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  • 201. Nasreen, Hashima-E
    et al.
    Nahar, Shamsun
    Al Mamun, Mahfuz
    Afsana, Kaosar
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Oral misoprostol for preventing postpartum haemorrhage in home births in rural Bangladesh: how effective is it?2011In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 4, p. 7017-Article in journal (Refereed)
    Abstract [en]

    AIMS: Evidence exists about prevention of postpartum haemorrhage (PPH) by oral administration of misoprostol in low-income countries, but effectiveness of prevention by lay community health workers (CHW) is not sufficient. This study aimed to investigate whether a single dose (400 µg) of oral misoprostol could prevent PPH in a community home-birth setting and to assess its acceptability and feasibility among rural Bangladeshi women.

    METHODS: This quasi-experimental trial was conducted among 2,017 rural women who had home deliveries between November 2009 and February 2010 in two rural districts of northern Bangladesh. In the intervention district 1,009 women received 400 µg of misoprostol immediately after giving birth by the lay CHWs, and in the control district 1,008 women were followed after giving birth with no specific intervention against PPH. Primary PPH (within 24 hours) was measured by women's self-reported subjective measures of the normality of blood loss using the 'cultural consensus model.' Baseline data provided socio-economic, reproductive, obstetric, and bleeding disorder information.

    FINDINGS: The incidence of primary PPH was found to be lower in the intervention group (1.6%) than the control group (6.2%) (p<0.001). Misoprostol provided 81% protection (RR: 0.19; 95% CI: 0.08-0.48) against developing primary PPH. The proportion of retained and manually removed placentae was found to be higher in the control group compared to the intervention group. Women in the control group were more likely to need an emergency referral to a higher level facility and blood transfusion than the intervention group. Unexpectedly few women experienced transient side effects of misoprostol. Eighty-seven percent of the women were willing to use the drug in future pregnancy and would recommend to other pregnant women.

    CONCLUSION: Community-based distribution of oral misoprostol (400 µg) by CHW appeared to be effective, safe, acceptable, and feasible in reducing the incidence of PPH in rural areas of Bangladesh. This strategy should be scaled up across the country where access to skilled attendance is limited.

  • 202. Ndila, Carolyne
    et al.
    Bauni, Evasius
    Mochamah, George
    Nyirongo, Vysaul
    Makazi, Alex
    Kosgei, Patrick
    Tsofa, Benjamin
    Nyutu, Gideon
    Etyang, Anthony
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Williams, Thomas N
    Causes of death among persons of all ages within the Kilifi Health and Demographic Surveillance System, Kenya, determined from verbal autopsies interpreted using the InterVA-4 model2014In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, article id 25593Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The vast majority of deaths in the Kilifi study area are not recorded through official systems of vital registration. As a result, few data are available regarding causes of death in this population.

    OBJECTIVE: To describe the causes of death (CODs) among residents of all ages within the Kilifi Health and Demographic Surveillance System (KHDSS) on the coast of Kenya.

    DESIGN: Verbal autopsies (VAs) were conducted using the 2007 World Health Organization (WHO) standard VA questionnaires, and VA data further transformed to align with the 2012 WHO VA instrument. CODs were then determined using the InterVA-4 computer-based probabilistic model.

    RESULTS: Five thousand one hundred and eighty seven deaths were recorded between January 2008 and December 2011. VA interviews were completed for 4,460 (86%) deaths. Neonatal pneumonia and birth asphyxia were the main CODs in neonates; pneumonia and malaria were the main CODs among infants and children aged 1-4, respectively, while HIV/AIDS was the main COD for adult women of reproductive age. Road traffic accidents were more commonly observed among men than women. Stroke and neoplasms were common CODs among the elderly over the age of 65.

    CONCLUSIONS: We have established the main CODs among people of all ages within the area served by the KHDSS on the coast of Kenya using the 2007 WHO VA questionnaire coded using InterVA-4. We hope that our data will allow local health planners to estimate the burden of various diseases and to allocate their limited resources more appropriately.

  • 203.
    Ng, Nawi
    et al.
    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.
    Wall, Stig
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Global health action: surviving infancy and taking first steps2013In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 6, p. 22815-Article in journal (Refereed)
  • 204.
    Ng, Nawi
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Norberg, Margareta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Trends of blood pressure levels and management in Västerbotten County, Sweden, during 1990-20102012In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 5, p. 1-12Article in journal (Refereed)
    Abstract [en]

    Background: Availability of longitudinal data on hypertension and blood pressure levels are important to assess changes over time at the population level. Moreover, detailed information in different population sub-groups is important to understand inequity and social determinants of blood pressure distribution in the population.

    Objectives: The objectives of this study are to: (1) describe the trends of population blood pressure levels in men and women between different educational levels and geographic areas in Sweden during 1990-2010; (2) identify prevalences of hypertension, awareness, treatment, and control in the population; and (3) assess the 10-year risk of developing hypertension among individuals with normal and high normal blood pressures.

    Methods: This study is based on data from the Vasterbotten Intervention Program (VIP) in Vasterbotten County, Sweden. The cross-sectional analysis includes 133,082 VIP health examinations among individuals aged 30, 40, 50, and 60 years from 1990 to 2010. The panel analysis includes 34,868 individuals who were re-examined 10 years after the baseline examination. Individuals completed a self-administered health questionnaire that covers demographic and socio-economic information, self-reported health, and lifestyle behaviours. Blood pressure measurement was obtained prior to the questionnaire. In the cross-sectional analysis, trends of blood pressure by sex, and between educational groups and geographic areas are presented. In the panel analysis, the 10-year risk of developing hypertension is estimated using the predicted probability from logistic regression analysis for each sex, controlling for age and educational level.

    Results: The prevalence of hypertension decreased from 1990 to 2010; from 43.8 to 36.0% (p<0.001) among men, and 37.6 to 27.5% among women (p<0.001). Individuals with basic education had a significantly higher prevalence of hypertension compared to those with medium or high education. Although the decreases were observed in all geographic areas, individuals in rural inland areas had a much higher prevalence compared to those who lived in Umea City. The proportion of hypertensive women who were aware of their hypertension (61.7%) was significantly higher than men (51.6%). About 34% of men and 42% of women with hypertension reported taking blood pressure medication. Over time, awareness and control of hypertension improved (from 46.5% in 1990 to 69% in 2010 and from 30 to 65%, respectively). The gaps between educational groups diminished. This study shows a significantly higher risk of developing hypertension for men and women with high normal blood pressure compared to those with normal blood pressure at baseline in all age cohorts and educational groups. The average risks of developing hypertension among men with high normal blood pressure were 21.5, 45.8, and 56.3% in the 30, 40, and 50-year cohorts, respectively. Corresponding numbers for women were 22.6, 47.4, and 57.9%.

    Conclusions: Levels of blood pressure and hypertension decreased significantly among the Vasterbotten population in the last 21 years. Hypertension management has improved and there is increased awareness, treatment, and control of blood pressure. Despite these achievements, the persisting social gaps in blood pressure levels and management demand further investigation and action from policy makers. Future research should attempt to identify and address the root causes of these health inequities to ensure better and equal health for the whole population.

  • 205.
    Ng, Nawi
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hakimi, Mohammad
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Wilopo, Siswanto
    Wall, Stig
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Health and quality of life among older rural people in Purworejo District, Indonesia2010In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 3, no Supplement 2, p. 78-87Article in journal (Refereed)
    Abstract [en]

    Introduction: Increasing life expectancy and longevity for people in many highly populated low- and middleincome countries has led to an increase in the number of older people. The population aged 60 years and over in Indonesia is projected to increase from 8.4% in 2005 to 25% in 2050. Understanding the determinants of healthy ageing is essential in targeting health-promotion programmes for older people in Indonesia. Objective: To describe patterns of socio-economic and demographic factors associated with health status, and to identify any spatial clustering of poor health among older people in Indonesia. Methods: In 2007, the WHO Study on global AGEing and adult health (SAGE) was conducted among 14,958 people aged 50 years and over in Purworejo District, Central Java, Indonesia. Three outcome measures were used in this analysis: self-reported quality of life (QoL), self-reported functioning and disability, and overall health score calculated from self-reported health over eight health domains. The factors associated with each health outcome were identified using multivariable logistic regression. Purely spatial analysis using Poisson regression was conducted to identify clusters of households with poor health outcomes. Results: Women, older age groups, people not in any marital relationship and low educational and socioeconomic levels were associated with poor health outcomes, regardless of the health indices used. Older people with low educational and socio-economic status (SES) had 3.4 times higher odds of being in the worst QoL quintile (OR=3.35; 95% CI=2.73-4.11) as compared to people with high education and high SES. This disadvantaged group also had higher odds of being in the worst functioning and most disabled quintile (OR=1.67; 95% CI=1.35-2.06) and the lowest overall health score quintile (OR=1.66; 95% CI=1.36-2.03). Poor health and QoL are not randomly distributed among the population over 50 years old in Purworejo District, Indonesia. Spatial analysis showed that clusters of households with at least one member being in the worst quintiles of QoL, functioning and health score intersected in the central part of Purworejo District, which is a semi-urban area with more developed economic activities compared with other areas in the district. Conclusion: Being female, old, unmarried and having low educational and socio-economic levels were significantly associated with poor self-reported QoL, health status and disability among older people in Purworejo District. This study showed the existence of geographical pockets of vulnerable older people in Purworejo District, and emphasized the need to take immediate action to address issues of older people’s health and QoL.

  • 206.
    Ng, Nawi
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Purworejo Health and Demographic Surveillance Systems, Indonesia.
    Hakimi, Mohammad
    Purworejo Health and Demographic Surveillance System, Indonesia.
    Van Minh, Hoang
    Filabavi Health and Demographic Surveillance System, Vietnam.
    Juvekar, Sanjay
    Vadu Health and Demographic Surveillance System, India.
    Razzaque, Abdur
    Matlab Health and Demographic Surveillance System, Bangladesh.
    Ashraf, Ali
    AMK Health and Demographic Surveillance System, Bangladesh.
    Masud Ahmed, Syed
    WATCH Health and Demographic Surveillance System, Bangladesh.
    Kanungsukkasem, Uraiwan
    Kanchanaburi Health and Demographic Surveillance System, Thailand.
    Soonthornthada, Kusol
    Kanchanaburi Health and Demographic Surveillance System, Thailand.
    Huu Bich, Tran
    Chililab Health and Demographic Surveillance System, Vietnam.
    Prevalence of physical inactivity in nine rural INDEPTH health and demographic surveillance systems in five Asian countries2009In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 2, no 1, p. 44-53Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Physical inactivity leads to higher morbidity and mortality from chronic non-communicable diseases (NCDs) such as stroke and heart disease. In high income countries, studies have measured the population level of physical activity, but comparable data are lacking from most low and middle-income countries.

