 4-15 days following exposure, peaking at a week's delay. The cumulative effect of cold exposure on CVD admissions was statistically significant with a relative risk of 1.12 (95% confidence interval: 1.01-1.25) for 1°C decrease below the threshold. The cumulative effect of hot temperature on CVD admissions was found to be non-significant and was estimated to be at a relative risk of 1.17 (95% confidence interval: 0.90-1.52) for 1°C increase in the temperature. No significant association was found between CVD admissions and the other weather variables. CONCLUSION: Exposure to cold temperature is associated with increasing CVD admission risk among the elderly population.

  • 108.
    Godefay, Hagos
    et al.
    Tigray Regional Health Bureau, Mekelle, Ethiopia.
    Abrha, Atakelti
    Tigray Regional Health Bureau, Mekelle, Ethiopia.
    Kinsman, John
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Myléus, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Institute of Applied Health Sciences, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, United Kingdom.
    Undertaking cause-specific mortality measurement in an unregistered population: an example from Tigray Region, Ethiopia2014In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, p. 25264-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The lack of adequate documentation of deaths, and particularly their cause, is often noted in African and Asian settings, but practical solutions for addressing the problem are not always clear. Verbal autopsy methods (interviewing witnesses after a death) have developed rapidly, but there remains a lack of clarity as to how these methods can be effectively applied to large unregistered populations. This paper sets out practical details for undertaking a representative survey of cause-specific mortality in a population of several million, taking Tigray Region in Ethiopia as a prototype.

    SAMPLING: Sampling was designed around an expected level of maternal mortality ratio of 400 per 100,000 live births, which needed measuring within a 95% confidence interval of approximately ±100. Taking a stratified cluster sample within the region at the district level for logistic reasons, and allowing for a design effect of 2, this required a population of around 900,000 people, equating to six typical districts. Since the region is administered in six geographic zones, one district per zone was randomly selected.

    IMPLEMENTATION: The survey was implemented as a two-stage process: first, to trace deaths that occurred in the sampled districts within the preceding year, and second to follow them up with verbal autopsy interviews. The field work for both stages was undertaken by health extension workers, working in their normally assigned areas. Most of the work was associated with tracing the deaths, rather than undertaking the verbal autopsy interviews.

    DISCUSSION: This approach to measuring cause-specific mortality in an unregistered Ethiopian population proved to be feasible and effective. Although it falls short of the ideal situation of continuous civil registration and vital statistics, a survey-based strategy of this kind may prove to be a useful intermediate step on the road towards full civil registration and vital statistics implementation.

  • 109.
    Goicolea, Isabel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Adolescent pregnancies in the Amazon Basin of Ecuador: a rights and gender approach to adolescents' sexual and reproductive health2010In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 3, article id 5280Article, review/survey (Refereed)
    Abstract [en]

    In the Andean region of Latin America over one million adolescent girls get pregnant every year. Adolescent pregnancy (AP) has been associated with adverse health and social outcomes, but it has also been favorably viewed as a pathway to adulthood. AP can also be conceptualized as a marker of inequity, since it disproportionately affects girls from the poorest households and those who have not been able to attend school. Using results from a study carried out in the Amazon Basin of Ecuador, this paper explores APs and adolescents' sexual and reproductive health from a rights and gender approach. The paper points out the main features of a rights and gender approach, and how it can be applied to explore APs. Afterward it describes the methodologies (quantitative and qualitative) and main results of the study, framing the findings within the rights and gender approach. Finally, some implications that could be generalizable to global research on APs are highlighted. The application of the rights and gender framework to explore APs contributes to a more integral view of the issue. The rights and gender framework stresses the importance of the interaction between rights-holders and duty-bearers on the realization of sexual and reproductive rights, and acknowledges the importance of gender-power relations on sexual and reproductive decisions. A rights and gender approach could lead to more integral and constructive interventions, and it could also be useful when exploring other sexual and reproductive health matters.

  • 110.
    Goicolea, Isabel
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Coe, Anna-Britt
    Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Hurtig, 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.
    Mechanisms for achieving adolescent-friendly services: a realist evaluation approach2012In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 5, p. 18748-Article in journal (Refereed)
    Abstract [en]

    Background: Despite evidence showing that adolescent-friendly health services (AFSs) increase young people's access to these services, health systems across the world are failing to integrate this approach.

    In Latin America, policies aimed at strengthening AFS abound. However, such services are offered only in a limited number of sites, and providers' attitudes and respect for confidentiality have not been addressed to a sufficient extent.

    Methods: The aim of this study was to explore the mechanisms that triggered the transformation of an 'ordinary' health care facility into an AFS in Ecuador. For this purpose, a realist evaluation approach was used in order to analyse three well-functioning AFSs. Information was gathered at the national level and from each of the settings including: (i) statistical information and unpublished reports; (ii) in-depth interviews and focus group discussions with policy makers, health care providers, users and adolescents participating in youth organisations and (iii) observations at the health care facilities. Thematic analysis was carried out, driven by the realist evaluation approach, namely exploring the connections between mechanisms, contexts and outcomes.

    Results: The results highlighted that the development of the AFSs was mediated by four mechanisms: grounded self-confidence in trying new things, legitimacy, a transformative process and an integral approach to adolescents. Along this process, contextual factors at the national and institutional levels were further explored.

    Conclusion: The Ministry of Health of Ecuador, based on the New Guidelines for Comprehensive Care of Adolescent Health, has started the scaling up of AFSs. Our research points towards the need to recognise and incorporate these mechanisms as part of the implementation strategy from the very beginning of the process.

    Although contextually limited to Ecuador, many mechanisms and good practices in these AFS may be relevant to the Latin American setting and elsewhere.

  • 111.
    Goicolea, Isabel
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Öhman, Ann
    Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS). Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Salazar Torres, Mariano
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Morras, Ione
    Medicus Mundi Gipuzkoa, San Sebastian, Spain.
    Edin, Kerstin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Condemning violence without rejecting sexism?: Exploring how young men understand intimate partner violence in Ecuador2012In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 5, p. 1-12Article in journal (Refereed)
    Abstract [en]

    Background: This study aims to explore young men's understanding of intimate partner violence (IPV) in Ecuador, examining similarities and differences between how ordinary and activist young men conceptualize IPV against women. Methods: We conducted individual interviews and focus group discussions (FGDs) with 35 young men - five FGDs and five interviews with ordinary young men, and 11 interviews with activists - and analysed the data generated using qualitative content analysis. Results: Among the ordinary young men the theme 'too much gender equality leads to IPV' emerged, while among the activists the theme 'gender inequality is the root of IPV'. Although both groups in our study rejected IPV, their positions differed, and we claim that this is relevant. While activists considered IPV as rooted in gender inequality, ordinary young men understood it as a response to the conflicts generated by increasing gender equality and women's attempts to gain autonomy.

  • 112.
    Goicolea, Isabel
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Öhman, Ann
    Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Vives-Cases, Carmen
    Intersections between gender and other relevant social determinants of health inequalities2017In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, article id 1397909Article in journal (Refereed)
  • 113.
    Gulliksen, Jan
    KTH, School of Computer Science and Communication (CSC), Media Technology and Interaction Design, MID.
    Institutionalizing human-computer interaction for global health2017In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, article id 1344003Article in journal (Refereed)
    Abstract [en]

    Digitalization is the societal change process in which new ICT-based solutions bring forward completely new ways of doing things, new businesses and new movements in the society. Digitalization also provides completely new ways of addressing issues related to global health. This paper provides an overview of the field of human-computer interaction (HCI) and in what way the field has contributed to international development in different regions of the world. Additionally, it outlines the United Nations' new sustainability goals from December 2015 and what these could contribute to the development of global health and its relationship to digitalization. Finally, it argues why and how HCI could be adopted and adapted to fit the contextual needs, the need for localization and for the development of new digital innovations. The research methodology is mostly qualitative following an action research paradigm in which the actual change process that the digitalization is evoking is equally important as the scientific conclusions that can be drawn. In conclusion, the paper argues that digitalization is fundamentally changing the society through the development and use of digital technologies and may have a profound effect on the digital development of every country in the world. But it needs to be developed based on local practices, it needs international support and to not be limited by any technological constraints. Particularly digitalization to support global health requires a profound understanding of the users and their context, arguing for user-centred systems design methodologies as particularly suitable.

  • 114.
    Gustafsson, Cecilia
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). Umeå University, Faculty of Social Sciences, Department of Geography and Economic History.
    ‘“For a better life …“ A study on migration and health in Nicaragua’2018In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 11, no 1, article id 1428467Article, review/survey (Refereed)
    Abstract [en]

    Background: Nicaraguans have migrated internally and internationally for centuries due to economic, political and sociocultural factors. Deficiencies in the country’s health care system have produced inequities in people’s access to health care and medicines. Remittances have become an important source of income, partly invested in health.

    Objectives: The overall aim of the study was to analyse migration–health relations in contemporary Nicaragua within a broader context of socio-economic transformations.

    Methods: The study uses a mixed-methods approach, combining qualitative interview data and quantitative survey data.

    Results: The findings show that migration is commonly practised as a strategy for making a living and is related to the struggle for a better life. Health concerns are indirectly embedded in people’s mobile livelihoods, but also directly influence migration motives. Furthermore, migration involves both advantages and disadvantages for health. Physical and sexual violence can come to an end for migrating women, health care and medicine can become more accessible for internal migrants, and vulnerabilities caused by environmental disasters can be avoided by moving. Moreover, remittances can improve people’s everyday life and health. Yet migration can also be a stressful and health-damaging event. International migrants, particularly the undocumented, can have problems accessing health care, and also experience much danger at border crossings. Transnational families can suffer emotionally as well as physically due to separation. Findings from the survey show that family members of migrants do not rate their physical health as good as often as non-migrating families.

