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  • 251.
    Rocklöv, Joacim
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Bao Giang, Kim
    Van Minh, Hoang
    Ebi, Kristie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Univ Washington, Sch Publ Hlth, Seattle, WA 98195 USA.
    Nilsson, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Sahlen, Klas-Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Local research evidence for public health interventions against climate change in Vietnam2014In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, article id 26552Article in journal (Refereed)
  • 252.
    Rocklöv, Joacim
    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.
    Comparing approaches for studying the effects of climate extremes: a case study of hospital admissions in Sweden during an extremely warm summer2009In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 2Article in journal (Refereed)
    Abstract [en]

    Background: Health effects induced by climate, weather and climatic change may act directly or indirectly on human physiology. The future total burden of global warming is uncertain, but in some areas and for specific outcomes, mortality and morbidity are likely to increase. One likely effect of global warming is an increasing number of extreme weather events, such as floods, storms and heat waves. The excess numbers of specific health outcomes attributable to climate-induced events can be estimated. This paper compares approaches for estimating excess numbers of outcomes associated with climate extremes, exemplified by a case study of hospital admissions during the extremely warm summer of 2006 in southern Sweden.

    Materials and methods: Daily hospital admission data were obtained from the Swedish National Board of Health and Welfare for six hospitals in the Skåne region of southern Sweden for the period 1998 to 2006. Daily temperature data for the region were obtained from the meteorological station in the city of Malmö. We used four established approaches for estimating the daily excess numbers associated with extreme heat. Time series of daily event rates were assumed to follow a Poisson distribution. Excess event rates were compared by using several approaches, such as standardised event ratios and generalised additive models to estimate the health risks attributable to the extreme climate event.

    Results: The four approaches yielded vastly different results. The estimates of excess were considerably biased when not accounting for time trends in previous years’ data. Three of four approaches showed a significant increase in excess hospitalisation rates attributable to the heat episode in Skåne in 2006. However, modelling the effect of temperature failed to describe the risks induced by the extreme heat.

    Conclusion: Estimates of excess events depend greatly on the approach used. Further research is needed to identify which method yielded the most accurate estimates. However, one of the approaches used generally seem to perform better than the others in estimating the excess rates associated with the heat episode. Further on, estimating relative risks of temperature or other determinants of disease may fail to incorporate the unique characteristics of particular weather events, such as the effect caused by very persistent heat exposure. Unless this can be incorporated into predictive models, such models may be less appropriate to use when predicting the future burden of heat waves on human health.

  • 253.
    Rocklöv, Joacim
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Ebi, Kristie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Bellander, Tom
    Susceptibility to mortality related to temperature and heat and cold wave duration in the population of Stockholm County, Sweden2014In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, p. 22737-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Ambient temperatures can cause an increase in mortality. A better understanding is needed of how health status and other factors modify the risk associated with high and low temperatures, to improve the basis of preventive measures. Differences in susceptibility to temperature and to heat and cold wave duration are relatively unexplored.

    OBJECTIVES: We studied the associations between mortality and temperature and heat and cold wave duration, stratified by age and individual and medical factors.

    METHODS: Deaths among all residents of Stockholm County between 1990 and 2002 were linked to discharge diagnosis data from hospital admissions, and associations were examined using the time stratified case-crossover design. Analyses were stratified by gender, age, pre-existing disease, country of origin, and municipality level wealth, and adjusted for potential confounding factors. Results : The effect on mortality by heat wave duration was higher for lower ages, in areas with lower wealth, for hospitalized patients younger than age 65. Odds were elevated among females younger than age 65, in groups with a previous hospital admission for mental disorders, and in persons with previous cardiovascular disease. Gradual increases in summer temperatures were associated with mortality in people older than 80 years, and with mortality in groups with a previous myocardial infarction and with chronic obstructive pulmonary disease (COPD) in the population younger than 65 years. During winter, mortality was associated with a decrease in temperature particularly in men and with the duration of cold spells for the population older than 80. A history of hospitalization for myocardial infarction increased the odds associated with cold temperatures among the population older than 65. Previous mental disease or substance abuse increased the odds of death among the population younger than 65.

    CONCLUSION: To increase effectiveness, we suggest preventive efforts should not assume susceptible groups are the same for warm and cold days and heat and cold waves, respectively.