    OBJECTIVE: To assess the level of physical inactivity and its associated factors in selected rural sites in five Asian countries. METHODS: The multi-site cross-sectional study was conducted in nine rural Health and Demographic Surveillance System (HDSS) sites within the INDEPTH Network in Bangladesh, India, Indonesia, Thailand, and Vietnam. Using the methodology from the WHO STEPwise approach to Surveillance (STEPS), about 2,000 men and women aged 25-64 years were selected randomly from each HDSS sampling frame. Physical activity at work and during leisure time, and on travel to and from places, was measured using the Global Physical Activity Questionnaire version 2 (GPAQ2). The total activity was calculated as the sum of the time spent in each domain of activities in metabolic equivalent-minutes per week, and was used to determine the level of physical activity. Multivariable logistic regression was used to assess demographic factors associated with a low level of physical activity.

    RESULTS: The prevalence of physical inactivity ranged from 13% in Chililab HDSS in Vietnam to 58% in Filabavi HDSS in Vietnam. The majority of men were physically active, except in the two sites in Vietnam. Most of the respondents walked or cycled for at least 10 minutes to get from place to place, with some exceptions in the HDSSs in Indonesia and Thailand. The majority of respondents, both men and women, were inactive during their leisure time. Women, older age, and high level of education were significantly associated with physical inactivity.

    CONCLUSION: This study showed that over 1/4 men and 1/3 women in Asian HDSSs within the INDEPTH Network are physically inactive. The wide fluctuations between the two HDSS in Vietnam offer an opportunity to explore further urbanisation and environmental impacts on physical activity. Considering the importance of physical activity in improving health and preventing chronic NCDs, efforts need to be made to promote physical activity particularly among women, older people, and high education groups in these settings.

  • 207.
    Ng, Nawi
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Johnson, Owe
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Lindahl, Bernt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Norberg, Margareta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Centre for Population Studies (CPS).
    A reversal of decreasing trends in population cholesterol levels in Västerbotten County, Sweden2012In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 5, p. 10367-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: High cholesterol is identified as a major risk factor for chronic non-communicable diseases, especially cardiovascular and cerebrovascular diseases. Monitoring trends of cholesterol levels and comparing trends across population groups are important to assess population distribution and risks related to cholesterol change over time. Cholesterol surveillance data are lacking, even in high-income countries.

    OBJECTIVES: To describe the trends in cholesterol and triglyceride levels in different population groups and to estimate the risk of developing hypercholesterolemia and hypertriglyceridemia in Västerbotten County, Sweden during 1990-2010.

    DESIGNS AND METHODS: Since 1990, 133,082 individuals living in Västerbotten County, Northern Sweden, invited on their 30th, 40th, 50th and 60th birthdays, participated in the Västerbotten Intervention Program. Ten years after baseline data collection, 34,868 individuals were surveyed for a second time. In addition to a self-administered health questionnaire (that included information on socioeconomic status, demographics, self-reported health and lifestyle behaviours), blood cholesterol and triglyceride were examined.

    RESULTS: The level and prevalence of hypercholesterolemia decreased significantly from 1990 to 2007, but the trends began to increase during 2008-2010 in men, women, and in all educational groups. Men had significantly higher serum triglyceride levels than women and their cholesterol levels were similar to those of the women. This study shows that those with basic education and who live in rural inlands had consistently higher triglyceride level than those who live in the city and have higher educational attainments. People with basic education are also at higher risk of developing hypercholesterolemia and hypertriglyceridemia at 10-year follow-up; the risk is much higher among the older cohorts, particularly women. During 1990-2010, the proportion of participants who reported treatment with lipid-lowering agents increased from 1.1% to 9.6% among men and 0.5% to 5.3% among women. About 60% of those treated achieved treatment goals for cholesterol or triglycerides.

    CONCLUSIONS: The increasing trend in cholesterol level in the Västerbotten population during 2008-2010 needs to be closely monitored. Addressing the unequal distribution of cholesterol, as well as other risk factors such as obesity, physical inactivity, high blood glucose, among those with basic education, and particularly among populations in rural areas are important to prevent higher burdens of chronic non-communicable diseases in this population.

  • 208.
    Ng, Nawi
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. INDEPTH Network, Accra, Ghana and Purworejo HDSS, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia.
    Kowal, Paul
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. INDEPTH Network, Accra, Ghana and MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
    Naidoo, Nirmala
    Abdullah, Salim
    Bawah, Ayaga
    Binka, Fred
    Chuc, Nguyen T K
    Debpuur, Cornelius
    Egondi, Thaddeus
    Xavier Gómez-Olivé, F
    Hakimi, Mohammad
    Hirve, Siddhivinayak
    Hodgson, Abraham
    Juvekar, Sanjay
    Kyobutungi, Catherine
    Van Minh, Hoang
    Mwanyangala, Mathew A
    Nathan, Rose
    Razzaque, Abdur
    Sankoh, Osman
    Kim Streatfield, P
    Thorogood, Margaret
    Wall, Stig
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Wilopo, Siswanto
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Tollman, Stephen M
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. INDEPTH Network, Accra, Ghana and MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
    Chatterji, Somnath
    Health inequalities among older men and women in Africa and Asia: evidence from eight Health and Demographic Surveillance System sites in the INDEPTH WHO-SAGE Study2010In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 3, no Supplement 2, p. 96-107Article in journal (Refereed)
    Abstract [en]

    Background: Declining rates of fertility and mortality are driving demographic transition in all regions of the world, leading to global population ageing and consequently changing patterns of global morbidity and mortality. Understanding sex-related health differences, recognising groups at risk of poor health and identifying determinants of poor health are therefore very important for both improving health trajectories and planning for the health needs of ageing populations.

    Objectives: To determine the extent to which demographic and socio-economic factors impact upon measures of health in older populations in Africa and Asia; to examine sex differences in health and further explain how these differences can be attributed to demographic and socio-economic determinants.

    Methods: A total of 46,269 individuals aged 50 years and over in eight Health and Demographic Surveillance System (HDSS) sites within the INDEPTH Network were studied during 2006-2007 using an abbreviated version of the WHO Study on global AGEing and adult health (SAGE) Wave I instrument The survey data were then linked to longitudinal HDSS background information. A health score was calculated based on self-reported health derived from eight health domains. Multivariable regression and post-regression decomposition provide ways of measuring and explaining the health score gap between men and women.

    Results: Older men have better self-reported health than older women. Differences in household socioeconomic levels, age, education levels, marital status and living arrangements explained from about 82% and 71% of the gaps in health score observed between men and women in South Africa and Kenya, respectively, to almost nothing in Bangladesh. Different health domains contributed differently to the overall health scores for men and women in each country.

    Conclusion: This study confirmed the existence of sex differences in self-reported health in low- and middleincome countries even after adjustments for differences in demographic and socio-economic factors. A decomposition analysis suggested that sex differences in health differed across the HDSS sites, with the greatest level of inequality found in Bangladesh. The analysis showed considerable variation in how differences in socio-demographic and economic characteristics explained the gaps in self-reported health observed between older men and women in African and Asian settings. The overall health score was a robust indicator of health, with two domains, pain and sleep/energy, contributing consistently across the HDSS sites. Further studies are warranted to understand other significant individual and contextual determinants to which these sex differences in health can be attributed. This will lay a foundation for a more evidence-based approach to resource allocation, and to developing health promotion programmes for older men and women in these settings.

  • 209.
    Ng, Nawi
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Centre for Population Studies (CPS).
    Söderman, Kerstin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Norberg, Margareta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Centre for Population Studies (CPS).
    Öhman, Ann
    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).
    Increasing physical activity, but persisting social gaps among middle-aged people: trends in Northern Sweden from 1990 to 20072011In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 4, p. 6347-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Physical activity is identified as one important protective factor for chronic diseases. Physical activity surveillance is important in assessing healthy population behaviour over time. Many countries lack population trends on physical activity.

    OBJECTIVE: To present trends in physical activity levels in Västerbotten County, Sweden and to evaluate physical activity among women and men with various educational levels.

    METHODS: opulation-based cross-sectional and panel data from the Västerbotten Intervention Programme (VIP) during 1990-2007 were used. All individuals in Västerbotten County who turned 40, 50, or 60 years old were invited to their local primary health care for a health screening. Physical activity during commuting, recreational activities, physical exercise, and socio-demographic data were collected using a self-administered questionnaire. Respondents were categorised as sedentary, moderate physically active, or physically active.

    RESULTS: The prevalences of physically active behaviours increased from 16 to 24.2% among men and from 12.6 to 30.4% among women. Increases are observed in all educational groups, but gaps between educational groups widened recently. The level of sedentary behaviour was stable over the time period studied. The 10-year follow-up data show that the prevalences of physically active behaviours increased from 15.8 to 21.4% among men and 12.7 to 23.3% among women. However, 10.2% of men and 3.8% of women remained sedentary.

    CONCLUSION: Despite the promising evidence of increasing physical activity levels among the population in Västerbotten County, challenges remain for how to reduce the stable levels of sedentary behaviours in some subgroups. Persisting social gaps in physical activity levels should be addressed further. An exploration of people's views on engaging in physical activity and barriers to doing so will allow better formulation of targeted interventions within this population.

  • 210.
    Ng, Nawi
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Van Minh, Hoang
    Juvekar, Sanjay
    Razzaque, Abdur
    Huu Bich, Tran
    Kanungsukkasem, Uraiwan
    Ashraf, Ali
    Masud Ahmed, Syed
    Soonthornthada, Kusol
    Using the INDEPTH HDSS to build capacity for chronic non-communicable disease risk factor surveillance in low and middle-income countries2009In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 2, no Supplement 1Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Chronic non-communicable diseases (NCDs) are the leading cause of morbidity, mortality, and disability worldwide. More than 80% of chronic disease deaths occur in low-income and middle-income countries. Epidemiological data on the burden of chronic NCD and the risk factors which predict them are lacking in most low-income countries. The INDEPTH Network (http://www.indepth-network.org) which includes the Health and Demographic Surveillance System (HDSS) with many surveillance sites in low-middle income countries provided an opportunity to establish surveillance of the major chronic NCD risk factors in 2005 using a standardised approach.

    OBJECTIVE: This paper presents the conceptual framework and research design of the chronic NCD risk factor surveillance within nine rural INDEPTH HDSS settings in Asia.

    METHODS: This multi-site study was designed as a baseline cross-sectional survey with sufficient sample size to measure trends over time. In each of nine HDSS sites in five Asian countries, a sample of 2,000 men and women aged 25-64 years, using the WHO STEPwise approach to Surveillance (http://who.int/chp/steps), was selected using stratified random sampling (in each 10-year interval) from the HDSS sampling frame.