    Conclusions: The Nicaraguan population is not guaranteed its social rights of citizenship. This results in mobile livelihoods and the need for translocal social support (e.g. remittances). Migration can have both positive and negative effects on health for migrants and their family members; geographical distance and social differences are key to the outcome.

  • 115.
    Gustafsson, Per E.
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Sebastián, Miguel San
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Mosquera, Paola A.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Meddling with middle modalities: a decomposition approach to mental health inequalities between intersectional gender and economic middle groups in northern Sweden2016In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 9, article id 32819Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Intersectionality has received increased interest within population health research in recent years, as a concept and framework to understand entangled dimensions of health inequalities, such as gender and socioeconomic inequalities in health. However, little attention has been paid to the intersectional middle groups, referring to those occupying positions of mixed advantage and disadvantage.

    OBJECTIVE: This article aimed to 1) examine mental health inequalities between intersectional groups reflecting structural positions of gender and economic affluence and 2) decompose any observed health inequalities, among middle groups, into contributions from experiences and conditions representing processes of privilege and oppression.

    DESIGN: Participants (N=25,585) came from the cross-sectional 'Health on Equal Terms' survey covering 16- to 84-year-olds in the four northernmost counties of Sweden. Six intersectional positions were constructed from gender (woman vs. men) and tertiles (low vs. medium vs. high) of disposable income. Mental health was measured through the General Health Questionnaire-12. Explanatory variables covered areas of material conditions, job relations, violence, domestic burden, and healthcare contacts. Analysis of variance (Aim 1) and Blinder-Oaxaca decomposition analysis (Aim 2) were used.

    RESULTS: Significant mental health inequalities were found between dominant (high-income women and middle-income men) and subordinate (middle-income women and low-income men) middle groups. The health inequalities between adjacent middle groups were mostly explained by violence (mid-income women vs. men comparison); material conditions (mid- vs. low-income men comparison); and material needs, job relations, and unmet medical needs (high- vs. mid-income women comparison).

    CONCLUSIONS: The study suggests complex processes whereby dominant middle groups in the intersectional space of economic affluence and gender can leverage strategic resources to gain mental health advantage relative to subordinate middle groups.

  • 116. Gómez-Olivé, Francesc Xavier
    et al.
    Thorogood, Margaret
    Clark, Benjamin
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana.
    Tollman, Stephen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana.
    Self-reported health and health care use in an ageing population in the Agincourt sub-district of rural South Africa2013In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 6, no 1, p. 181-192, article id 19305Article in journal (Refereed)
    Abstract [en]

    Background: South Africa is experiencing a demographic and epidemiological transition with an increase in population aged 50 years and older and rising prevalence of non-communicable diseases. This, coupled with high HIV and tuberculosis prevalence, puts an already weak health service under greater strain.

    Objective: To measure self-reported chronic health conditions and chronic disease risk factors, including smoking and alcohol use, and to establish their association with health care use in a rural South African population aged 50 years or older.

    Methods: The Study on Global Ageing and Adult Health (SAGE), in collaboration with the INDEPTH Network and the World Health Organization, was implemented in the Agincourt sub-district in rural northeast South Africa where there is a long-standing health and socio-demographic surveillance system. Household-based interviews were conducted in a random sample of people aged 50 years and older. The interview included questions on self-reported health and health care use, and some physical measurements, including blood pressure and anthropometry.

    Results: Four hundred and twenty-five individuals aged 50 years or older participated in the study. Musculoskeletal pain was the most prevalent self-reported condition (41.7%; 95% Confidence Interval [CI] 37.0-46.6) followed by hypertension (31.2%; 95% CI 26.8-35.9) and diabetes (6.1%; 95% CI 4.1-8.9). All self-reported conditions were significantly associated with low self-reported functionality and quality of life, 57% of participants had hypertension, including 44% of those who reported normal blood pressure. A large waist circumference and current alcohol consumption were associated with high risk of hypertension in men, whereas in women, old age, high waist-hip ratio, and less than 6 years of formal education were associated with high risk of hypertension. Only 45% of all participants reported accessing health care in the last 12 months. Those who reported higher use of the health facilities also reported lower levels of functioning and quality of life.

    Conclusions: Self-reported chronic health conditions, especially hypertension, had a high prevalence in this population and were strongly associated with higher levels of health care use. The primary health care system in South Africa will need to provide care for people with non-communicable diseases.

  • 117. Hall, Charles S
    et al.
    Fottrell, Edward
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. UCL Institute for Global Health, London, UK.
    Wilkinson, Sophia
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Assessing the impact of mHealth interventions in low- and middle-income countries: what has been shown to work?2014In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, p. 1-12, article id 25606Article, review/survey (Refereed)
    Abstract [en]

    BACKGROUND: Low-cost mobile devices, such as mobile phones, tablets, and personal digital assistants, which can access voice and data services, have revolutionised access to information and communication technology worldwide. These devices have a major impact on many aspects of people's lives, from business and education to health. This paper reviews the current evidence on the specific impacts of mobile technologies on tangible health outcomes (mHealth) in low- and middle-income countries (LMICs), from the perspectives of various stakeholders.

    DESIGN: Comprehensive literature searches were undertaken using key medical subject heading search terms on PubMed, Google Scholar, and grey literature sources. Analysis of 676 publications retrieved from the search was undertaken based on key inclusion criteria, resulting in a set of 76 papers for detailed review. The impacts of mHealth interventions reported in these papers were categorised into common mHealth applications.

    RESULTS: There is a growing evidence base for the efficacy of mHealth interventions in LMICs, particularly in improving treatment adherence, appointment compliance, data gathering, and developing support networks for health workers. However, the quantity and quality of the evidence is still limited in many respects.

    CONCLUSIONS: Over all application areas, there remains a need to take small pilot studies to full scale, enabling more rigorous experimental and quasi-experimental studies to be undertaken in order to strengthen the evidence base.

  • 118.
    Hanpatchaiyakul, Kulnaree
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Eriksson, H
    Swedish Red Cross Univ Coll, Stockholm, Sweden.
    Kijsomporn, J
    Minist Publ Hlth, PIHWD, Nonthaburi, Thailand.
    Östlund, Gunnel
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Barriers to successful treatment of alcohol addiction perceived by healthcare professionals in Thailand: a Delphi study about obstacles and improvement suggestions2016In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 9Article in journal (Refereed)
  • 119.
    Hanpatchaiyakul, Kulnaree
    et al.
    School of Health Care and Social Welfare, Mälardalen University; Basic Concept of Nursing Practice Department, Boromarajonani College of Nursing Changwat Nonthaburi, Nonthaburi, Thailand.
    Eriksson, Henrik
    The Swedish Red Cross University College. School of Health Care and Social Welfare, Mälardalen University.
    Kijsompon, Jureerat
    Praboromarajchanok Institute for Health Workforce Development (PIHWD), Ministry of Public Health, Nonthaburi, Thailand.
    Östlund, Gunnel
    School of Health Care and Social Welfare, Mälardalen University.
    Thai men’s experiences of alcohol addiction and treatment2014In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, p. 23712-Article in journal (Refereed)
  • 120.
    Hanpatchaiyakul, Kulnaree
    et al.
    Mälardalen University, School of Health, Care and Social Welfare. Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Eriksson, Henrik
    Mälardalen University, School of Health, Care and Social Welfare. Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Kijsompon, Jureerat
    Ministry of Public Health, Nonthaburi, Thailand.
    Östlund, Gunnel
    Mälardalen University, School of Health, Care and Social Welfare. Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Thai Men’s experiences of Alcohol Addiction and Treatment2014In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, no 1, p. Article number 23712-Article in journal (Refereed)
    Abstract [en]

    Background: Men are overrepresented with regard to alcohol addiction and in terms of alcohol treatment worldwide. In Thailand, alcohol consumption continues to rise, but few of those afflicted with alcohol addiction attend alcohol treatment programs, even though there is universal care for all. No comprehensive studies have been done on men's experiences with addiction and alcohol treatment programs in Thailand.Objective: The aim of this study was to explore men's experiences in terms of the 'pros and cons of alcohol consumption' in order to identify the barriers that exist for Thai men with regard to alcohol addiction and the decision to stop drinking. Design: Purposive sampling was applied in the process of recruiting participants at an alcohol clinic in a hospital in Thailand. Thirteen men with alcohol addiction (aged 32-49 years) were willing to participate and were interviewed in thematic interviews. The analysis of the data was done with descriptive phenomenology. Results: Through men's descriptions, three clusters of experiences were found that were 'mending the body', 'drinking as payoff and doping related to work', and 'alcohol becoming a best friend' as ways of describing the development of addiction. Conclusions: The results highlight the importance of addressing concepts of masculinity and related hegemonic ideas in order to decrease the influence of the barriers that exist for Thai men with alcohol addiction with regard to entering treatment and to stop drinking. © 2014 Kulnaree Hanpatchaiyakul et al.