  • 254.
    Rocklöv, Joacim
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Sauerborn, Rainer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Sankoh, Osman
    Weather conditions and population level mortality in resource-poor settings - understanding the past before projecting the future2012In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 5, p. 2-5Article in journal (Other academic)
  • 255.
    Ruano, Ana Lorena
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    The role of social participation in municipal-level health systems: the case of Palencia, Guatemala2013In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 6, article id 20786Article, review/survey (Refereed)
    Abstract [en]

    Background: Social participation has been recognized as an important public health policy since the declaration of Alma-Ata presented it as one of the pillars of primary health care in 1978. Since then, there have been many adaptations to the original policy but participation in health is still seen as a means to make the health system more responsive to local health needs and as a way to bring the health sector and the community closer together. Objective: To explore the role that social participation has in a municipal-level health system in Guatemala in order to inform future policies and programs. Design: Documentary analysis was used to study the context of participation in Guatemala. To do this, written records and accounts of Guatemalan history during the 20th century were reviewed. The fieldwork was carried out over 8 months and three field visits were conducted between early January of 2009 and late March of 2010. A total of 38 in-depth interviews with regional health authorities, district health authorities, community representatives, and community health workers (CHWs) were conducted. Data were analyzed using thematic analysis. Results: Guatemala's armed civil struggle was framed in the cold war and the fight against communism. Locally, the war was fed by the growing social, political, and ethnic inequalities that existed in the country. The process of reconstructing the country's social fabric started with the signing of the peace agreements of 1996, and continued with the passing of the 2002 legal framework designed to promote decentralization through social participation. Today, Guatemala is a post-war society that is trying to foster participation in a context full of challenges for the population and for the institutions that promote it. In the municipality of Palencia, there are three different spaces for participation in health: the municipal-level health commission, in community-level social development councils, and in the CHW program. Each of these spaces has participants with specific roles and processes. Conclusions: True participation and collaboration among can only be attained through the promotion and creation of meaningful partnerships between institutional stakeholders and community leaders, as well as with other stakeholders working at the community level. For this to happen, more structured support for the participation process in the form of clear policies, funding and capacity building is needed.

  • 256.
    Ruano, Ana Lorena
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Dahlblom, Kjerstin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hurtig, Anna-Karin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    San Sebastían, Miguel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    'If no one else stands up, you have to': a story of community participation and water in rural Guatemala2011In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 4, p. Article nr 6412-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Access to water is a right and a social determinant of health that should be provided by the state. However, when it comes to access to water in rural areas, the current trend is for communities to arrange for the service themselves through locally run projects. This article presents a narrative of a single community's process of participation in implementing and running a water project in the village of El Triunfo, Guatemala.

    METHODS: Using an ethnographic approach, we conducted a series of interviews with five village leaders, field visits, and participant observations in different meetings and activities of the community.

    FINDINGS: El Triunfo has had a long tradition of community participation, where it has been perceived as an important value. The village has a council of leaders who have worked together in various projects, although water has always been a priority. When it comes to participation, this community has achieved its goals when it collaborated with other stakeholders who provided the expertise and/or the funding needed to carry out a project. At the time of the study, the challenge was to develop a new phase of the water project with the help of other stakeholders and to maintain and sustain the tradition of participation by involving new generations in the process.

    DISCUSSION: This narrative focuses on the participation in this village's efforts to implement a water project. We found that community participation has substituted the role of the central and local governments, and that the collaboration between the council and other stakeholders has provided a way for El Triunfo to satisfy some of its demand for water.

    CONCLUSION: El Triunfo's case shows that for a participatory scheme to be successful it needs prolonged engagement, continued support, and successful experiences that can help to provide the kind of stable participatory practices that involves community members in a process of empowered decision-making and policy implementation.

  • 257.
    Salazar, Mariano
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Dahlblom, Kjerstin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Solórzano, Lucia
    Nicaraguan Natl Autonomous Univ, Ctr Demog & Hlth Res, Leon, Nicaragua.
    Herrera, Andrés
    Nicaraguan Natl Autonomous Univ, Ctr Demog & Hlth Res, Leon, Nicaragua.
    Exposure to intimate partner violence reduces the protective effect that women's high education has on children's corporal punishment: a population-based study2014In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, p. 24774-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Previous studies have shown that women's education is protective against corporal punishment (CP) of children. However, the effect that women's exposure to intimate partner violence (IPV) has on the association between women's education and children's CP has not been studied.

    OBJECTIVE: To understand how the interaction between women's exposure to IPV and their education level influences the occurrence of children's CP at the household level.