    RESULTS: A total of 18,494 men and women from the nine sites were interviewed with an overall response rate of 98%. The major NCDs risk factors included self-reported information on tobacco and alcohol consumption, fruit and vegetable intake, physical activity patterns, and measured body weight, height, waist circumference, and blood pressure. A series of training sessions were conducted for research scientists, supervisors, and surveyors in each site. Data quality was ensured through spot check, re-check, and data validation procedures, including accuracy and completeness of data obtained. Standardised data entry programme, created using the EPIDATA software, was used to ensure uniform database structure across sites. The data merging and analysis were done using STATA Version 10.

    CONCLUSION: This multi-site study confirmed the feasibility of conducting chronic NCD risk factor surveillance in the low and middle-income settings by integrating the chronic NCDs risk factor surveillance into an existing HDSS data collection and management setting. This collaborative work has provided reliable epidemiological data as a basis for developing chronic NCD prevention and control activities.

  • 211.
    Nilsson, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Kjellström, Tord
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Climate change impacts on working people: how to develop prevention policies2010In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 3Article in journal (Refereed)
    Abstract [en]

    The evidence on negative consequences from climate change on human health and well-being is growing. The Intergovernmental Panel on Climate Change (IPCC) described climate change as a threat to the climate system that sets the basis for life and human health conditions. The changing climate is expected to affect basic requirements needed to support and sustain human health such as good food, clean water, and unpolluted air, with negative effects that are expected to be unequally distributed.

  • 212.
    Norberg, Margareta
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Blomstedt, Yulia
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Lonnberg, Goran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Nystrom, Lennarth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Stenlund, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Wall, Stig
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Community participation and sustainability: evidence over 25 years in the Vasterbotten Intervention Programme2012In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 5, p. 1-9Article in journal (Refereed)
    Abstract [en]

    Background: Selection bias and declining participation rates are of concern in many long-term epidemiological studies. The Vasterbotten Intervention Programme (VIP) was launched in 1985 as a response to alarming reports on elevated cardiovascular disease (CVD) mortality in Vasterbotten County in Northern Sweden. The VIP invites women and men to a health examination and health counselling during the year of their 40th, 50th, and 60th birthdays. Objective: To evaluate trends in participation rates and determinants of participation in the VIP from 1990 to 2006. Design: Registry data on socio-economic status from Statistics Sweden, and mortality and hospitalisation data from the National Board of Health and Welfare, both covering the whole Swedish population, were linked to the VIP and analysed for participants and non-participants. Results: During 1990 - 2006, 117,710 individuals were eligible to participate in the VIP, and 40,472 of them were eligible to participate twice. There were 96,560 observations for participants and 61,622 for non-participants. The overall participation rate increased from 56 to 65%. Participants and non-participants had minimal differences in education and age. Initial small differences by sex and degree of urban residence decreased over time. Despite an increasing participation rate in all groups, those with low income or who were single had an approximately 10% lower participation rate than those with high or medium-income or who were married or cohabitating. Conclusion: Sustainability of the VIP is based on organisational integration into primary health care services and targeting of the entire middle-aged population. This enables the programme to meet population expectations of health promotion and to identify high-risk individuals who are then entered into routine preventive health care services. This has the potential to increase participation rates, to minimise social selection bias, and to reinforce other community-based interventions.

  • 213.
    Norberg, Margareta
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Lindvall, Kristina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Stenlund, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Lindahl, Bernt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    The obesity epidemic slows among the middle-aged population in Sweden while the socioeconomic gap widens2010In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 3Article in journal (Refereed)
    Abstract [en]

    The trend of increasing obesity has slowed in this middle-aged Northern Sweden population, but this trend shift occurred primarily among those with high education who live in an urban environment. Greater efforts to combat obesogenic environments are needed and should take socioeconomic and sociocultural aspects into account.

  • 214.
    Norberg, Margareta
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Lundqvist, Gunnar
    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.
    Gilljam, Hans
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Changing patterns of tobacco use in a middle-aged population: the role of snus, gender, age, and education2011In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 4, p. 5613-Article in journal (Refereed)
    Abstract [en]

    Background In Sweden, the smoking prevalence has declined. In 2007, it was among the lowest in the industrialized world. A steady increase in the use of Swedish oral moist snuff, snus, has occurred in parallel. This development is neither solicited by authorities nor the medical establishment, but rather has occurred along with increased awareness of the dangers of smoking, and has been promoted by product development and marketing of snus.

    Objective To evaluate time trends in patterns of tobacco use in northern Sweden during 1990–2007.

    Design Cross-sectional (99,381 subjects) and longitudinal (26,867 subjects) data from the Västerbotten Intervention Programme (VIP) 1990–2007 were analyzed. All adults in Västerbotten County are invited to a VIP health examination at ages 40, 50, and 60 years, and until 1995 also 30 years. Smoking and use of snus were evaluated by gender, age and educational groups. Intermittent smoking was categorized as smoking.

    Results From the period 1990–1995 to the period 2002–2007, smoking prevalence decreased from 26 to 16% among men and from 27 to 18% among women. The differences in prevalence increased between educational groups. The decline in smoking was less and the increase of snus use was greater among those with basic education. The use of snus among basic-educated 40-year-olds reached 35% among men and 14% among women during 2002–2007. Dual smoking and snus use increased among men and women with basic education. Smoking without snus use was more prevalent among women. Gender differences in total smoking prevalence (smoking only plus dual use) were small in all age groups, but increased among those with basic education reaching 7.3% during 2002–2007, with women being more frequent smokers. Smoking prevalences were similar among never, former and current snus users. Among the 30,000 former smokers, 38% of men and 64% of women had never used snus. Longitudinal data showed a decline in total tobacco use from baseline until follow-up and this was mainly due to a smoking cessation rate of<1% a year. Snus use was started by 6.2% of the 30-year-old women (age at baseline), and this contributed to a stable prevalence of total tobacco use in this group. Seventy percent of baseline snus users still used snus at follow-up. Among smokers, 55% continued smoking, 12% of men and 7% of women switched to snus. Among those with dual tobacco use at baseline, a third of men and a fourth of women remained dual users 10 years later.

    Conclusion There are increasing differences in tobacco use between educational groups. Higher smoking and snus use prevalence are found among those with basic education, and this is most pronounced in the younger group of this middle-aged population. In spite of a higher prevalence of smoking without snus use among women, total smoking prevalence is similar in men and women due to a higher prevalence of dual tobacco use, i.e. snus and cigarettes, among men. The increase in snus use is being paralleled by a slight increase in dual use and the smoking prevalence does not seem to be influenced by snus. This should be the subject of further studies and also have implications for tobacco control policies.

  • 215.
    Nordin, Per
    et al.
    The Skaraborg Institute for Research and Development, Skövde, Sweden.
    Poggensee, Gabriele
    Nigerian Field Epidemiology and Laboratory Training Program, Abuja, Nigeria.
    Mtweve, Sabina
    Department of Community Health, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
    Krantz, Ingela
    The Skaraborg Institute for Research and Development, Skövde, Sweden.
    From a weighing scale to a pole: a comparison of two different dosage strategies in mass treatment of Schistosomiasis haematobium2014In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, article id 25351Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Clinical schistosomiasis in endemic countries is treated with a single dose of praziquantel per 40 mg/kg body weight. Treating according to weight, in resource-poor settings when thousands of doses are to be administered in mass treatment campaigns, is considered problematic. A calibrated dose-pole based on height was developed and is now used in mass treatment campaigns for determining the doses for schoolchildren. The dose-pole will generate dose errors since every child population contains individuals that are either short or tall for weight. The aim of this study is to explore whether the WHO praziquantel pole is a satisfactory dose instrument for mass treatment of S. haematobium.

    METHODS: In 1996 and 2002, 1,694 children were surveyed in the Kilimanjaro Region, Tanzania. We compared doses given by weight to doses given by height using descriptive statistics and regression.

    CONCLUSIONS AND INTERPRETATION: The WHO dose-pole for praziquantel is based on height of the patient; however, children with the same height will differ in weight. Our study shows that children with the same weight could qualify for up to four different dose levels based on their height. The largest variation of doses based on the WHO dose-pole will be found in children below 20 kg of bodyweight. Using bodyweight and tablet halves as the smallest tablet division unit to determine the doses of praziquantel, one only has to identify every 6th kilogram of bodyweight; the doses will then vary a lot less than when using the WHO dose-pole.

  • 216. Norris, Shane A.
    et al.
    Daar, Abdallah
    Balasubramanian, Dorairajan
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Stellenbosch Univ, Wallenberg Res Ctr, Stellenbosch Inst Adv Study STIAS, Stellenbosch, South Africa.
    Kimani-Murage, Elizabeth
    Macnab, Andrew
    Pauw, Christoff
    Singhal, Atul
    Yajnik, Chittaranjan
    Akazili, James
    Levitt, Naomi
    Maatoug, Jihene
    Mkhwanazi, Nolwazi
    Moore, Sophie E.
    Nyirenda, Moffat
    Pulliam, Juliet R. C.
    Rochat, Tamsen
    Said-Mohamed, Rihlat
    Seedat, Soraya
    Sobngwi, Eugene
    Tomlinson, Mark
    Toska, Elona
    van Schalkwyk, Cari
    Understanding and acting on the developmental origins of health and disease in Africa would improve health across generations2017In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, no 1, article id 1334985Article in journal (Refereed)
    Abstract [en]

    Data from many high- and low- or middle-income countries have linked exposures during key developmental periods (in particular pregnancy and infancy) to later health and disease. Africa faces substantial challenges with persisting infectious disease and now burgeoning non-communicable disease. This paper opens the debate to the value of strengthening the developmental origins of health and disease (DOHaD) research focus in Africa to tackle critical public health challenges across the life-course. We argue that the application of DOHaD science in Africa to advance life-course prevention programmes can aid the achievement of the Sustainable Development Goals, and assist in improving health across generations. To increase DOHaD research and its application in Africa, we need to mobilise multisectoral partners, utilise existing data and expertise on the continent, and foster a new generation of young African scientists engrossed in DOHaD.

  • 217. Nyamhanga, Tumaini
    et al.
    Frumence, Gasto
    Mwangu, Mughwira
    Hurtig, Anna-Karin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    We do not do any activity until there is an outbreak: Barriers to disease prevention and health promotion at the community level in Kongwa District, Tanzania2014In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, article id 23878Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Little is known about the barriers to disease prevention and health promotion at the community level--within a decentralized health system.

    OBJECTIVE: This paper, therefore, presents and discusses findings on barriers (and opportunities) for instituting disease prevention and health promotion activities.

    DESIGN: The study was conducted in Kongwa District, Tanzania, using an explorative case study approach. Data were collected through document reviews and in-depth interviews with key informants at district, ward, and village levels. A thematic approach was used in the analysis of the data.

    RESULTS: This study has identified several barriers, namely decision-makers at the national and district levels lack the necessary political will in prioritizing prevention and health promotion; the gravity of prevention and health promotion stated in the national health policy is not reflected in the district health plans; gross underfunding of community-level disease prevention and health promotion activities; and limited community participation.