  • 121.
    Hanpatchaiyakul, Kulnaree
    et al.
    School of Health, Care and Social Welfare, Mälardalen University; Basic Concept of Nursing Practice Department, Boromarajonani College of Nursing Changwat Nonthaburi, Nonthaburi, Thailand.
    Eriksson, Henrik
    The Swedish Red Cross University College, Department of Nursing and Care.
    Kijsomporn, Jureerat
    Praboromarajchanok Institute for Health Workforce Development, Ministry of Public Health, Nonthaburi, Thailand.
    Östlund, Gunnel
    School of Health, Care and Social Welfare, Mälardalen University.
    Barriers to successful treatment of alcohol addiction as perceived by healthcare professionals in Thailand: a Delphi study about obstacles and improvement suggestions2016In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 9, article id 31738Article in journal (Refereed)
    Abstract [en]

    Background: Many Thai people experiencing alcohol addiction do not seek help, and those who do often have inadequate access to treatment. There are few research studies focusing on alcohol addiction treatment in Thailand.

    Objective: The purpose of the current study was to identify barriers to the treatment of alcohol addiction and to collect experts’ suggestions for improving treatment in Thailand. The Delphi technique was used to achieve consensual agreement among an expert panel within the field of alcohol addiction and treatment.

    Design: Three rounds of a Delphi survey were completed by a panel of experts in alcohol addiction, including physicians, nurses, social workers, psychologists, healthcare officers, and an Alcoholics Anonymous member. The open-ended answers provided by 34 experts in the first round resulted in 60 statements, which were later grouped into three themes. After three rounds of questionnaires, 51 statements were accepted as consensus.

    Results: Thirty-two experts participated in all three Delphi rounds. Over 80% of participants were particularly concerned about five obstacles to alcohol addiction treatment. The majority of suggestions from the expert panel were related to patients’ right to treatment and the national policy for reducing the negative effects of alcohol. According to the results of the present study, the experts suggested that the treatment of alcohol addiction should be continuous from primary care to tertiary care, and convenient pathways should be established in healthcare services. The experts would also like to increase the number of healthcare providers and improve their knowledge and skills in working with people experiencing alcohol addiction.

    Conclusions: Equal rights to health and treatment for people experiencing alcohol addiction in Thailand require policy improvements, as well as acceptance and awareness of alcohol addiction from both the public and policymakers.

  • 122.
    Hayati, Elli Nur
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Eriksson, Malin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hakimi, Mohammad
    Högberg, Ulf
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Emmelin, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    "Elastic band strategy": women's lived experience of coping with domestic violence in rural Indonesia2013In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 6, p. 1-12Article in journal (Refereed)
    Abstract [en]

    Background: Experiencing domestic violence is considered a chronic and stressful life event. A theoretical framework of coping strategies can be used to understand how women deal with domestic violence. Traditional values strongly influenced by religious teachings that interpret men as the leaders of women play an important role in the lives of Javanese women, where women are obliged to obey their husbands. Little is known about how sociocultural and psychosocial contexts influence the ways in which women cope with domestic violence.

    Objective: Our study aimed to deepen our understanding of how rural Javanese women cope with domestic violence. Our objective was to explore how the sociocultural context influences coping dynamics of women survivors of domestic violence in rural Purworejo.

    Design: A phenomenological approach was used to transform lived experiences into textual expressions of the coping dynamics of women survivors of domestic violence.

    Results: Experiencing chronic violence ruined the women's personal lives because of the associated physical, mental, psychosocial, and financial impairments. These chronic stressors led women to access external and internal resources to form coping strategies. Both external and internal factors prompted conflicting impulses to seek support, that is, to escape versus remain in the relationship. This strong tension led to a coping strategy that implied a long-term process of moving between actively opposing the violence and surrendering or tolerating the situation, resembling an elastic band that stretches in and out.

    Conclusions: Women survivors in Purworejo face a lack of institutional support and tend to have traditional beliefs that hamper their potential to stop the abuse. Although the women in this study were educated and economically independent, they still had difficulty mobilizing internal and external support to end the abuse, partly due to internalized gender norms.

  • 123.
    Hayati, Elli Nur
    et al.
    Faculty of Psychology, Ahmad Dahlan University, Yogyakarta, Indonesia.
    Eriksson, Malin
    Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umea University, Sweden.
    Hakimi, Mohammad
    Center for Health and Nutrition Research Laboratory, Gadjah Mada University, Yogyakarta, Indonesia.
    Högberg, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Emmelin, Maria
    Department of Clinical Sciences, Social Medicine and Global Health, Lund University, Sweden.
    'Elastic band strategy': women's lived experiences of coping with domestic violence in rural Indonesia2013In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 6, p. 1-12Article in journal (Refereed)
    Abstract [en]

    Background: Experiencing domestic violence is considered a chronic and stressful life event. A theoretical framework of coping strategies can be used to understand how women deal with domestic violence. Traditional values strongly influenced by religious teachings that interpret men as the leaders of women play an important role in the lives of Javanese women, where women are obliged to obey their husbands. Little is known about how sociocultural and psychosocial contexts influence the ways in which women cope with domestic violence. Objective: Our study aimed to deepen our understanding of how rural Javanese women cope with domestic violence. Our objective was to explore how the sociocultural context influences coping dynamics of women survivors of domestic violence in rural Purworejo. Design: A phenomenological approach was used to transform lived experiences into textual expressions of the coping dynamics of women survivors of domestic violence. Results: Experiencing chronic violence ruined the women's personal lives because of the associated physical, mental, psychosocial, and financial impairments. These chronic stressors led women to access external and internal resources to form coping strategies. Both external and internal factors prompted conflicting impulses to seek support, that is, to escape versus remain in the relationship. This strong tension led to a coping strategy that implied a long-term process of moving between actively opposing the violence and surrendering or tolerating the situation, resembling an elastic band that stretches in and out. Conclusions: Women survivors in Purworejo face a lack of institutional support and tend to have traditional beliefs that hamper their potential to stop the abuse. Although the women in this study were educated and economically independent, they still had difficulty mobilizing internal and external support to end the abuse, partly due to internalized gender norms.

  • 124.
    Hedlund, Christina
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Blomstedt, Yulia
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Schumann, Barbara
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Association of climatic factors with infectious diseases in the Arctic and subarctic region: a systematic review2014In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, p. 1-16Article, review/survey (Refereed)
    Abstract [en]

    Background:

    The Arctic and subarctic area are likely to be highly affected by climate change, with possible impacts on human health due to effects on food security and infectious diseases.

    Objectives:

    To investigate the evidence for an association between climatic factors and infectious diseases, and to identify the most climate-sensitive diseases and vulnerable populations in the Arctic and subarctic region.

    Methods:

    A systematic review was conducted. A search was made in PubMed, with the last update in May 2013. Inclusion criteria included human cases of infectious disease as outcome, climate or weather factor as exposure, and Arctic or subarctic areas as study origin. Narrative reviews, case reports, and projection studies were excluded. Abstracts and selected full texts were read and evaluated by two independent readers. A data collection sheet and an adjusted version of the SIGN methodology checklist were used to assess the quality grade of each article.

    Results:

    In total, 1953 abstracts were initially found, of which finally 29 articles were included. Almost half of the studies were carried out in Canada (n = 14), the rest from Sweden (n = 6), Finland (n = 4), Norway (n = 2), Russia (n = 2), and Alaska, US (n = 1). Articles were analyzed by disease group: food-and waterborne diseases, vector-borne diseases, airborne viral-and airborne bacterial diseases. Strong evidence was found in our review for an association between climatic factors and food-and waterborne diseases. The scientific evidence for a link between climate and specific vector-and rodent-borne diseases was weak due to that only a few diseases being addressed in more than one publication, although several articles were of very high quality. Air temperature and humidity seem to be important climatic factors to investigate further for viral-and bacterial airborne diseases, but from our results no conclusion about a causal relationship could be drawn.

    Conclusions:

    More studies of high quality are needed to investigate the adverse health impacts of weather and climatic factors in the Arctic and subarctic region. No studies from Greenland or Iceland were found, and only a few from Siberia and Alaska. Disease and syndromic surveillance should be part of climate change adaptation measures in the Arctic and subarctic regions, with monitoring of extreme weather events known to pose a risk for certain infectious diseases implemented at the community level.

  • 125.
    Henriksson, Dorcus Kiwanuka
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Fredriksson, Mio
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Waiswa, Peter
    Karolinska Institutet, Sweden; Makerere University College of Health Sciences, Uganda.
    Selling, Katarina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Swartling Peterson, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda.
    Bottleneck analysis at district level to illustrate gaps within the district health system in Uganda2017In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, no 1, article id 1327256Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Poor quality of care and access to effective and affordable interventions have been attributed to constraints and bottlenecks within and outside the health system. However, there is limited understanding of health system barriers to utilization and delivery of appropriate, high-impact, and cost-effective interventions at the point of service delivery in districts and sub-districts in low-income countries. In this study we illustrate the use of the bottleneck analysis approach, which could be used to identify bottlenecks in service delivery within the district health system.

    METHODS: A modified Tanahashi model with six determinants for effective coverage was used to determine bottlenecks in service provision for maternal and newborn care. The following interventions provided during antenatal care were used as tracer interventions: use of iron and folic acid, intermittent presumptive treatment for malaria, HIV counseling and testing, and syphilis testing. Data from cross-sectional household and health facility surveys in Mayuge and Namayingo districts in Uganda were used in this study.

    RESULTS: Effective coverage and human resource gaps were identified as the biggest bottlenecks in both districts, with coverage ranging from 0% to 66% for effective coverage and from 46% to 58% for availability of health facility staff. Our findings revealed a similar pattern in bottlenecks in both districts for particular interventions although the districts are functionally independent.

    CONCLUSION: The modified Tanahashi model is an analysis tool that can be used to identify bottlenecks to effective coverage within the district health system, for instance, the effective coverage for maternal and newborn care interventions. However, the analysis is highly dependent on the availability of data to populate all six determinants and could benefit from further validation analysis for the causes of bottlenecks identified.