    METHODS: We selected 10,156 women who had at least one child less than 16 years old from cross-sectional data from the 2006-2007 Nicaraguan Demographic and Health Survey. Children's CP was defined as the punishment of children by slapping them, hitting them with a fist, or hitting them with a rope, belt, stick, or other object. IPV was measured by using a conflict tactic scale. The WHO Self-Reporting Questionnaire 20 (SRQ-20) was used to assess the women's mental health. We computed adjusted risk ratios (ARR) and 95% confidence intervals (CI) using Poisson regression with a robust variance estimator.

    RESULTS: Women's exposure to IPV was associated with a 10-17% increase in the risk of children's CP. IPV and children's CP were associated with impaired women's mental health. Women's lifetime exposure to emotional IPV and controlling behavior by a partner significantly decreased the protective effect from women's high education level on children's CP. When women were exposed to emotional IPV, the protective effect from having a college education decreased from ARR=0.61 (95% CI 0.47-0.80) to ARR=0.98 (95% CI 0.80-1.19). A similar pattern was found among women exposed to controlling behavior by a partner, the protective effect decreased from ARR=0.71 (95% CI 0.53-0.90) to ARR=0.86 (95% CI 0.70-1.06).

    CONCLUSION: This study shows how significant gains in one positive social determinant of children's well-being can be undermined when it interacts with men's violence toward women. Policies that aim to end children's CP must include actions to end women's exposure to IPV.

  • 258. Sankoh, Osman
    et al.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Cause-specific mortality at INDEPTH Health and Demographic Surveillance System Sites in Africa and Asia: concluding synthesis2014In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, article id 25590Article in journal (Refereed)
    Abstract [en]

    This synthesis brings together findings on cause-specific mortality documented by means of verbal autopsies applied to over 110,000 deaths across Africa and Asia, within INDEPTH Network sites.

    METHODS: Developments in computerised methods to assign causes of death on the basis of data from verbal autopsy (VA) interviews have made possible these standardised analyses of over 110,000 deaths from 22 African and Asian Health and Demographic Surveillance System sites in the INDEPTH Network. In addition to previous validations of the InterVA-4 probabilistic model, these wide-ranging analyses provide further evidence of the applicability of this approach to assigning the cause of death. Plausible comparisons with existing knowledge of disease patterns, as well as substantial correlations with out-of-model parameters such as time period, country, and other independent data sources were observed.

    FINDINGS: Substantial variations in mortality between sites, and in some cases within countries, were observed. A number of the mortality burdens revealed clearly constitute grounds for public health actions. At an overall level, these included high maternal and neonatal mortality rates. More specific examples were childhood drowning in Bangladesh and homicide among adult males in eastern and southern Africa. Mortality from non-communicable diseases, particularly in younger adulthood, is an emerging cause for concern. INDEPTH's approach of documenting all deaths in particular populations, and successfully assigning causes to the majority, is important for formulating health policies.

    FUTURE DIRECTIONS: The pooled dataset underlying these analyses is available at the INDEPTH Data Repository for further analysis. INDEPTH will continue to fill cause-specific mortality knowledge gaps across Africa and Asia, which will also serve as a baseline for post-2015 development goals. The more widespread use of similar VA methods within routine civil registration systems is likely to become an important medium-term strategy in many countries.

  • 259. Sanneving, Linda
    et al.
    Kulane, Asli
    Iyer, Aditi
    Åhgren, Bengt
    Nordic School of Public Health.
    Health system capacity: maternal health policy implementation in the state of Gujarat, India2013In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 6, p. 19629-Article in journal (Refereed)
    Abstract [en]

    Introduction: The Government of Gujarat has for the past couple of decades continuously initiated several interventions to improve access to care for pregnant and delivering women within the state. Data from the last District Family Heath survey in Gujarat in 2007-2008 show that 56.4% of women had institutional deliveries and 71.5% had at least one antenatal check-up, indicating that challenges remain in increasing use of and access to maternal health care services.

    Objective: To explore the perceptions of high-level stakeholders on the process of implementing maternal health interventions in Gujarat. Method: Using the policy triangle framework developed by Walt and Gilson, the process of implementation was approached using in-depth interviews and qualitative content analysis.

    Result: Based on the analysis, three themes were developed: lack of continuity; the complexity of coordination; and lack of confidence and underutilization of the monitoring system. The findings suggest that decisions made and actions advocated and taken are more dependent on individual actors than on sustainable structures. The findings also indicate that the context in which interventions are implemented is challenged in terms of weak coordination and monitoring systems that are not used to evaluate and develop interventions on maternal health.