    CONCLUSION: In this era, when Tanzania is burdened with both communicable and non-communicable diseases, prevention and health promotion should be at the top of the health care agenda. Despite operating in a neoliberal climate, a stronger role of the state is called for. Accordingly, the government should prioritize higher health-protecting physical, social, and economic environments. This will require a national health promotion policy that will clearly chart out how multisectoral collaboration can be put into practice.

  • 218. Nyirenda, Moffat J.
    et al.
    Ramsay, Michèle
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. STIAS Wallenberg Research Centre, Stellenbosch University, Stellenbosch, South Africa.
    Patterns of adult body mass in sub-Saharan Africa2018In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 11, p. 1-3Article in journal (Refereed)
  • 219.
    Odaga, John
    et al.
    Univ Liverpool Liverpool Sch Trop Med, Kampala, Uganda..
    Henriksson, Dorcus K.
    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). Karolinska Inst, Dept Publ Hlth Sci, Hlth Syst & Policy HSP Res Grp, Tomtebodavagen 18A, SE-17177 Stockholm, Sweden..
    Nkolo, Charles
    Univ Liverpool Liverpool Sch Trop Med, Kampala, Uganda..
    Tibeihaho, Hector
    ChildFund Int, Kampala, Uganda..
    Musabe, Richard
    ChildFund Int, Kampala, Uganda..
    Katusiime, Margaret
    ChildFund Int, Kampala, Uganda..
    Sinabulya, Zaccheus
    ChildFund Int, Kampala, Uganda..
    Mucunguzi, Stephen
    ChildFund Int, Kampala, Uganda..
    Mbonye, Anthony K.
    Minist Hlth, Kampala, Uganda.;Makerere Univ, Coll Hlth Sci, Sch Publ Hlth, Kampala, Uganda..
    Valadez, Joseph J.
    Univ Liverpool Liverpool Sch Trop Med, Kampala, Uganda..
    Empowering districts to target priorities for improving child health service in Uganda using change management and rapid assessment methods2016In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 9, article id 30983Article in journal (Refereed)
    Abstract [en]

    Background: Local health system managers in low- and middle-income countries have the responsibility to set health priorities and allocate resources accordingly. Although tools exist to aid this process, they are not widely applied for various reasons including non-availability, poor knowledge of the tools, and poor adaptability into the local context. In Uganda, delivery of basic services is devolved to the District Local Governments through the District Health Teams (DHTs). The Community and District Empowerment for Scale-up (CODES) project aims to provide a set of management tools that aid contextualised priority setting, fund allocation, and problem-solving in a systematic way to improve effective coverage and quality of child survival interventions. Design: Although the various tools have previously been used at the national level, the project aims to combine them in an integral way for implementation at the district level. These tools include Lot Quality Assurance Sampling (LQAS) surveys to generate local evidence, Bottleneck analysis and Causal analysis as analytical tools, Continuous Quality Improvement, and Community Dialogues based on Citizen Report Cards and U reports. The tools enable identification of gaps, prioritisation of possible solutions, and allocation of resources accordingly. This paper presents some of the tools used by the project in five districts in Uganda during the proof-of-concept phase of the project. Results: All five districts were trained and participated in LQAS surveys and readily adopted the tools for priority setting and resource allocation. All districts developed health operational work plans, which were based on the evidence and each of the districts implemented more than three of the priority activities which were included in their work plans. Conclusions: In the five districts, the CODES project demonstrated that DHTs can adopt and integrate these tools in the planning process by systematically identifying gaps and setting priority interventions for child survival.

  • 220. Olff, Miranda
    et al.
    Wall, Stig
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Intimate partner violence and mental health-remarks from two Chief Editors on a joint publishing venture2014In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, no 1-3, article id 25711Article in journal (Other academic)
  • 221.
    Oli, Natalia
    et al.
    Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Sweden / Department of Community Medicine, Kathmandu Medical College, Nepal.
    Vaidya, Abhinav
    Department of Community Medicine, Kathmandu Medical College, Nepal.
    Eiben, Gabriele
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Krettek, Alexandra
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Sweden / Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
    Effectiveness of health promotion regarding diet and physical activity among Nepalese mothers and their young children: The Heart-health Associated Research, Dissemination, and Intervention in the Community (HARDIC) trial2019In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 12, p. 1-12, article id 1670033Article in journal (Refereed)
    Abstract [en]

    Background: Nepal, like many low- and middle-income countries, exhibits rising burden of cardiovascular diseases. Misconceptions, poor behavior, and a high prevalence of risk factors contribute to this development. Health promotion efforts along with primary prevention strategies, including risk factor reduction in both adults and children, are therefore critical. Objectives: This study assessed the effectiveness of a health promotion intervention on mothers' knowledge, attitude and practice (KAP) and their children's behavior regarding diet and physical activity. Methods: The Heart-health Associated Research, Dissemination and Intervention in the Community (HARDIC), a community-based trial, used peer education to target mothers with 1-9-year-old children in the peri-urban Jhaukhel-Duwakot Health Demographic Surveillance Site, Nepal, during August-November 2016. In the intervention area, 47 peer mothers were trained to conduct four education classes for about 10 fellow mothers (N = 391). After 3 months, all eligible mothers in the intervention and control areas were interviewed and the results were compared with the KAP of all eligible mothers at baseline. Results: Post-intervention, mothers' KAP median scores had improved regarding heart-healthy diet and physical activity. More mothers had 'good' KAP (>75% of maximum possible scores), and mothers with 'good' knowledge increased from 50% to 81%. Corresponding control values increased only from 58% to 63%. Mothers' attitude and practice improved. Additionally, mothers in the intervention area reported improvement in their children's diet and physical activity behavior. Moreover, Difference in Differences analysis showed that the HARDIC intervention significantly increased mothers' KAP scores and children's behavior scores in the intervention area compared to the control area. Conclusions: Our intervention improves KAP scores regarding diet and physical activity and shows potential for expansion via community health workers, volunteers, and/or local women. Moreover, HARDIC can contribute to Nepal's Package of Essential Noncommunicable Diseases Initiative, which currently lacks a specific package for health promotion.

  • 222.
    Oli, Natalia
    et al.
    Kathmandu Medical College, Kathmandu, Nepal / Sahlgrenska Academy at University of Gothenburg.
    Vaidya, Abhinav
    Kathmandu Medical College, Kathmandu, Nepal / Sahlgrenska Academy at University of Gothenburg.
    Subedi, Madhusudan
    Patan Academy of Health Sciences, Lalitpur, Nepal.
    Krettek, Alexandra
    Sahlgrenska Academy at University of Gothenburg / Nordic School of Public Health NHV, Gothenburg.
    Experiences and perceptions about cause and prevention of cardiovascular disease among people with cardiometabolic conditions: findings of in-depth interviews from a peri-urban Nepalese community.2014In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, article id 24023Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Nepal currently faces an increasing burden of cardiovascular disease (CVD). Earlier studies on health literacy and the behavior dimension of cardiovascular health reported a substantial gap between knowledge and practice.

    OBJECTIVE: This qualitative study aimed to deepen understanding of the community perspective on cardiovascular health from the patients' viewpoint.

    DESIGN: We conducted in-depth interviews (IDIs) with 13 individuals with confirmed heart disease, hypertension, or diabetes mellitus. All participants provided verbal consent. We used an IDI guide to ask respondents about their perception and experiences with CVD, particularly regarding causation and preventability. We manually applied qualitative content analysis to evaluate the data and grouped similar content into categories and subcategories.

    RESULTS: Respondents perceived dietary factors, particularly consumption of salty, fatty, and oily food, as the main determinants of CVD. Similarly, our respondents unanimously linked smoking, alcohol intake, and high blood pressure with cardiac ailments but reported mixed opinion regarding the causal role of body weight and physical inactivity. Although depressed and stressed at the time of diagnosis, respondents learned to handle their situation better over time. Despite good family support for health care, the financial burden of disease was a major issue. All respondents understood the importance of lifestyle modification and relied upon health professionals for information and motivation. Respondents remarked that community awareness of CVD was inadequate and that medical doctors or trained local people should help increase awareness.

    CONCLUSIONS: This study provided insight into the perceptions of patients regarding CVD. Respondents embraced the importance of lifestyle modification only after receiving their diagnosis. Although better health care is important in terms of aiding patients to better understand and cope with their disease, interventions should be tailored to improve the community's cardiovascular health literacy and preventive practices.

  • 223.
    Olofsson, Jenny
    et al.
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Padyab, Mojgan
    Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Malmberg, Gunnar
    Umeå University, Faculty of Social Sciences, Department of Geography and Economic History. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Health disparities in Europe’s ageing population: the role of social network2018In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 11, no 1, article id 1445498Article in journal (Refereed)
    Abstract [en]

    Background: Previous research suggests that the social network may play very different roles in relation to health in countries with differing welfare regimes. 

    Objective: The study aimed to assess the interplay between social network, socioeconomic position, and self-rated health (SRH) in European countries. 

    Methods: The study used cross-sectional data on individuals aged 50+ from the fourth wave of the Survey of Health, Ageing and Retirement in Europe (SHARE) and includes data from 16 countries. The outcome is poor SRH. All analyses are adjusted for age and stratified by gender. 

    Results: Low satisfaction with the social network was associated with poor SRH among women in all country groups, but predicted poor SRH among males in West/Central and Eastern Europe only. The results from the multivariable analysis showed an increased likelihood of poor SRH among those with relatively lower education, as well as among those with low satisfaction with the social network (women from all country groups and men from Western/Central and Eastern Europe). However, the results from interaction analysis show that poor SRH for those with lower relative position in educational level was greater among those with higher satisfaction with the social network among male and female participants from Northern Europe. The health of individuals who are highly satisfied with their social network is more associated with socioeconomic status in Northern Europe. 

    Conclusions: This study highlights the significance of social network and socioeconomic gradients in health among the elderly in Europe.

  • 224.
    Onta, Sharad
    et al.
    Tribhuvan University, Kathmandu, Nepal .
    Choulagai, Bishnu
    Tribhuvan University, Kathmandu, Nepal / Sahlgrenska Academy, University of Gothenburg, Sweden.
    Shrestha, Binjwala
    Tribhuvan University, Kathmandu, Nepal / Sahlgrenska Academy, University of Gothenburg, Sweden.
    Subedi, Narayan
    Nepal Public Health Foundation, Kathmandu, Nepal .
    Bhandari, Gajananda P
    Nepal Public Health Foundation, Kathmandu, Nepal .
    Krettek, Alexandra
    Sahlgrenska Academy, University of Gothenburg, Sweden / Nordic School of Public Health NHV, Gothenburg, Sweden.
    Perceptions of users and providers on barriers to utilizing skilled birth care in mid- and far-western Nepal: a qualitative study2014In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, p. 1-9, article id 24580Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Although skilled birth care contributes significantly to the prevention of maternal and newborn morbidity and mortality, utilization of such care is poor in mid- and far-western Nepal. This study explored the perceptions of service users and providers regarding barriers to skilled birth care.