  • 126.
    Hernández, Alison R
    et al.
    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.
    Assessing the technical efficiency of health posts in rural Guatemala: a data envelopment analysis2014In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, p. 23190-Article in journal (Refereed)
    Abstract [en]

    Introduction : Strengthening health service delivery to the rural poor is an important means of redressing inequities. Meso-level managers can help enhance efficiency in the utilization of existing resources through the application of practical tools to analyze routinely collected data reflecting inputs and outputs. This study aimed to assess the efficiency and change in productivity of health posts over two years in a rural department of Guatemala.

    Methods : Data envelopment analysis was used to measure health posts' technical efficiency and productivity change for 2008 and 2009. Input/output data were collected from the regional health office of Alta Verapaz for 34 health posts from the 19 districts comprising the health region.

    Results : Technical efficiency varied widely across health posts, with mean scores of 0.78 (SD=0.24) and 0.75 (SD=0.21) in 2008 and 2009, respectively. Overall, productivity increased by 4%, though 47% of health posts experienced a decline in productivity. Results were combined on a bivariate plot to identify health posts at the high and low extremes of efficiency, which should be followed up to determine how and why their production processes are operating differently.

    Conclusions : Assessing efficiency using the data that are available at the meso-level can serve as a first step in strengthening performance. Further work is required to support managers in the routine application of efficiency analysis and putting the results to use in guiding efforts to improve service delivery and increase utilization.

  • 127.
    Hii, Yien Ling
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Rocklöv, Joacim
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Tang, Choon Siang
    Environment Health Department, National Environment Agency, Singapore.
    Pang, Fung Yin
    Environment Health Department, National Environment Agency, Singapore.
    Sauerborn, Rainer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Climate variability and increase in intensity and magnitude of dengue incidence in Singapore2009In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 2, p. 124-132Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Dengue is currently a major public health burden in Asia Pacific Region. This study aims to establish an association between dengue incidence, mean temperature and precipitation, and further discuss how weather predictors influence the increase in intensity and magnitude of dengue in Singapore during the period 2000-2007.

    MATERIALS AND METHODS: Weekly dengue incidence data, daily mean temperature and precipitation and the midyear population data in Singapore during 2000-2007 were retrieved and analysed. We employed a time series Poisson regression model including time factors such as time trends, lagged terms of weather predictors, considered autocorrelation, and accounted for changes in population size by offsetting.

    RESULTS: The weekly mean temperature and cumulative precipitation were statistically significant related to the increases of dengue incidence in Singapore. Our findings showed that dengue incidence increased linearly at time lag of 5-16 and 5-20 weeks succeeding elevated temperature and precipitation, respectively. However, negative association occurred at lag week 17-20 with low weekly mean temperature as well as lag week 1-4 and 17-20 with low cumulative precipitation.

    DISCUSSION: As Singapore experienced higher weekly mean temperature and cumulative precipitation in the years 2004-2007, our results signified hazardous impacts of climate factors on the increase in intensity and magnitude of dengue cases. The ongoing global climate change might potentially increase the burden of dengue fever infection in near future.

  • 128.
    Hirve, Siddhivinayak
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Gomez-Olive, Xavier
    Oti, Samuel
    Debpuur, Cornelius
    Juvekar, Sanjay
    Tollman, Stephen
    Blomstedt, Yulia
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Wall, Stig
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Use of anchoring vignettes to evaluate health reporting behavior amongst adults aged 50 years and above in Africa and Asia: testing assumptions2013In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 6, p. 1-15Article in journal (Refereed)
    Abstract [en]

    Background: Comparing self-rating health responses across individuals and cultures is misleading due to different reporting behaviors. Anchoring vignettes is a technique that allows identifying and adjusting self-rating responses for reporting heterogeneity (RH). Objective: This article aims to test two crucial assumptions of vignette equivalence (VE) and response consistency (RC) that are required to be met before vignettes can be used to adjust self-rating responses for RH. Design: We used self-ratings, vignettes, and objective measures covering domains of mobility and cognition from the WHO study on global AGEing and adult health, administered to older adults aged 50 years and above from eight low-and middle-income countries in Africa and Asia. For VE, we specified a hierarchical ordered probit (HOPIT) model to test for equality of perceived vignette locations. For RC, we tested for equality of thresholds that are used to rate vignettes with thresholds derived from objective measures and used to rate their own health function. Results: There was evidence of RH in self-rating responses for difficulty in mobility and cognition. Assumptions of VE and RC between countries were violated driven by age, sex, and education. However, within a country context, assumption of VE was met in some countries (mainly in Africa, except Tanzania) and violated in others (mainly in Asia, except India). Conclusion: We conclude that violation of assumptions of RC and VE precluded the use of anchoring vignettes to adjust self-rated responses for RH across countries in Asia and Africa.

  • 129. Hofman, Karen
    et al.
    Blomstedt, Yulia
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Addei, Sheila
    Kalage, Rose
    Maredza, Mandy
    Sankoh, Osman
    Bangha, Martin
    Kahn, Kathleen
    Becher, Heiko
    Haafkens, Joke
    Kinsman, John
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Addressing research capacity for health equity and the social determinants of health in three African countries: the INTREC programme2013In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 6, p. 1-7, article id 19668Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The importance of tackling economic, social and health-related inequities is increasingly accepted as a core concern for the post-Millennium Development Goal framework. However, there is a global dearth of high-quality, policy-relevant and actionable data on inequities within populations, which means that development solutions seldom focus on the people who need them most. INTREC (INDEPTH Training and Research Centres of Excellence) was established with this concern in mind. It aims to provide training for researchers from the INDEPTH network on associations between health inequities, the social determinants of health (SDH), and health outcomes, and on presenting their findings in a usable form to policy makers.

    OBJECTIVE: As part of a baseline situation analysis for INTREC, this paper assesses the current status of SDH training in three of the African INTREC countries - Ghana, Tanzania, and South Africa - as well as the gaps, barriers, and opportunities for training.

    METHODS: SDH-related courses from the three countries were identified through personal knowledge of the researchers, supplemented by snowballing and online searches. Interviews were also conducted with, among others, academics engaged in SDH and public health training in order to provide context and complementary material. Information regarding access to the Internet, as a possible INTREC teaching medium, was gathered in each country through online searches.

    RESULTS: SDH-relevant training is available, but 1) the number of places available for students is limited; 2) the training tends to be public-health-oriented rather than inclusive of the broader, multi-sectoral issues associated with SDH; and 3) insufficient funding places limitations on both students and on the training institutions themselves, thereby affecting participation and quality. We also identified rapidly expanding Internet connectivity in all three countries, which opens up opportunities for e-learning on SDH, though the current quality of the Internet services remains mixed.

    CONCLUSIONS: SDH training is currently in short supply, and there is a clear role for INTREC to contribute to the training of a critical mass of African researchers on the topic. This work will be accomplished most effectively by building on pre-existing networks, institutions, and methods.

  • 130.
    Holmlund, Sophia
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology.
    Ntaganira, Joseph
    Edvardsson, Kristina
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology. La Trobe Univ, Judith Lumley Ctr, Melbourne, Vic, Australia.
    Lan, Pham Thi
    Sengoma, Jean Paul Semasaka
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology. Univ Rwanda, Coll Med & Hlth Sci, Sch Publ Hlth, Kigali, Rwanda.
    Åhman, Annika
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology.
    Small, Rhonda
    Mogren, Ingrid
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology.
    Improved maternity care if midwives learn to perform ultrasound: a qualitative study of Rwandan midwives' experiences and views of obstetric ultrasound2017In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, no 1, article id 1350451Article in journal (Refereed)
    Abstract [en]

    Background: Obstetric ultrasound has become an indispensable part of antenatal care worldwide. Although the use of ultrasound has shown benefits in the reduction of maternal and foetal morbidity and mortality, it has also raised many ethical challenges. Because of insufficient numbers of midwives in Rwanda, uncomplicated pregnancy care is usually provided by nurses in local health centres. Obstetric ultrasound is generally performed by physicians at higher levels of healthcare, where midwives are also more likely to be employed.

    Objectives: To explore Rwandan midwives’ experiences and views of the role of obstetric ultrasound in relation to clinical management, including ethical aspects.

    Methods: A qualitative study design was employed. Six focus group discussions were held in 2015 with 23 midwives working in maternity care in rural and urban areas of Rwanda, as part of the CROss Country Ultrasound Study (CROCUS).

    Results: Obstetric ultrasound was experienced as playing a very important role in clinical management of pregnant women, but participants emphasised that it should not overshadow other clinical examinations. The unequal distribution of ultrasound services throughout Rwanda was considered a challenge, and access was described as low, especially in rural areas. To increase the quality of maternity care, some advocated strongly for midwives to be trained in ultrasound and for physicians to receive additional training. In general, pregnant women were perceived both as requesting more ultrasound examinations than they received, and as not being satisfied with an antenatal consultation if ultrasound was not performed.

    Conclusions: Obstetric ultrasound plays a significant role in maternity care in Rwanda. Increasing demand for ultrasound examinations from pregnant women needs to be balanced with medical indication and health benefits. Training of midwives to perform obstetric ultrasound and further training for physicians would help to address access to ultrasound for greater numbers of women across Rwanda.