    DESIGN: We conducted 24 focus group discussions, 12 each with service users and service providers from different health institutions in mid- and far-western Nepal. All discussions examined the perceptions and experiences of service users and providers regarding barriers to skilled birth care and explored possible solutions to overcoming such barriers.

    RESULTS: Our results determined that major barriers to skilled birth care include inadequate knowledge of the importance of services offered by skilled birth attendants (SBAs), distance to health facilities, unavailability of transport services, and poor availability of SBAs. Other barriers included poor infrastructure, meager services, inadequate information about services/facilities, cultural practices and beliefs, and low prioritization of birth care. Moreover, the tradition of isolating women during and after childbirth decreased the likelihood that women would utilize delivery care services at health facilities.

    CONCLUSIONS: Service users and providers perceived inadequate availability and accessibility of skilled birth care in remote areas of Nepal, and overall utilization of these services was poor. Therefore, training and recruiting locally available health workers, helping community groups establish transport mechanisms, upgrading physical facilities and services at health institutions, and increasing community awareness of the importance of skilled birth care will help bridge these gaps.

  • 225. Otero-Garcia, Laura
    et al.
    Goicolea, Isabel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Gea-Sánchez, Montserrat
    Sanz-Barbero, Belen
    Access to and use of sexual and reproductive health services provided by midwives among rural immigrant women in Spain: midwives' perspectives2013In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 6, no 1, article id 22645Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: There insufficient information regarding access and participation of immigrant women in Spain in sexual and reproductive health programs. Recent studies show their lower participation rate in gynecological cancer screening programs; however, little is known about the participation in other sexual and reproductive health programs by immigrant women living in rural areas with high population dispersion.

    OBJECTIVES: The objective of this study is to explore the perceptions of midwives who provide these services regarding immigrant women's access and participation in sexual and reproductive health programs offered in a rural area.

    DESIGN: A qualitative study was performed, within a larger ethnographic study about rural primary care, with data collection based on in-depth interviews and field notes. Participants were the midwives in primary care serving 13 rural basic health zones (BHZ) of Segovia, a region of Spain with high population dispersion. An interview script was designed to collect information about midwives' perceptions on immigrant women's access to and use of the healthcare services that they provide. Interviews were recorded and transcribed with participant informed consent. Data were analyzed based on the qualitative content analysis approach and triangulation of results with fieldwork notes.

    RESULTS: Midwives perceive that immigrants in general, and immigrant women in particular, underuse family planning services. This underutilization is associated with cultural differences and gender inequality. They also believe that the number of voluntary pregnancy interruptions among immigrant women is elevated and identify childbearing and childrearing-related tasks and the language barrier as obstacles to immigrant women accessing the available prenatal and postnatal healthcare services.

    CONCLUSIONS: Immigrant women's underutilization of midwifery services may be linked to the greater number of unintended pregnancies, pregnancy terminations, and the delay in the first prenatal visit, as discerned by midwives. Future research should involve samples of immigrant women themselves, to provide a deeper understanding of the current knowledge, attitudes, and practices of the immigrant population regarding reproductive and sexual health to provide better health services.

  • 226.
    Pallangyo, Eunice N.
    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).
    Mbekenga, Columba
    Olsson, Pia
    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).
    Rubertsson, Christine
    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).
    Källestål, Carina
    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).
    Improved postpartum care after a participatory facilitation intervention in Dar es Salaam, Tanzania: a mixed method evaluation2017In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, no 1, article id 1295697Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    In order to improve the health and survival of mothers/newborns, the quality and attendance rates of postpartum care (PPC) must be increased, particularly in low-resource settings.

    OBJECTIVE:

    To describe outcomes of a collegial facilitation intervention to improve PPC in government-owned health institutions in a low-resource suburb in Dar es Salaam, Tanzania.

    METHODS:

    A before-and-after evaluation of an intervention and comparison group was conducted using mixed methods (focus group discussions, questionnaires, observations, interviews, and field-notes) at health institutions. Maternal and child health aiders, enrolled nurse midwives, registered nurse midwives, and medical and clinical officers participated. A collegial facilitation intervention was conducted and healthcare providers were organized in teams to improve PPC at their workplaces. Facilitators defined areas of improvement with colleagues and met regularly with a supervisor for support.

    RESULTS:

    The number of mothers visiting the institution for PPC increased in the intervention group. Some care actions were noted in more than 80% of the observations and mothers reported high satisfaction with care. In the comparison group, PPC continued to be next to non-existent. The healthcare providers' knowledge increased in both groups but was higher in the intervention group. The t-test showed a significant difference in knowledge between the intervention and comparison groups and between before and after the intervention in both groups. The difference of differences for knowledge was 1.3. The providers perceived the intervention outcomes to include growing professional confidence/knowledge, improved PPC quality, and mothers' positive response. The quality grading was based on the national guidelines and involved nine experts and showed that none of the providers reached the level of good quality of care.

    CONCLUSIONS:

    The participatory facilitation intervention contributed to improved quality of PPC, healthcare providers' knowledge and professional confidence, awareness of PPC among mothers, and increased PPC attendance.

  • 227.
    Palmgren, Helena
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Meningococcal disease and climate2009In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 2Article in journal (Refereed)
  • 228. Parkinson, Alan J
    et al.
    Evengård, Birgitta
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Climate change, its impact on human health in the Arctic and the public health response to threats of emerging infectious diseases2009In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 2Article in journal (Refereed)
  • 229. Paul, Mandira
    et al.
    Danielsson, Kristina Gemzell
    Essen, Birgitta
    Klingberg-Allvin, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    The importance of considering the evidence in the MTP 2014 Amendment debate in India - unsubstantiated arguments should not impede improved access to safe abortion2015In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 8, p. 1-4Article in journal (Refereed)
    Abstract [en]

    With the objective to improve access to safe abortion services in India, the Ministry of Health and Welfare, with approval of the Law Ministry, published draft amendments of the MTP Act on October 29, 2014. Instead of the expected support, the amendments created a heated debate within professional medical associations of India. In this commentary, we review the evidence in response to the current discourse with regard to the amendments. It would be unfortunate if unsubstantiated one-sided arguments would impede the intention of improving access to safe abortion care in India.

  • 230.
    Paul, Mandira
    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).
    Danielsson, Kristina Gemzell
    Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    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).
    Allvin, Marie Klingberg
    Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, Stockholm Sweden.
    The importance of considering the evidence in the MTP 2014 Amendment debate in India: unsubstantiated arguments should not impede improved access to safe abortion2015In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 8, p. 27512-Article in journal (Refereed)
    Abstract [en]

    With the objective to improve access to safe abortion services in India, the Ministry of Health and Welfare, with approval of the Law Ministry, published draft amendments of the MTP Act on October 29, 2014. Instead of the expected support, the amendments created a heated debate within professional medical associations of India. In this commentary, we review the evidence in response to the current discourse with regard to the amendments. It would be unfortunate if unsubstantiated one-sided arguments would impede the intention of improving access to safe abortion care in India.

  • 231.
    Paul, Mandira
    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).
    Nasstrom, Sara B.
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden..
    Klingberg-Allvin, Marie
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden.;Dalarna Univ, Sch Educ Hlth & Social Studies, Falun, Sweden..
    Kiggundu, Charles
    Mulago Hosp, Dept Obstet & Gynaecol, Kampala, Uganda..
    Larsson, Elin C.
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden..
    Healthcare providers balancing norms and practice: challenges and opportunities in providing contraceptive counselling to young people in Uganda - a qualitative study2016In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 9, p. 1-9, article id 30283Article in journal (Refereed)
    Abstract [en]

    Background: Pregnancies among young women force girls to compromise education, resulting in low educational attainment with subsequent poverty and vulnerability. A pronounced focus is needed on contraceptive use, pregnancy, and unsafe abortion among young women. Objective: This study aims to explore healthcare providers' (HCPs) perceptions and practices regarding contraceptive counselling to young people. Design: We conducted 27 in-depth interviews with doctors and midwives working in seven health facilities in central Uganda. Interviews were open-ended and allowed the participant to speak freely on certain topics. We used a topic guide to cover areas topics of interest focusing on post-abortion care (PAC) but also covering contraceptive counselling. Transcripts were transcribed verbatim and data were analysed using thematic analysis. Results: The main theme, HCPs' ambivalence to providing contraceptive counselling to sexually active young people is based on two sub-themes describing the challenges of contraceptive counselling: A) HCPs echo the societal norms regarding sexual practice among young people, while at the same time our findings B) highlights the opportunities resulting from providers pragmatic approach to contraceptive counselling to young women. Providers expressed a self-identified lack of skill, limited resources, and inadequate support from the health system to successfully provide appropriate services to young people. They felt frustrated with the consultations, especially when meeting young women seeking PAC. Conclusions: Despite existing policies for young people's sexual and reproductive health in Uganda, HCPs are not sufficiently equipped to provide adequate contraceptive counselling to young people. Instead, HCPs are left in between the negative influence of social norms and their pragmatic approach to address the needs of young people, especially those seeking PAC. We argue that a clear policy supported by a clear strategy with practical guidelines should be implemented alongside in-service training including value clarification and attitude transformation to equip providers to be able to better cater to young people seeking sexual and reproductive health advice.

  • 232. Paul, Mandira
    et al.
    Näsström, Sara B
    Klingberg-Allvin, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska institutet.
    Kiggundu, Charles
    Larsson, Elin C
    Healthcare providers balancing norms and practice: challenges and opportunities in providing contraceptive counselling to young people in Uganda - a qualitative study2016In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 9, no 1, article id 30283Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Pregnancies among young women force girls to compromise education, resulting in low educational attainment with subsequent poverty and vulnerability. A pronounced focus is needed on contraceptive use, pregnancy, and unsafe abortion among young women.

    OBJECTIVE: This study aims to explore healthcare providers' (HCPs) perceptions and practices regarding contraceptive counselling to young people.

    DESIGN: We conducted 27 in-depth interviews with doctors and midwives working in seven health facilities in central Uganda. Interviews were open-ended and allowed the participant to speak freely on certain topics. We used a topic guide to cover areas topics of interest focusing on post-abortion care (PAC) but also covering contraceptive counselling. Transcripts were transcribed verbatim and data were analysed using thematic analysis.

    RESULTS: The main theme, HCPs' ambivalence to providing contraceptive counselling to sexually active young people is based on two sub-themes describing the challenges of contraceptive counselling: A) HCPs echo the societal norms regarding sexual practice among young people, while at the same time our findings B) highlights the opportunities resulting from providers pragmatic approach to contraceptive counselling to young women. Providers expressed a self-identified lack of skill, limited resources, and inadequate support from the health system to successfully provide appropriate services to young people. They felt frustrated with the consultations, especially when meeting young women seeking PAC.

    CONCLUSIONS: Despite existing policies for young people's sexual and reproductive health in Uganda, HCPs are not sufficiently equipped to provide adequate contraceptive counselling to young people. Instead, HCPs are left in between the negative influence of social norms and their pragmatic approach to address the needs of young people, especially those seeking PAC. We argue that a clear policy supported by a clear strategy with practical guidelines should be implemented alongside in-service training including value clarification and attitude transformation to equip providers to be able to better cater to young people seeking sexual and reproductive health advice.

  • 233. Paulander, Johan
    et al.
    Olsson, Henrik
    Lemma, Hailemariam
    Getachew, Asefaw
    San Sebastian, Miguel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Knowledge, attitudes and practice about malaria in rural Tigray, Ethiopia2009In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 2Article in journal (Refereed)
    Abstract [en]

    Objective: To assess the knowledge, attitude and practice (KAP) regarding malaria and their determinants in a rural population of northern Ethiopia.

    Methods: The study was conducted in the district of Samre Saharti, Tigray, northern Ethiopia. A structured questionnaire collecting socio-demographic and malaria-related KAP information was administered to the mothers from a representative sample of households.

    Results: A total of 1652 questionnaires were available for analysis. Most of the respondents (92.7%) were able to mention at least one symptom of malaria. Mosquito as a cause of malaria was recognized by nearly half of the respondents (48.8%). Most of the households had a bednet (85.9%). To have a literate person at home, to belong to the lowland stratum, to have received some type of health education and to own a radio were associated with the knowledge of malaria. A strong association remained between living in the lowland stratum, to own a radio and to live close to the health post and the use of ITN. Being a housewife, lack of health education and to live further than 60 minutes walking distance to the health post were related to a delay on treatment finding.

    Conclusion: This study has identified some aspects which the MCP might need to improve. The knowledge about malaria transmission should be strengthened. Promotion of literacy and participation in health education are vital components in terms of malaria knowledge and practice. Issues related to geographical location and accessibility to health post should be also carefully examined.

  • 234.
    Peltzer, Karl
    et al.
    Human Sci Res Council, Pretoria, South Africa.
    Stewart Williams, Jennifer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Research Centre for Gender, Health & Ageing, University of Newcastle, Newcastle, Australia.
    Kowal, Paul
    Univ Newcastle, Res Ctr Gender Hlth & Ageing, Newcastle, Australia.
    Negin, Joel
    Snodgrass, James Josh
    Univ Sydney, Sch Publ Hlth, Sydney, Australia.
    Yawson, Alfred
    Univ Ghana, Dept Community Hlth, Accra, Ghana.
    Minicuci, Nadia
    Univ Ghana, Dept Community Hlth, Accra, Ghana.
    Thiele, Liz
    Phaswana-Mafuya, Nancy
    Nelson Mandela Metropolitan Univ, Off Deputy Vice Chancellor, Port Elizabeth, South Africa.
    Biritwum, Richard Berko
    Univ Ghana, Dept Community Hlth, Accra, Ghana.
    Naidoo, Nirmala
    WHO, HIS HSI, CH-1211 Geneva, Switzerland.
    Chatterji, Somnath
    WHO, HIS HSI, CH-1211 Geneva, Switzerland.
    Universal health coverage in emerging economies: findings on health care utilization by older adults in China, Ghana, India, Mexico, the Russian Federation, and South Africa2014In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, article id 25314Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND OBJECTIVE:

    The achievement of universal health coverage (UHC) in emerging economies is a high priority within the global community. This timely study uses standardized national population data collected from adults aged 50 and older in China, Ghana, India, Mexico, the Russian Federation, and South Africa. The objective is to describe health care utilization and measure association between inpatient and outpatient service use and patient characteristics in these six low- and middle-income countries.

    DESIGN:

    Secondary analysis of data from the World Health Organization's Study on global AGEing and adult health Wave 1 was undertaken. Country samples are compared by socio-demographic characteristics, type of health care, and reasons for use. Logistic regressions describe association between socio-demographic and health factors and inpatient and outpatient service use.

    RESULTS:

    In the pooled multi-country sample of over 26,000 adults aged 50-plus, who reported getting health care the last time it was needed, almost 80% of men and women received inpatient or outpatient care, or both. Roughly 30% of men and women in the Russian Federation used inpatient services in the previous 3 years and 90% of men and women in India used outpatient services in the past year. In China, public hospitals were the most frequently used service type for 52% of men and 51% of women. Multivariable regression showed that, compared with men, women were less likely to use inpatient services and more likely to use outpatient services. Respondents with two or more chronic conditions were almost three times as likely to use inpatient services and twice as likely to use outpatient services compared with respondents with no reported chronic conditions.

    CONCLUSIONS:

    This study provides a basis for further investigation of country-specific responses to UHC.

  • 235.
    Pembe, Andrea
    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). Muhimbili University of Health and Allied Sciences, School of Medicine, Department of Obstetrics and Gynaecology.
    Mbekenga, Columba K.
    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). Aga Khan University, School of Nursing and Midwifery.
    Olsson, Pia
    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).
    Darj, Elisabeth
    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). Norwegian University of Science and Technology, NTNU, Department of Public Health and Nursing; St Olav's Hospital, Department of Obstetrics and Gynaecology.
    Why do women not adhere to advice on maternal referral in rural Tanzania?: Narratives of women and their family members2017In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, no 1, article id 1364888Article in journal (Refereed)
    Abstract [en]

    Background: In most low-income countries, many women with high-risk pregnancies and complications do not reach the referral hospitals despite the provision of referral advice.

    Objective: To explore how antenatal maternal referral advice is understood and handled in a rural Tanzanian community.

    Methods: Individual in-depth interviews were conducted with six women who did not go to hospital and 13 people who were involved in the referral advice. Narrative analysis was used to describe and create meanings out of the decision-making process.

    Results: In all interviews, not following the referral advice was greatly influenced by close family members. Three main traits of how referral advice was understood emerged: convinced referral is not necessary, accepting referral advice but delayed by others, and passive and moving with the wind. The main reasons given for declining the referral advice included discrediting midwives' advice, citing previous successful deliveries despite referral advice; being afraid of undergoing surgery; lack of support for care of siblings at home; and high costs incurred during referral.

    Conclusions: Declining maternal referral advice centred around the pregnant women's position and their dependence on the family members around them, with a decreased ability to show autonomy. If they were socially and economically empowered, women could positively influence decision making during maternal referrals.

  • 236.
    Petersen, Solveig
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry. Deakin University, Burwood and Geelong, Victoria, Australia.
    Swinburn, Boyd
    Mavoa, Helen
    Fotu, Kalesita
    Tupoulahi-Fusimalohi, Caroline
    Faeamani, Gavin
    Moodie, Marjory
    Low health-related quality of life in school-aged children in Tonga, a lower-middle income country in the South Pacific2014In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, no 1, p. 24896-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Ensuring a good life for all parts of the population, including children, is high on the public health agenda in most countries around the world. Information about children's perception of their health-related quality of life (HRQoL) and its socio-demographic distribution is, however, limited and almost exclusively reliant on data from Western higher income countries.

    OBJECTIVES: To investigate HRQoL in schoolchildren in Tonga, a lower income South Pacific Island country, and to compare this to HRQoL of children in other countries, including Tongan children living in New Zealand, a high-income country in the same region.

    DESIGN: A cross-sectional study from Tonga addressing all secondary schoolchildren (11-18 years old) on the outer island of Vava'u and in three districts of the main island of Tongatapu (2,164 participants). A comparison group drawn from the literature comprised children in 18 higher income and one lower income country (Fiji). A specific New Zealand comparison group involved all children of Tongan descendent at six South Auckland secondary schools (830 participants). HRQoL was assessed by the self-report Pediatric Quality of Life Inventory 4.0.

    RESULTS: HRQoL in Tonga was overall similar in girls and boys, but somewhat lower in children below 15 years of age. The children in Tonga experienced lower HRQoL than the children in all of the 19 comparison countries, with a large difference between children in Tonga and the higher income countries (Cohen's d 1.0) and a small difference between Tonga and the lower income country Fiji (Cohen's d 0.3). The children in Tonga also experienced lower HRQoL than Tongan children living in New Zealand (Cohen's d 0.6).

    CONCLUSION: The results reveal worrisome low HRQoL in children in Tonga and point towards a potential general pattern of low HRQoL in children living in lower income countries, or, alternatively, in the South Pacific Island countries.

  • 237. Phillips, Susan P.
    et al.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Doubly blind: a systematic review of gender in randomised controlled trials2016In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 9, p. 1-18, article id 29597Article, review/survey (Refereed)
    Abstract [en]

    Background: Although observational data show social characteristics such as gender or socio-economic status to be strong predictors of health, their impact is seldom investigated in randomised controlled studies (RCTs).

    Objective & design: Using a random sample of recent RCTs from high-impact journals, we examined how the most often recorded social characteristic, sex/gender, is considered in design, analysis, and interpretation. Of 712 RCTs published from September 2008 to 31 December 2013 in the Annals of Internal Medicine, British Medical Journal, Lancet, Canadian Medical Association Journal, or New England Journal of Medicine, we randomly selected 57 to analyse funding, methods, number of centres, documentation of social circumstances, inclusion/exclusion criteria, proportions of women/men, and reporting about sex/gender in analyses and discussion.

    Results: Participants' sex was recorded in most studies (52/57). Thirty-nine percent included men and women approximately equally. Overrepresentation of men in 43% of studies without explicit exclusions for women suggested interference in selection processes. The minority of studies that did analyse sex/gender differences (22%) did not discuss or reflect upon these, or dismissed significant findings. Two studies reinforced traditional beliefs about women's roles, finding no impact of breastfeeding on infant health but nevertheless reporting possible benefits. Questionable methods such as changing protocols mid-study, having undefined exclusion criteria, allowing local researchers to remove participants from studies, and suggesting possible benefit where none was found were evident, particularly in industry-funded research.

    Conclusions: Social characteristics like sex/gender remain hidden from analyses and interpretation in RCTs, with loss of information and embedding of error all along the path from design to interpretation, and therefore, to uptake in clinical practice. Our results suggest that to broaden external validity, in particular, more refined trial designs and analyses that account for sex/gender and other social characteristics are needed.

  • 238.
    Phillips, Susan P
    et al.
    Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS). Queens University, Family Medciine, Kingston, Canada.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Women's relative immunity to the socio-economic health gradient: artifact or real?2015In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 8, article id 27259Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Individual and area socio-economic status (SES) are significant predictors of morbidity and mortality in developed and developing countries. However, the span in health from poorest to richest, that is, the socio-economic gradient, appears steeper for men than women.

    OBJECTIVE: Our aim is to understand women's apparent immunity to the health harms of the SES gradient.