  • 131.
    Holmner, Åsa
    et al.
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics.
    Rocklöv, Joacim
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Nilsson, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Climate change and eHealth: a promising strategy for health sector mitigation and adaptation2012In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 5, p. 1-9Article, review/survey (Refereed)
    Abstract [en]

    Climate change is one of today's most pressing global issues. Policies to guide mitigation and adaptation are needed to avoid the devastating impacts of climate change. The health sector is a significant contributor to greenhouse gas emissions in developed countries, and its climate impact in low-income countries is growing steadily. This paper reviews and discusses the literature regarding health sector mitigation potential, known and hypothetical co-benefits, and the potential of health information technology, such as eHealth, in climate change mitigation and adaptation. The promising role of eHealth as an adaptation strategy to reduce societal vulnerability to climate change, and the link's between mitigation and adaptation, are also discussed. The topic of environmental eHealth has gained little attention to date, despite its potential to contribute to more sustainable and green health care. A growing number of local and global initiatives on 'green information and communication technology (ICT)' are now mentioning eHealth as a promising technology with the potential to reduce emission rates from ICT use. However, the embracing of eHealth is slow because of limitations in technological infrastructure, capacity and political will. Further research on potential emissions reductions and co-benefits with green ICT, in terms of health outcomes and economic effectiveness, would be valuable to guide development and implementation of eHealth in health sector mitigation and adaptation policies.

  • 132.
    Holmström, Oscar
    et al.
    Univ Helsinki, Inst Mol Med Finland FIMM, POB 20, FI-00014 Helsinki, Finland.
    Linder, Nina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition. Univ Helsinki, Inst Mol Med Finland FIMM, POB 20, FI-00014 Helsinki, Finland.
    Ngasala, Billy
    Muhimbili Univ Hlth & Allied Sci, Sch Publ Hlth, Dept Med Entomol & Parasitol, Dar Es Salaam, Tanzania.
    Mårtensson, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition.
    Linder, Ewert
    Univ Oulu, Ctr Microscopy & Nanotechnol, Oulu, Finland.
    Lundin, Mikael
    Univ Helsinki, Inst Mol Med Finland FIMM, POB 20, FI-00014 Helsinki, Finland.
    Moilanen, Hannu
    Univ Oulu, Ctr Microscopy & Nanotechnol, Oulu, Finland.
    Suutala, Antti
    Univ Helsinki, Inst Mol Med Finland FIMM, POB 20, FI-00014 Helsinki, Finland.
    Diwan, Vinod
    Karolinska Inst, Dept Publ Hlth Sci, Stockholm, Sweden.
    Lundin, Johan
    Univ Helsinki, Inst Mol Med Finland FIMM, POB 20, FI-00014 Helsinki, Finland.; Karolinska Inst, Dept Publ Hlth Sci, Stockholm, Sweden.
    Point-of-care mobile digital microscopy and deep learning for the detection of soil-transmitted helminths and Schistosoma haematobium2017In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, no sup3, article id 1337325Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Microscopy remains the gold standard in the diagnosis of neglected tropical diseases. As resource limited, rural areas often lack laboratory equipment and trained personnel, new diagnostic techniques are needed. Low-cost, point-of-care imaging devices show potential in the diagnosis of these diseases. Novel, digital image analysis algorithms can be utilized to automate sample analysis.

    OBJECTIVE: Evaluation of the imaging performance of a miniature digital microscopy scanner for the diagnosis of soil-transmitted helminths and Schistosoma haematobium, and training of a deep learning-based image analysis algorithm for automated detection of soil-transmitted helminths in the captured images.

    METHODS: A total of 13 iodine-stained stool samples containing Ascaris lumbricoides, Trichuris trichiura and hookworm eggs and 4 urine samples containing Schistosoma haematobium were digitized using a reference whole slide-scanner and the mobile microscopy scanner. Parasites in the images were identified by visual examination and by analysis with a deep learning-based image analysis algorithm in the stool samples. Results were compared between the digital and visual analysis of the images showing helminth eggs.

    RESULTS: Parasite identification by visual analysis of digital slides captured with the mobile microscope was feasible for all analyzed parasites. Although the spatial resolution of the reference slide-scanner is higher, the resolution of the mobile microscope is sufficient for reliable identification and classification of all parasites studied. Digital image analysis of stool sample images captured with the mobile microscope showed high sensitivity for detection of all helminths studied (range of sensitivity = 83.3-100%) in the test set (n = 217) of manually labeled helminth eggs.

    CONCLUSIONS: In this proof-of-concept study, the imaging performance of a mobile, digital microscope was sufficient for visual detection of soil-transmitted helminths and Schistosoma haematobium. Furthermore, we show that deep learning-based image analysis can be utilized for the automated detection and classification of helminths in the captured images.

  • 133. Hondula, David M
    et al.
    Rocklöv, Joacim
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Sankoh, Osman A
    Past, present, and future climate at select INDEPTH member Health and Demographic Surveillance Systems in Africa and Asia2012In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 5, p. 74-86Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Climate and weather affect human health directly and indirectly. There is a renewed interest in various aspects of environmental health as our understanding of ongoing climate change improves. In particular, today, the health effects in low- and middle-income countries (LMICs) are not well understood. Many computer models predict some of the biggest changes in places where people are equipped with minimal resources to combat the effects of a changing environment, particularly with regard to human health.

    OBJECTIVE: This article documents the observed and projected climate profiles of select sites within the International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH) network of Health and Demographic Surveillance System sites in Africa and Asia to support the integration of climate research with health practice and policy.

    DESIGN: The climatology of four meteorological stations representative of a suite of INDEPTH Health and Demographic Surveillance Systems (HDSSs) was assessed using daily data of 10 years. Historical and future trends were analyzed using reanalysis products and global climate model projections.

    RESULTS: The climate characteristics of the HDSS sites investigated suggest vulnerability to different environmental stressors, and the changes expected over the next century are far greater in magnitude than those observed at many of the INDEPTH member sites.

    CONCLUSIONS: The magnitude of potential future climate changes in the LMICs highlights the need for improvements in collaborative climate-health research in these countries. Climate data resources are available to support such research efforts. The INDEPTH studies presented in this supplement are the first attempt to assess and document associations of climatic factors with mortality at the HDSSs.

  • 134. Hounton, Sennen
    et al.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences. University of Aberdeen, Immpact, Aberdeen, Scotland.
    Brahima, Bassane
    Towards reduction of maternal and perinatal mortality in rural Burkina Faso: communities are not empty vessels2009In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 2Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Reducing maternal and perinatal mortality in sub Saharan Africa remains challenging and requires effective and context specific interventions. OBJECTIVE: The aims of this paper were to demonstrate the impact of the community mobilisation of the Skilled Care Initiative (SCI) in reducing maternal and perinatal mortality and to describe the concept and implementation in order to guide replication and scaling up. DESIGNS: A quasi experimental design was used to assess the extent to which the SCI was associated with increased institutional births, maternal and perinatal mortality reduction in an intervention (Ouargaye) versus a comparison (Diapaga) district. A geo-referenced census was conducted to retrospectively assess changes in outcomes and process measures. A detailed description of activities, rationale and timing of implementation were gathered from the SCI project officers and summarised. Data analyses included descriptive statistics and multivariate analyses. RESULTS: At macro level, the main significant difference between Ouargaye and Diapaga districts was the scope and intensity of the community-based interventions implemented in Ouargaye. There was a temporal association relationship before and after the implementation of the demand-driven interventions and a remarkable 30% increase in institutional births in the intervention district compared to 10% increase in comparison district. There was a significant reduction of perinatal mortality rates (OR =0.75, CI 0.70-0.80) in intervention district and a larger decrease in maternal mortality ratios in intervention district, although statistical significance was not reached. A comprehensive framework of community mobilisation strategy is proposed to improve maternal and child health in poorest communities. CONCLUSION: Controlling for the availability and quality of health services, working in partnership and effectively with communities, and not for them - hence characterising communities as not being empty vessels - can have impacts on outcomes. Here, in the district with a community mobilisation programme, there was a marked increase in institutional births and reductions in maternal and perinatal deaths.

  • 135. Huong, Le Thi
    et al.
    Xuan, Le Thi Thanh
    Phuong, Le Hong
    Huyen, Doan Thi Thu
    Rocklöv, Joacim
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Diet and nutritional status among children 24-59 months by seasons in a mountainous area of Northern Vietnam in 20122014In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, article id 23121Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Seasonal variation affects food availability. However, it is not clear if it affects dietary intake and nutritional status of children in Vietnam. OBJECTIVES: This paper aims at examining the seasonal variation in nutrition status and dietary intake of children aged 24-59 months. DESIGN: A repeated cross-sectional study design was used to collect data of changes in nutritional status and diets of children from 24 to 59 months through four seasons in Chiem Hoa district, Tuyen Quang province, a predominately rural mountainous province of northern Vietnam. The quantitative component includes anthropometric measurements, 24 hours dietary recall and socio-economic characteristics. The qualitative component was conducted through focus group discussions (FGDs) with mothers of the children surveyed in the quantitative component. The purpose of FGDs was to explore the food habits of children during the different seasons and the behaviours of their mothers in relation to the food that they provide during these seasons. RESULTS: The prevalence of underweight among children aged 24-59 months is estimated at around 20-25%; it peaked in summer (24.9%) and reached a low in winter (21.3%). The prevalence of stunting was highest in summer (29.8%) and lowest in winter (22.2%). The prevalence of wasting in children was higher in spring and autumn (14.3%) and lower in summer (9.3%). Energy intake of children was highest in the autumn (1259.3 kcal) and lowest in the summer (996.9 kcal). Most of the energy and the nutrient intakes during the four seasons did not meet the Vietnamese National Institute of Nutrition recommendation. CONCLUSIONS: Our study describes some seasonal variation in nutrition status and energy intake among children in a mountainous area northern Vietnam. Our study indicated that the prevalence of stunting and underweight was higher in summer and autumn, while the prevalence of wasting was higher in spring and autumn. Energy intake did not always meet national recommendations, especially in summer.