    DESIGN: Findings from a non-systematic search of Medline for population-based, SES gradient studies reporting results for both men and women and with health outcomes of morbidity, mortality or self-rated health (SRH) were reflectively analyzed.

    RESULTS: The 36 papers reviewed generally showed women to be relatively immune to the SES gradient for all but cardiovascular health outcomes. However, addressing the interconnected nature of socio-economic circumstances, exploring whether some measures of SES had ambiguous meanings for either women or men, including modifiers of SES such as household circumstances, social capital or area gender equity, or using indicators of area SES that were contextual rather than aggregates of individual, compositional measures increased the SES gradient for women. Outcome measures that combined mental and physical health, accounted for gender differences in SRH and adjusted for sex-specific differences in causes of mortality also explained some of the observed amelioration of the SES gradient among women.

    CONCLUSIONS: Socio-economic circumstances have a real and sustained impact on individual health. The SES gradient appears stronger for men than for women for all health outcomes other than heart disease. However, some of the observed variability between men and women may be an artifact of biased methodology. Considering webs of causation rather than individual markers of SES along with other sources of gender bias can explain much of women's blunted socio-economic gradient and deepen understanding of the pathways from SES to morbidity and mortality overall.

  • 239.
    Pongthippat, Weerati
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. b Mental Health and Psychiatric Nursing Department, Boromarajonani College of Nursing Udon Thani, Udon Thani, Thailand.
    Darvishpour, Mehrdad
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Kijsompon, Jureerat
    c Praboromrajchanok Institute for Health Workforce Development, Ministry of Public Health, Nonthaburi, Thailand.
    Östlund, Gunnel
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Broken dreams of a better life in Sweden: Thai women’s lived experiences of intimate partner violence by Swedish men in international marriages2018In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 11, no 1, p. 1-10Article in journal (Refereed)
    Abstract [en]

    Background: Intimate partner violence by men against women has detrimental effects on equality, health and integration. Migrated and ‘imported’ wives experience an increased risk of intimate partner violence. Objectives: The purpose of this study was to explore Thai immigrant women’s lived experiences of intimate partner violence in Sweden. Method: Semi-structured interviews based on the critical incident technique with specific questions about experiences of male-to-female intimate partner violence were used to collect data. The participants were Thai immigrant women who had lived in Sweden for more than five years. Qualitative content analysis was used to identify patterns and variations in the transcribed data material. Results: Eighteen interviewees reported psychological, physical, economic and/or sexual violence in their international marriages. These Thai women described being faithful and silent and reliable housewives. However, this did not keep them from being replaced and losing dignity as a result of intimate partner violence, including experiencing broken dreams and deception. Although their dreams were broken, they did not give up their efforts to achieve better lives in Sweden. Conclusions: The vulnerability of imported wives in international marriages needs to be further recognised by health and welfare agencies in Sweden, as elsewhere, to ensure that these women have equal access to human rights, welfare and health as other citizens. From a health promotion perspective, home-based health check-ups are needed to stop the exploitation of imported wives. In Thailand, information and education about the unrecognised negative conditions of the Mia farang role (Imported wife role) need to be disseminated.

  • 240.
    Preet, Raman
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Health professionals for global health: include dental personnel upfront!2013In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 6, p. 1-4Article in journal (Refereed)
    Abstract [en]

    The Global Health Beyond 2015 was organized in Stockholm in April 2013, which was announced as public engagement and where the dialogue focused on three main themes: social determinants of health, climate change and the non-communicable diseases. This event provided opportunity for both students and health professionals to interact and brainstorm ideas to be formalized into Stockholm Declaration on Global Health. Amongst the active participation of various health professionals, one that was found significantly missing was that of oral health. Keeping this as background in this debate, a case for inclusion of oral health professions is presented by organizing the argument in four areas: education, evidence base, political will and context and what each one offers at a time when Scandinavia is repositioning itself in global health.

  • 241.
    Preet, Raman
    et al.
    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.
    Schumann, Barbara
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Evengård, Birgitta
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    The gender perspective in climate change and global health2010In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 3, p. 5720-Article in journal (Refereed)
    Abstract [en]

    Despite recognizing the differential effects of climate change on health of women and men as a consequence of complex social contexts and adaptive capacities, the study finds gender to be an underrepresented or non-existing variable both in research and studied policy documents in the field of climate change and health.

  • 242.
    Probandari, Ari Natalia
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Utarini, Adi
    Department of Public Health, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia.
    Hurtig, Anna-Karin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Achieving quality in the directly observed treatment short-course (DOTS) strategy implementation process: a challenge for hospital public–private mix in Indonesia2008In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 1Article in journal (Refereed)
    Abstract [en]

    Background: The Directly Observed Treatment Short-course (DOTS) expansion strategy through Public–Private Mix (PPM) is in progress at an international level as well as in Indonesia. The number of hospitals involved in PPM has been rapidly scaling up, requiring the assessment of quality of implementation.

    Objective: The paper presents the assessment of quality in implementing DOTS strategy in hospitals in Indonesia and emphasises the challenge of achieving high process quality in managing adult TB cases seen in the outpatient unit.

    Design: A multiple-case study, involving eight general hospitals in Yogyakarta and Central Java provinces. The cases are comprised of public and private hospitals as well as teaching and non-teaching hospitals. Using the Donabedian's model, the quality of DOTS strategy implementation in hospitals was assessed in three aspects, i.e. structure, process and outcome. Data were collected through self-administered questionnaires, focus group discussions, interviews, observation and documents.

    Results: The study revealed the importance of process, i.e. mainly commitment and case holding process, to the treatment success rate, treatment completion rate and default rate.

    Conclusion: A systemic approach and structural support from the hospital is critical in this endeavour. Process improvement in the implementation of DOTS strategy in hospitals should be given more emphasis in hospital PPM-DOTS.

  • 243.
    Pun, Kunta Devi
    et al.
    Kathmandu Univ, Sch Med Sci, POB 11008, Dhulikhel, Kavre, Nepal.; Norwegian Univ Sci & Technol, Dept Publ Hlth & Gen Practice, Trondheim, Norway..
    Infanti, Jennifer J.
    Norwegian Univ Sci & Technol, Dept Publ Hlth & Gen Practice, Trondheim, Norway..
    Koju, Rajendra
    Kathmandu Univ, Sch Med Sci, POB 11008, Dhulikhel, Kavre, Nepal..
    Schei, Berit
    Norwegian Univ Sci & Technol, Dept Publ Hlth & Gen Practice, Trondheim, Norway.; St Olavs Hosp, Dept Obstet & Gynecol, Trondheim, Norway..
    Darj, Elisabeth
    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). Norwegian Univ Sci & Technol, Dept Publ Hlth & Gen Practice, Trondheim, Norway.; St Olavs Hosp, Dept Obstet & Gynecol, Trondheim, Norway..
    Community perceptions on domestic violence against pregnant women in Nepal: a qualitative study2016In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 9, article id 31964Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Globally, knowledge of health sector options to respond to domestic violence during pregnancy is increasing, but this topic is under-investigated in Nepal. This gap affects the provision of adequate antenatal care services and understanding of factors that influence women's willingness and ability to use available services. It is critical to know more about the social norms in a community that promote and prevent women experiencing domestic violence from seeking antenatal care.

    OBJECTIVE: To explore community perceptions of domestic violence against pregnant women.

    METHODS: A qualitative study was conducted in Dhulikhel municipality, involving 41 men and 76 women in 12 focus group discussions in different gender and family role separated groups. The interviews were recorded, transcribed in verbatim, and analyzed using content analysis. A socio-ecological model was used as a theoretical framework to illustrate linkages between individual, relationship, community, and societal influences on perceptions of domestic violence during pregnancy.

    RESULTS: The community recognized different forms of violence during pregnancy threatening women's physical and psychological health and presenting obstacles to seeking antenatal care. Some types of culturally specific violence were considered particularly harmful, such as pressure to give birth to sons, denial of food, and forcing pregnant women to do hard physical work during pregnancy, which may leave daughters-in-law vulnerable to domestic violence in extended families. A culture where violence is normalized and endurance and family reconciliation are promoted above individual health was perceived to cause women to tolerate and accept the situation. Participants suggested actions and strategies to address continuing violence, which indicated a societal transition toward increased awareness and changing attitudes and practices.

    CONCLUSIONS: Domestic violence during pregnancy needs to be addressed at different levels in Nepal, where women are often dependent on others for access to health care. Social norms were perceived to be shifting toward reduced acceptance of violence against women, but restrictions on women's life options, movement, and decision-making authority were still considered impediments to pregnant women's health.

  • 244.
    Puthoopparambil, Soorej J.
    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).
    Bjerneld, Magdalena
    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).
    Källestål, Carina
    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).
    Quality of life among immigrants in Swedish immigration detention centres: a cross-sectional questionnaire study2015In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 8, article id 28321Article in journal (Refereed)
    Abstract [en]

    Background: Detention of immigrants negatively affects their health and well-being. Quality of life (QOL) is a broad concept incorporating the self-evaluation of one's own health and well-being that can provide an understanding of the health and well-being of immigrant detainees. The aim of this study was to estimate QOL among immigrant detainees in Sweden and to assess its relationship with the services provided in detention centres and with the duration of detention. Design: All immigrants in all five existing Swedish detention centres (N = 193) were invited to participate in the study (n = 127). In this cross-sectional study, QOL was measured using the WHOQOL-BREF questionnaire, which was administered by the first author. The questionnaire contained four additional questions measuring participants' satisfaction with the services provided in detention. Associations between QOL domain scores and service satisfaction scores were assessed using regression analysis. The Spearman's rank correlation coefficient was calculated to measure the degree of association between the duration of detention and QOL scores. Results: The mean QOL domain scores (out of 100) were 47.0, 57.5, 41.9, and 60.5 for the environmental, physical, psychological, and social domains, respectively. The level of support detainees received from detention staff was significantly positively associated with detainees' physical (beta adjusted 3.93, confidence interval [CI] 0.06-7.80) and psychological (beta(adjusted) 5.72, CI 1.77-9.66) domain scores. There was also significant positive association between detainees' satisfaction with the care they received from detention staff and the domain scores. The general health score in the WHOQOL-BREF was significantly associated with the detainees' ability to understand the Swedish or English languages. Although not statistically significant, a longer duration of detention was negatively correlated with QOL scores. Conclusion: Immigrant detainees report low QOL. Services provided at the centres, especially the support received from detention staff, is positively associated with their QOL. A review of detention guidelines addressing language barriers, staff training, and duration of detention is highly recommended.

  • 245.
    Puthoopparambil, Soorej Jose
    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).
    Bjerneld, Magdalena
    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).
    Detainees, staff and healthcare services in immigration detention centers: A descriptive comparison of detention systems in Sweden and the Benelux countries2016In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 9, article id 30358Article in journal (Refereed)
    Abstract [en]

    Background:

    Immigration detention has been shown to negatively affect the health and well-being of detainees. The aim of the study was to describe and compare policies and practices that could affect the health and well-being of immigrant detainees in the Benelux countries (Belgium, the Netherlands, and Luxembourg) to those in Sweden.

    Design:

    This was a case study. Data were collected in two phases using a questionnaire developed particularly for this study. In the first phase, authorities in the Benelux countries responded to the questionnaire via email. During the second phase, a research team visited detention centres in the Benelux countries to observe and further explore, strengthening findings through triangulation. Data on Swedish detention centres were collected in previous studies.

    Results:

    Compared to the Benelux countries, Sweden has limited health care provision available in the detention centres. Swedish detention centres did not have mental health care professionals working at the centres and had fewer restrictions within the centres with regard to access to mobile phone, internet, and various recreational activities. Compared to Sweden, the detention centres in the Benelux countries have more staff categories providing services to the detainees that are provided with relevant and timely on-the-job training. All the countries, except Belgium, provide subsistence allowances to detainees.

    Conclusion:

    Despite the Common European Asylum System framework, differences exist among the four European Union member states in providing services to immigrant detainees. This study highlights these differences, thereby providing a window on how these diverse approaches may serve as a learning tool for improving services offered to immigrant detainees. In Sweden, the health care available to detainees and training and recruitment of staff should be improved, while the Benelux countries should strive to reduce restrictions within detention centres.

  • 246.
    Påfs, Jessica
    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).
    Rulisa, Stephen
    Department of Obstetrics & Gynecology, School of Medicine, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
    Musafili, Aimable
    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).
    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).
    Binder-Finnema, Pauline
    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).
    'You try to play a role in her pregnancy' - a qualitative study on recent fathers' perspectives about childbearing and encounter with the maternal health system in Kigali, Rwanda2016In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 9, article id 31482Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Rwanda has raised gender equality on the political agenda and is, among other things, striving for involving men in reproductive health matters. With these structural changes taking place, traditional gender norms in this setting are challenged. Deeper understanding is needed of men's perceptions about their gendered roles in the maternal health system.

    OBJECTIVE: To explore recent fathers' perspectives about their roles during childbearing and maternal care-seeking within the context of Rwanda's political agenda for gender equality.

    DESIGN: Semi-structured interviews were conducted with 32 men in Kigali, Rwanda, between March 2013 and April 2014. A framework of naturalistic inquiry guided the overall study design and analysis. In order to conceptualize male involvement and understand any gendered social mechanisms, the analysis is inspired by the central principles from relational gender theory.

    RESULTS: The participants in this study appeared to disrupt traditional masculinities and presented ideals of an engaged and caring partner during pregnancy and maternal care-seeking. They wished to carry responsibilities beyond the traditional aspects of being the financial provider. They also demonstrated willingness to negotiate their involvement according to their partners' wishes, external expectations, and perceived cultural norms. While the men perceived themselves as obliged to accompany their partner at first antenatal care (ANC) visit, they experienced several points of resistance from the maternal health system for becoming further engaged.

    CONCLUSIONS: These men perceived both maternal health system policy and care providers as resistant toward their increased engagement in childbearing. Importantly, perceiving themselves as estranged may consequently limit their engagement with the expectant partner. Our findings therefore recommend maternity care to be more responsive to male partners. Given the number of men already taking part in ANC, this is an opportunity to embrace men's presence and promote behavior in favor of women's health during pregnancy and childbirth - and may also function as a cornerstone in promoting gender-equitable attitudes.

  • 247. Raza, Wasif
    et al.
    Forsberg, Bertil
    Johansson, Christer
    Stockholm University, Faculty of Science, Department of Environmental Science and Analytical Chemistry. Environment and Health Administration, SLB, Sweden.
    Nilsson Sommar, Johan
    Air pollution as a risk factor in health impact assessments of a travel mode shift towards cycling2018In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 11, no 1, article id 1429081Article, review/survey (Refereed)
    Abstract [en]

    Background: Promotion of active commuting provides substantial health and environmental benefits by influencing air pollution, physical activity, accidents, and noise. However, studies evaluating intervention and policies on a mode shift from motorized transport to cycling have estimated health impacts with varying validity and precision. Objective: To review and discuss the estimation of air pollution exposure and its impacts in health impact assessment studies of a shift in transport from cars to bicycles in order to guide future assessments. Methods: A systematic database search of PubMed was done primarily for articles published from January 2000 to May 2016 according to PRISMA guidelines. Results: We identified 18 studies of health impact assessment of change in transport mode. Most studies investigated future hypothetical scenarios of increased cycling. The impact on the general population was estimated using a comparative risk assessment approach in the majority of these studies, whereas some used previously published cost estimates. Air pollution exposure during cycling was estimated based on the ventilation rate, the pollutant concentration, and the trip duration. Most studies employed exposure-response functions from studies comparing background levels of fine particles between cities to estimate the health impacts of local traffic emissions. The effect of air pollution associated with increased cycling contributed small health benefits for the general population, and also only slightly increased risks associated with fine particle exposure among those who shifted to cycling. However, studies calculating health impacts based on exposure-response functions for ozone, black carbon or nitrogen oxides found larger effects attributed to changes in air pollution exposure. Conclusion: A large discrepancy between studies was observed due to different health impact assessment approaches, different assumptions for calculation of inhaled dose and different selection of dose-response functions. This kind of assessments would improve from more holistic approaches using more specific exposure- response functions.

  • 248.
    Raza, Wasif
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Johansson, Christer
    Nilsson Sommar, Johan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Air pollution as a risk factor in health impact assessments of a travel mode shift towards cycling2018In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 11, no 1, article id 1429081Article, review/survey (Refereed)
    Abstract [en]

    BACKGROUND: Promotion of active commuting provides substantial health and environmental benefits by influencing air pollution, physical activity, accidents, and noise. However, studies evaluating intervention and policies on a mode shift from motorized transport to cycling have estimated health impacts with varying validity and precision.

    OBJECTIVE: To review and discuss the estimation of air pollution exposure and its impacts in health impact assessment studies of a shift in transport from cars to bicycles in order to guide future assessments.

    METHODS: A systematic database search of PubMed was done primarily for articles published from January 2000 to May 2016 according to PRISMA guidelines.

    RESULTS: We identified 18 studies of health impact assessment of change in transport mode. Most studies investigated future hypothetical scenarios of increased cycling. The impact on the general population was estimated using a comparative risk assessment approach in the majority of these studies, whereas some used previously published cost estimates. Air pollution exposure during cycling was estimated based on the ventilation rate, the pollutant concentration, and the trip duration. Most studies employed exposure-response functions from studies comparing background levels of fine particles between cities to estimate the health impacts of local traffic emissions. The effect of air pollution associated with increased cycling contributed small health benefits for the general population, and also only slightly increased risks associated with fine particle exposure among those who shifted to cycling. However, studies calculating health impacts based on exposure-response functions for ozone, black carbon or nitrogen oxides found larger effects attributed to changes in air pollution exposure.

    CONCLUSION: A large discrepancy between studies was observed due to different health impact assessment approaches, different assumptions for calculation of inhaled dose and different selection of dose-response functions. This kind of assessments would improve from more holistic approaches using more specific exposure-response functions.

  • 249. Razzaque, Abdur
    et al.
    Nahar, Lutfun
    Van Minh, Hoang
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. India.
    Juvekar, Sanjay
    Ashraf, Ali
    Ahmed, Syed Masud
    Soonthornthada, Kusol
    Kanungsukkasem, Uraiwan
    Huu Bich, Tran
    Social factors and overweight: evidence from nine Asian INDEPTH Network sites2009In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 2Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Overweight/obesity increases the risk of morbidity and mortality from a number of chronic conditions, including heart disease, stroke, diabetes and some cancers. This study examined the distribution of body mass index (BMI) in nine Health and Demographic Surveillance System (HDSS) sites in five Asian countries and investigated the association between social factors and overweight.

    DATA AND METHODS: This cross-sectional study was conducted in nine HDSS sites in Bangladesh, India, Indonesia, Thailand and Vietnam. The methodology of the WHO STEPwise approach to Surveillance with core risk factors (Step 1) and physical measurements for weight, height and waist circumference (Step 2) were included. In each site, about 2,000 men and women aged 25-64 years were selected randomly using the HDSS database. Weight was measured using electronic scales, height was measured by portable stadiometers and waist circumference was measured by measuring tape. Overweight/obesity was assessed by BMI defined as the weight in kilograms divided by the square of the height in metres (kg/m(2)).

    RESULTS: At least 10% people were overweight (BMI >/= 25) in each site except for the two sites in Vietnam and WATCH HDSS in Bangladesh where few men and women were overweight. After controlling for all the variables in the model, overweight increases with age initially and then declines, with increasing education, and with gender with women being heavier than men. People who eat vegetables and fruits below the recommended level and those who do high level of physical activity are, on the whole, less heavy than those who eat more and do less physical activity.

    CONCLUSIONS: As the proportion of the population classified as being overweight is likely to increase in most sites and overweight varies by age, sex, and social and behavioural factors, behavioural interventions (physical exercise, healthy diet) should be developed for the whole population together with attention to policy around nutrition and the environment, in order to reduce the adverse effects of overweight on health.

  • 250.
    Rishal, Poonam
    et al.
    Norwegian Univ Sci & Technol, Norway.
    Joshi, Sunil Kumar
    Kathmandu Med Coll, Nepal.
    Lukasse, Mirjam
    Oslo & Akershus Univ, Norway.
    Schei, Berit
    Norwegian Univ Sci & Technol, Norway ; Univ Trondheim Hosp, St Olavs Hosp, Norway.
    Swahnberg, Katarina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    'They just walk away' - women's perception of being silenced by antenatal health workers: a qualitative study on women survivors of domestic violence in Nepal2016In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 9, p. 1-10, article id 31838Article in journal (Refereed)
    Abstract [en]

    Background: Domestic violence during pregnancy has detrimental effects on the health of the mother and the newborn. Antenatal care provides a 'window of opportunity' to identify and assist victims of domestic violence during pregnancy. Little is known about the experience, needs, and expectations from the women's perspective in relation to domestic violence in Nepal. Objective: Our study aims to explore how women who have experienced domestic violence evaluate their antenatal care and their expectations and needs from health centers. Design: Twelve in-depth interviewswere conducted among women who had experienced domestic violence during pregnancy and utilized antenatal care. The women were recruited from two different organizations in Nepal. Results: Women in our study concealed their experience of domestic violence due to fear of being insulted, discriminated, and negative attitudes of the health care providers. The women wished that the health care providers were compassionate and asked them about their experience, ensured confidentiality and privacy, and referred them to services that is free of cost. Conclusions: Findings from our study may help the health care providers to change their attitudes toward women survivors of domestic violence. Identifying and assisting these women through antenatal care could result in improved services for them and their newborns.

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