  • 136. Hussain-Alkhateeb, Laith
    et al.
    Fottrell, Edward
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Institute for Global Health, University College London, London, UK.
    Petzold, Max
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. INDEPTH Network, Accra, Ghana; Medical Research Council, Johannesburg, South Africa; Medical Research Council, Johannesburg, South Africa; Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Medical Research Council, Johannesburg, South Africa; Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
    Local perceptions of causes of death in rural South Africa: a comparison of perceived and verbal autopsy causes of death2015In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 8, p. 1-9, article id 28302Article in journal (Refereed)
    Abstract [en]

    Background: Understanding how lay people perceive the causes of mortality and their associated risk factors is important for public health. In resource-limited settings, where verbal autopsy (VA) is used as the most expedient method of determining cause of death, it is important to understand how pre-existing concepts of cause of death among VA-informants may influence their VA-responses and the consequential impact on cause of death assessment. This study describes the agreement between VA-derived causes of death and informant-perceived causes and associated influential factors, which also reflects lay health literacy in this setting. Method: Using 20 years of VA data (n = 11,228) from the Agincourt Health and Demographic Surveillance System (HDSS) site in rural South Africa, we explored the agreement between the causes of death perceived by the VA-informants and those assigned by the automated Inter-VA tool. Kappa statistics and concordance correlation coefficients were applied to measure agreement at individual and population levels, respectively. Multivariable regression models were used to explore factors associated with recognised lay perceptions of causes of mortality. Results: Agreement between informant-perceived and VA-derived causes of death at the individual level was limited, but varied substantially by cause of death. However, agreement at the population level, comparing cause-specific mortality fractions was higher, with the notable exception of bewitchment as a cause. More recent deaths, those in adults aged 15-49 years, deaths outside the home, and those associated with external causes showed higher concordance with InterVA. Conclusion: Overall, informant perception of causes of death was limited, but depended on informant characteristics and causes of death, and to some extent involved non-biomedical constructs. Understanding discordance between perceived and recognised causes of death is important for public health planning; low community understanding of causes of death may be detrimental to public health. These findings also illustrate the importance of using rigorous and standardised VA methods rather than relying on informants' reported causes of death.

  • 137.
    Huu Bich, Tran
    et al.
    Hanoi School of Public Health Viet Nam.
    Thi Quyng Nga, Pham
    Hanoi School of Public Health Viet Nam.
    Ngoc Quang, La
    Hanoi School of Public Health Viet Nam.
    Van Minh, Hoang
    Hanoi Medical University Viet Nam.
    Ng, Nawi
    Jogjakarta Indonesia.
    Juvekar, Sanjay
    Pune India.
    Razzaque, Abdur
    ICDDR, B Bangladesh.
    Ashraf, Ali
    ICDDR, B Bangladesh.
    Masud Ahmed, Syed
    BRAC Watch Project Bangladesh.
    Soonthornthada, Kusol
    Mahidol University Thailand.
    Kanungsukkasem, Uraiwan
    Mahidol University Thailand.
    Patterns of alcohol consumption in diverse rural populations in the Asian region2009In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 2, no 1, p. 28-37Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Alcohol abuse, together with tobacco use, is a major determinant of health and social well-being, and is one of the most important of 26 risk factors comparatively assessed in low and middle income countries, surpassed only by high blood pressure and tobacco. OBJECTIVES: The alcohol consumption patterns and the associations between consumption of alcohol and socio-demographic and cultural factors have been investigated in nine rural Health and Demographic Surveillance System (HDSS) located in five Asian countries. METHODS: The information was collected from multiple study sites, with sample sizes of sufficient size to measure trends in age and sex groups over time. Adopting the WHO STEPwise approach to Surveillance (WHO STEPS), stratified random sampling (in each 10-year interval) from the HDSS sampling frame was undertaken. Information regarding alcohol consumption and demographic indicators were collected using the WHO STEPwise standard surveillance form. The data from the nine HDSS sites were merged and analysed using STATA software version 10. RESULTS: Alcohol was rarely consumed in five of the HDSS (four in Bangladesh, and one in Indonesia). In the two HDSS in Vietnam (Chililab, Filabavi) and one in Thailand (Kanchanaburi), alcohol consumption was common in men. The mean number of drinks per day during the last seven days, and prevalence of at-risk drinker were found to be highest in Filabavi. The prevalence of female alcohol consumption was much smaller in comparison with men. In Chililab, people who did not go to school or did not complete primary education were more likely to drink in comparison to people who graduated from high school or university. CONCLUSIONS: Although uncommon in some countries because of religious and cultural practices, alcohol consumption patterns in some sites were cause for concern. In addition, qualitative studies may be necessary to understand the factors influencing alcohol consumption levels between the two sites in Vietnam and the site in Thailand in order to design appropriate interventions.

  • 138. Ingole, Vijendra
    et al.
    Juvekar, Sanjay
    Muralidharan, Veena
    Sambhudas, Somnath
    Rocklöv, Joacim
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    The short-term association of temperature and rainfall with mortality in Vadu Health and Demographic Surveillance System: a population level time series analysis.2012In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 5, p. 44-52Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Research in mainly developed countries has shown that some changes in weather are associated with increased mortality. However, due to the lack of accessible data, few studies have examined such effects of weather on mortality, particularly in rural regions in developing countries.

    OBJECTIVE: In this study, we aimed to investigate the relationship between temperature and rainfall with daily mortality in rural India.

    DESIGN: Daily mortality data were obtained from the Health and Demographic Surveillance System (HDSS) in Vadu, India. Daily mean temperature and rainfall data were obtained from a regional meteorological center, India Meteorological Department (IMD), Pune. A Poisson regression model was established over the study period (January 2003-May 2010) to assess the short-term relationship between weather variables and total mortality, adjusting for time trends and stratifying by both age and sex.

    RESULT: Mortality was found to be significantly associated with daily ambient temperatures and rainfall, after controlling for seasonality and long-term time trends. Children aged 5 years or below appear particularly susceptible to the effects of warm and cold temperatures and heavy rainfall. The population aged 20-59 years appeared to face increased mortality on hot days. Most age groups were found to have increased mortality rates 7-13 days after rainfall events. This association was particularly evident in women.

    CONCLUSION: We found the level of mortality in Vadu HDSS in rural India to be highly affected by both high and low temperatures and rainfall events, with time lags of up to 2 weeks. These results suggest that weather-related mortality may be a public health problem in rural India today. Furthermore, as changes in local climate occur, adaptation measures should be considered to mitigate the potentially negative impacts on public health in these rural communities.

  • 139. Ivarsson, Anneli
    et al.
    Kinsman, John
    Johansson, Karin
    Mohamud, Khalif Bile
    Weinehall, Lars
    Freij, Lennart
    Wall, Stig
    Dalmar, Abdirisak Ahmed
    Erlandsson, Kerstin
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Klingberg-Allvin, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Healing the health system after civil unrest2015In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 8, article id 27381Article in journal (Other academic)
  • 140. Ivarsson, Anneli
    et al.
    Kinsman, John
    Johansson, Karin
    Mohamud, Khalif Bile
    Weinehall, Lars
    Freij, Lennart
    Wall, Stig
    Dalmar, Abdirisak Ahmed
    Ibrahim, Abdirashid Omer
    Hagi, Abdisamad Abikar
    Abdi, Abshir Ali
    Hussein, Abdullahi Sheik
    Shirwa, Abdulkadir Mohamed
    Warsame, Amina
    Ereg, Derie Ismail
    Aden, Mohamed Hussain
    Qasim, Maryan
    Ali, Mohamed Khalid
    Elmi, Abdullahi
    KTH, School of Architecture and the Built Environment (ABE), Sustainable development, Environmental science and Engineering, Land and Water Resources Engineering.
    Afrah, Abdullahi Warsame
    Sabtiye, Faduma Omar
    Guled, Fatuma Ege
    Ahmed, Hinda Jama
    Mohamed, Halima
    Tinay, Halima Ali
    Mohamud, Kadigia Ali
    Yusuf, Mariam Warsame
    Omar, Mayeh
    Abdi, Yakoub Aden
    Abdulkadir, Yusuf
    Johansson, Annika
    Kulane, Asli Ali
    Schumann, Barbara
    Essen, Birgitta
    Kalengayi, Faustine Nkulu
    Elgh, Fredrik
    Norstrom, Fredrik
    Lonnberg, Goran
    Norder, Helene
    Schroders, Julia
    Erlandsson, Kerstin
    Edin, Kerstin
    Sahlen, Klas-Goran
    Gustafsson, Lars L.
    Persson, Lars-Ake
    Eriksson, Malin
    Emmelin, Maria
    Hasselberg, Marie
    Klingberg, Marie
    Preet, Raman
    Hogberg, Ulf
    Sjostrom, Urban
    Omar, Saif
    Healing the health system after civil unrest2015In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 8, no 1, p. 1-4, article id 27381Article in journal (Refereed)
  • 141.
    Ivarsson, Anneli
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Kinsman, John
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Johansson, Karin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Mohamud, Khalif Bile
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Freij, Lennart
    Wall, Stig
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Dalmar, Abdirisak Ahmed
    Ibrahim, Abdirashid Omer
    Hagi, Abdisamad Abikar
    Abdi, Abshir Ali
    Hussein, Abdullahi Sheik
    Shirwa, Abdulkadir Mohamed
    Warsame, Amina
    Ereg, Derie Ismail
    Aden, Mohamed Hussain
    Qasim, Maryan
    Ali, Mohamed Khalid
    Elmi, Abdullahi
    Afrah, Abdullahi Warsame
    Sabtiye, Faduma Omar
    Guled, Fatuma Ege
    Ahmed, Hinda Jama
    Mohamed, Halima
    Tinay, Halima Ali
    Mohamud, Kadigia Ali
    Yusuf, Mariam Warsame
    Omar, Mayeh
    Abdi, Yakoub Aden
    Abdulkadir, Yusuf
    Johansson, Annika
    Kulane, Asli Ali
    Schumann, Barbara
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Essen, Birgitta
    Kalengayi, Faustine Nkulu
    Elgh, Fredrik
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Virology.
    Norström, Fredrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Lönnberg, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Norder, Helene
    Schröders, Julia
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Erlandsson, Kerstin
    Edin, Kerstin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Sahlen, Klas-Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Gustafsson, Lars L.
    Persson, Lars-Ake
    Eriksson, Malin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Emmelin, Maria
    Hasselberg, Marie
    Klingberg, Marie
    Preet, Raman
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hogberg, Ulf
    Sjostrom, Urban
    Omar, Saif
    Healing the health system after civil unrest2015In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 8, p. 1-4Article in journal (Other academic)
  • 142. Ivarsson, Anneli
    et al.
    Kinsman, John
    Johansson, Karin
    Mohamud, Khalif Bile
    Weinehall, Lars
    Freij, Lennart
    Wall, Stig
    Dalmar, Abdirisak Ahmed
    Ibrahim, Abdirashid Omer
    Hagi, Abdisamad Abikar
    Abdi, Abshir Ali
    Hussein, Abdullahi Sheik
    Shirwa, Abdulkadir Mohamed
    Warsame, Amina
    Ereg, Derie Ismail
    Aden, Mohamed Hussain
    Qasim, Maryan
    Ali, Mohamed Khalid
    Elmi, Abdullahi
    Afrah, Abdullahi Warsame
    Sabtiye, Faduma Omar
    Guled, Fatuma Ege
    Ahmed, Hinda Jama
    Mohamed, Halima
    Tinay, Halima Ali
    Mohamud, Kadigia Ali
    Yusuf, Mariam Warsame
    Omar, Mayeh
    Abdi, Yakoub Aden
    Abdulkadir, Yusuf
    Johansson, Annika
    Kulane, Asli Ali
    Schumann, Barbara
    Essén, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Kalengayi, Faustine Nkulu
    Elgh, Fredrik
    Norstrom, Fredrik
    Lonnberg, Goran
    Norder, Helene
    Schroders, Julia
    Erlandsson, Kerstin
    Edin, Kerstin
    Sahlen, Klas-Goran
    Gustafsson, Lars L.
    Persson, Lars-Åke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Eriksson, Malin
    Emmelin, Maria
    Hasselberg, Marie
    Klingberg, Marie
    Preet, Raman
    Högberg, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Sjostrom, Urban
    Omar, Saif
    Healing the health system after civil unrest2015In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 8, article id 27381Article in journal (Other academic)
  • 143. Jack, Helen
    et al.
    Wagner, Ryan G.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
    Petersen, Inge
    Thom, Rita
    Newton, Charles R.
    Stein, Alan
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana.
    Tollman, Stephen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana.
    Hofman, Karen J.
    Closing the mental health treatment gap in South Africa: a review of costs and cost-effectiveness2014In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, p. 137-147Article in journal (Refereed)
    Abstract [en]

    Background: Nearly one in three South Africans will suffer from a mental disorder in his or her lifetime, a higher prevalence than many low- and middle-income countries. Understanding the economic costs and consequences of prevention and packages of care is essential, particularly as South Africa considers scaling-up mental health services and works towards universal health coverage. Economic evaluations can inform how priorities are set in system or spending changes.

    Objective: To identify and review research from South Africa and sub-Saharan Africa on the direct and indirect costs of mental, neurological, and substance use (MNS) disorders and the cost-effectiveness of treatment interventions.

    Design: Narrative overview methodology.

    Results and conclusions: Reviewed studies indicate that integrating mental health care into existing health systems may be the most effective and cost-efficient approach to increase access to mental health services in South Africa. Integration would also direct treatment, prevention, and screening to people with HIV and other chronic health conditions who are at high risk for mental disorders. We identify four major knowledge gaps: 1) accurate and thorough assessment of the health burdens of MNS disorders, 2) design and assessment of interventions that integrate mental health screening and treatment into existing health systems, 3) information on the use and costs of traditional medicines, and 4) cost-effectiveness evaluation of a range of specific interventions or packages of interventions that are tailored to the national context.

  • 144.
    Jat, Tej Ram
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Deo, Prakash R.
    Goicolea, Isabel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Hurtig, Anna-Karin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Sebastian, Miguel San
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Socio-cultural and service delivery dimensions of maternal mortality in rural central India: a qualitative exploration using a human rights lens2015In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 8, p. 1-15Article in journal (Refereed)
    Abstract [en]

    Background: Despite the avoidable nature of maternal mortality, unacceptably high numbers of maternal deaths occur in developing countries. Considering its preventability, maternal mortality is being increasingly recognised as a human rights issue. Integration of a human rights perspective in maternal health programmes could contribute positively in eliminating avertable maternal deaths. This study was conducted to explore socio-cultural and service delivery-related dimensions of maternal deaths in rural central India using a human rights lens. Design: Social autopsies were conducted for 22 maternal deaths during 2011 in Khargone district in central India. The data were analysed using thematic analysis. The factors associated with maternal deaths were classified by using the 'three delays' framework and were examined by using a human rights lens. Results: All 22 women tried to access medical assistance, but various factors delayed their access to appropriate care. The underestimation of the severity of complications by family members, gender inequity, and perceptions of low-quality delivery services delayed decisions to seek care. Transportation problems and care seeking at multiple facilities delayed reaching appropriate health facilities. Negligence by health staff and unavailability of blood and emergency obstetric care services delayed receiving adequate care after reaching a health facility. Conclusions: The study highlighted various socio-cultural and service delivery - related factors which are violating women's human rights and resulting in maternal deaths in rural central India. This study highlights that, despite the health system's conscious effort to improve maternal health, normative elements of a human rights approach to maternal health (i. e. availability, accessibility, acceptability, and quality of maternal health services) were not upheld. The data and analysis suggest that the deceased women and their relatives were unable to claim their entitlements and that the duty bearers were not successful in meeting their obligations. Based on the findings of our study, we conclude that to prevent maternal deaths, further concentrated efforts are required for better community education, women's empowerment, and health systems strengthening to provide appropriate and timely services, including emergency obstetric care, with good quality.

  • 145.
    Jat, Tej Ram
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Swedish Research School for Global Health, Umeå University and United Nations Population Fund, Bhopal, India.
    San Sebastian, Miguel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Technical efficiency of public district hospitals in Madhya Pradesh, India: a data envelopment analysis2013In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 6Article in journal (Refereed)
    Abstract [en]

    Background: Scarcity of resources for healthcare is a well-acknowledged problem. In this context, efficient utilization of existing financial and human resources becomes crucial for strengthening the healthcare delivery. The assessment of efficiency of health facilities can guide decision makers in ensuring the optimum utilization of available resources.

    Objective: The objective of this study was to evaluate the technical efficiency (TE) of the public district hospitals in Madhya Pradesh, India, with special emphasis on maternal healthcare services, using data envelopment analysis (DEA).

    Methods: Data from 40 district hospitals from January to December 2010 were collected from the health management information system and other records of the department of health and family welfare of the state. DEA was performed with input orientation and variable returns to scale assumption.

    Results: TE and scale efficiency scores of the district hospitals were 0.90 (SD = 0.14) and 0.88 (SD = 0.15), respectively. Of the total district hospitals in the study, 20 (50%) were technically efficient constituting the 'best practice frontier'. The other half were technically inefficient, with an average TE score of 0.79 (SD = 0.12) meaning that these hospitals could produce the same outputs by using 21% less inputs from current input levels. Twenty-six (65%) district hospitals were found to be scale inefficient, manifesting a mean score of 0.81 (SD = 0.16).

    Conclusions: Half of the district hospitals in the study were operating inefficiently. Decision makers and administrators in the state should identify the causes of the observed inefficiencies and take appropriate measures to increase efficiency of these hospitals.

  • 146.
    Jerdén, Lars
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Center for Clinical Research Dalarna, Falun, Sweden; School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    Dalton, James
    Johansson, Helene
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Sorensen, Julie
    Jenkins, Paul
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Lifestyle counseling in primary care in the United States and Sweden: a comparison of patients' expectations and experiences2018In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 11, no 1, article id 1438238Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Despite various guidelines, shortcomings in lifestyle counseling in primary care have been demonstrated. Comparisons between countries may provide insight on how to improve such counseling. To the best of our knowledge, studies comparing patients' views of lifestyle counseling beween the United States (US) and European countries have not been reported.

    OBJECTIVES: To quantify and compare patients' perspectives in the US and Sweden on primary care providers' counseling on weight, eating habits, physical activity, smoking, and alcohol consumption.

    METHODS: In a cross-sectional study, 629 patients from Sweden and the US completed a telephone interview about their experiences after a visit to a physician in primary care. The survey focused on patients' perception of the importance of healthy lifestyle habits, their need to change, their desire to receive support from primary care, and the support they had actually received. Data were analyzed using chi-square or Fisher's exact test.

    RESULTS: For three of the four lifestyle habits, the proportion saying they needed to change was higher in the US. The exception was for alcohol, where Swedish subjects indicated a greater need to change. Among those stating a need to change, the proportion saying that they would like to have support from primary care was generally above 80% in both countries. The proportion of US patients reporting that their primary care provider had initiated a discussion of lifestyle modification was, with the exception of alcohol, roughly double the level reported by the Swedish patients.

    CONCLUSIONS: This study demonstrates high and quite similar patient expectations concerning lifestyle counseling in both countries, but more frequent initiation of discussions of most lifestyle issues in US primary care. Further studies, e.g. qualitative interviews with physicians, and medical record reviews, are required to better understand what can explain the differences between countries indicated by the study.

  • 147.
    Jha, Paridhi
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Larsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Christensson, Kyllike
    Karolinska Institutet, Dept. of Women's and Children's Health.
    Skoog Svanberg, Agneta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Satisfaction with childbirth services provided in public health facilities: results from a cross-sectional survey among postnatal women in Chhattisgarh, India2017In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, no 1, article id 1386932Article in journal (Refereed)
  • 148.
    Johansson, Emily White
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Uppsala Univ, Dept Womens & Childrens Hlth Int Maternal & Child, Akad Sjukhuset, Uppsala, Sweden..
    Beyond 'test and treat' - malaria diagnosis for improved pediatric fever management in sub-Saharan Africa2016In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 9, p. 1-14, article id 31744Article, review/survey (Refereed)
    Abstract [en]

    Background: Malaria rapid diagnostic tests (RDTs) have great potential to improve quality care and rational drug use in malaria-endemic settings although studies have shown common RDT non-compliance. Yet, evidence has largely been derived from limited hospital settings in few countries. This article reviews a PhD thesis that analyzed national surveys from multiple sub-Saharan African countries to generate large-scale evidence of malaria diagnosis practices and its determinants across different contexts. Design: A mixed-methods approach was used across four studies that included quantitative analysis of national household and facility surveys conducted in multiple sub-Saharan African countries at the outset of new guidelines (Demographic and Health Surveys and Service Provision Assessments). Qualitative methods were used to explore reasons for quantitative findings in select settings. Results: There was low (17%) and inequitable test uptake across 13 countries in 2009-2011/ 12, with greater testing at hospitals than at peripheral clinics (odds ratio [OR]: 0.62, 95% confidence interval [CI]: 0.56-0.69) or community health workers (OR: 0.31, 95% CI: 0.23-0.43) (Study I). Significant variation was found in the effect of diagnosis on antimalarial use at the population level across countries (Uganda OR: 0.84, 95% CI: 0.66-1.06; Mozambique OR: 3.54, 95% CI: 2.33-5.39) (Study II). A Malawi national facility census indicated common compliance to malaria treatment guidelines (85% clients with RDT-confirmed malaria prescribed first-line treatment), although other fever assessments were not often conducted and there was poor antibiotic targeting (59% clients inappropriately prescribed antibiotics). RDT-negative patients had 16.8 (95% CI: 8.6- 32.7) times higher odds of antibiotic overtreatment than RDT-positive patients conditioned by cough or difficult breathing complaints (Study III). In Mbarara (Uganda), health workers reportedly prescribed antimalarials to RDT-negative patients if no other fever cause was identified and non-compliance seemed further driven by RDT perceptions, system constraints, and client interactions (Study IV). Conclusions: A shift from malaria-focused test and treat strategies toward IMCI with testing is needed to improve quality care and rational use of both antimalarial and antibiotic medicines. Strengthened health systems are also needed to support quality clinical care, including adherence to malaria test results, and RDT deployment should be viewed as a unique opportunity to contribute to these important efforts.

  • 149. Kabudula, Chodziwadziwa W
    et al.
    Tollman, Stephen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Mee, Paul
    Ngobeni, Sizzy
    Silaule, Bernard
    Gómez-Olivé, F Xavier
    Collinson, Mark
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Two decades of mortality change in rural northeast South Africa2014In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, p. 25596-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The MRC/Wits University Agincourt research centre, part of the INDEPTH Network, has documented mortality in a defined population in the rural northeast of South Africa for 20 years (1992-2011) using long-term health and socio-demographic surveillance. Detail on the unfolding, at times unpredicted, mortality pattern has been published. This experience is reviewed here and updated using more recent data.

    OBJECTIVE: To present a review and summary of mortality patterns across all age-sex groups in the Agincourt sub-district population for the period 1992-2011 as a comprehensive basis for public health action.

    DESIGN: Vital events in the Agincourt population have been updated in annual surveys undertaken since 1992. All deaths have been rigorously recorded and followed by verbal autopsy interviews. Responses to questions from these interviews have been processed retrospectively using the WHO 2012 verbal autopsy standard and the InterVA-4 model for assigning causes of death in a standardised manner.

    RESULTS: Between 1992 and 2011, a total of 12,209 deaths were registered over 1,436,195 person-years of follow-up, giving a crude mortality rate of 8.5 per 1,000 person-years. During the 20-year period, the population experienced a major HIV epidemic, which resulted in more than doubling of overall mortality for an extended period. Recent years show signs of declining mortality, but levels remain above the 1992 baseline recorded using the surveillance system.

    CONCLUSIONS: The Agincourt population has experienced a major mortality shock over the past two decades from which it will take time to recover. The basic epidemic patterns are consistent with generalised mortality patterns observed in South Africa as a whole, but the detailed individual surveillance behind these analyses allows finer-grained analyses of specific causes, age-related risks, and trends over time. These demonstrate the complex, somewhat unpredicted course of mortality transition over the years since the dawn of South Africa's democratic era in 1994.

  • 150.
    Kadobera, Daniel
    et al.
    Iganga Mayuge Hlth & Demog Surveillance Syst, Indepth Network Maternal Newborn & Child Hlth Wor, Iganga, Uganda.;Minist Hlth, Dept Clin Serv, Kampala, Uganda..
    Waiswa, Peter
    Iganga Mayuge Hlth & Demog Surveillance Syst, Indepth Network Maternal Newborn & Child Hlth Wor, Iganga, Uganda.;Karolinska Inst, Dept Publ Hlth Sci, Hlth Syst Policy, Stockholm, Sweden.;Makerere Univ, Coll Hlth Sci, Sch Publ Hlth, Maternal Newborn & Child Hlth Ctr Excellence, Kampala, Uganda..
    Peterson, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Makerere Univ, Coll Hlth Sci, Sch Publ Hlth, Maternal Newborn & Child Hlth Ctr Excellence, Kampala, Uganda.;Karolinska Inst, Dept Publ Hlth Sci Global Hlth IHCAR, Stockholm, Sweden..
    Blencowe, Hannah
    London Sch Hyg & Trop Med, Ctr Maternal Adolescent Reprod & Child Hlth MARCH, London, England..
    Lawn, Joy
    London Sch Hyg & Trop Med, Ctr Maternal Adolescent Reprod & Child Hlth MARCH, London, England..
    Kerber, Kate
    Save Children US, Saving Newborn Lives, Washington, DC USA..
    Tumwesigye, Nazarius Mbona
    Makerere Univ, Coll Hlth Sci, Sch Publ Hlth, Dept Epidemiol & Biostat, Kampala, Uganda..
    Comparing performance of methods used to identify pregnant women, pregnancy outcomes, and child mortality in the Iganga-Mayuge Health and Demographic Surveillance Site, Uganda2017In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, no 1, article id 1356641Article in journal (Refereed)
    Abstract [en]

    Background: In most low and middle-income countries vital events registration for births and child deaths is poor, with reporting of pregnancy outcomes highly inadequate or nonexistent. Health and Demographic Surveillance System (HDSS) sites and periodic population- based household-level surveys can be used to identify pregnancies and retrospectively capture pregnancy outcomes to provide data for decision making. However, little is known about the performance of different methods in identifying pregnancy and pregnancy outcomes, yet this is critical in assessing improvements in reducing maternal and newborn mortality and stillbirths.

    Objective: To explore differences between a population-based household pregnancy survey and prospective health demographic surveillance system in identifying pregnancies and their outcomes in rural eastern Uganda.

    Methods: The study was done within the Iganga-Mayuge HDSS site, a member centre of the INDEPTH Network. Prospective data about pregnancies and their outcomes was collected in the routine biannual census rounds from 2006 to 2010 in the HDSS. In 2011 a cross-sectional survey using the pregnancy history survey (PHS) tool was conducted among women aged 15 to 49 years in the HDSS area. We compared differences between the HDSS biannual census updates and the PHS capture of pregnancies identified as well as neonatal and child deaths, stillbirths and abortions.

    Findings: A total of 10,540 women aged 15 to 49 years were interviewed during the PHS. The PHS captured 12.8% more pregnancies than the HDSS in the most recent year (20102011), though between 2006 and 2010 (earlier periods) the PHS captured only 137 (0.8%) more pregnancies overall. The PHS also consistently identified more stillbirths (18.2%), spontaneous abortions (94.5%) and induced abortions (185.8%) than the prospective HDSS update rounds.

    Conclusions: Surveillance sites are designed to prospectively track population-level outcomes. However, the PHS identified more pregnancy-related outcomes than the HDSS in this study. Asking about pregnancy and its outcomes may be a useful way to improve measurement of pregnancy outcomes. Further research is needed to identify the most effective methods of improving the capture of pregnancies and their outcomes within HDSS sites, household surveys and routine health information systems.

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