    Conclusions: The implementation of interventions on maternal health is dependent on the capacity of the health system to implement evidence-based policies. The capacity of the health system in Gujarat to facilitate implementation of maternal health interventions needs to be improved, both in terms of the role of actors and in terms of structures and processes.

  • 260. Santosa, Ailiana
    et al.
    Wall, Stig
    Fottrell, Edward
    Högberg, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Byass, Peter
    The development and experience of epidemiological transition theory over four decades: a systematic review2014In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, no SI, p. 56-71Article, review/survey (Refereed)
    Abstract [en]

    Background: Epidemiological transition (ET) theory, first postulated in 1971, has developed alongside changes in population structures over time. However, understandings of mortality transitions and associated epidemiological changes remain poorly defined for public health practitioners. Here, we review the concept and development of ET theory, contextualising this in empirical evidence, which variously supports and contradicts the original theoretical propositions. Design: A Medline literature search covering publications over four decades, from 1971 to 2013, was conducted. Studies were included if they assessed human populations, were original articles, focused on mortality and health or demographic or ET and were in English. The reference lists of the selected articles were checked for additional sources. Results: We found that there were changes in emphasis in the research field over the four decades. There was an increasing tendency to study wide-ranging aspects of the determinants of mortality, including risk factors, lifestyle changes, socio-economics, and macro factors such as climate change. Research on ET has focused increasingly on low-and middle-income countries rather than industrialised countries, despite its origins in industrialised countries. Countries have experienced different levels of progress in ET in terms of time, pace, and underlying mechanisms. Elements of ET are described for many countries, but observed transitions have not always followed pathways described in the original theory. Conclusions: The classic ET theory largely neglected the critical role of social determinants, being largely a theoretical generalisation of mortality experience in some countries. This review shows increasing interest in ET all over the world but only partial concordance between established theory and empirical evidence. Empirical evidence suggests that some unconsidered aspects of social determinants contributed to deviations from classic theoretical pathways. A better-constructed, revised ET theory, with a stronger basis in evidence, is needed.

  • 261.
    Santosa, Ailiana
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå Centre for Global Health Research.
    Wall, Stig
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå Centre for Global Health Research.
    Fottrell, Edward
    Institute for Global Health, University College London, London, UK.
    Högberg, Ulf
    Department of Women’s and Children’s Health, Uppsala University, Uppsala.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå Centre for Global Health Research and MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
    The development and experience of epidemiological transition theory over four decades: a systematic review2014In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, article id 23574Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Epidemiological transition (ET) theory, first postulated in 1971, has developed alongside changes in population structures over time. However, understandings of mortality transitions and associated epidemiological changes remain poorly defined for public health practitioners. Here, we review the concept and development of ET theory, contextualising this in empirical evidence, which variously supports and contradicts the original theoretical propositions.

    DESIGN: A Medline literature search covering publications over four decades, from 1971 to 2013, was conducted. Studies were included if they assessed human populations, were original articles, focused on mortality and health or demographic or ET and were in English. The reference lists of the selected articles were checked for additional sources.

    RESULTS: We found that there were changes in emphasis in the research field over the four decades. There was an increasing tendency to study wide-ranging aspects of the determinants of mortality, including risk factors, lifestyle changes, socio-economics, and macro factors such as climate change. Research on ET has focused increasingly on low- and middle-income countries rather than industrialised countries, despite its origins in industrialised countries. Countries have experienced different levels of progress in ET in terms of time, pace, and underlying mechanisms. Elements of ET are described for many countries, but observed transitions have not always followed pathways described in the original theory.

    CONCLUSIONS: The classic ET theory largely neglected the critical role of social determinants, being largely a theoretical generalisation of mortality experience in some countries. This review shows increasing interest in ET all over the world but only partial concordance between established theory and empirical evidence. Empirical evidence suggests that some unconsidered aspects of social determinants contributed to deviations from classic theoretical pathways. A better-constructed, revised ET theory, with a stronger basis in evidence, is needed.

  • 262.
    Sartorius, Benn
    et al.
    MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa ; INDEPTH Network, Accra, Ghana.
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa ; INDEPTH Network, Accra, Ghana.
    Vounatsou, Penelope
    Swiss Tropical Institute, Basel, Switzerland.
    Collinson, Mark A.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa ; INDEPTH Network, Accra, Ghana.
    Tollman, Stephen M
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa ; INDEPTH Network, Accra, Ghana.
    Space and time clustering of mortality in rural South Africa (Agincourt HDSS), 1992-20072010In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 3, p. 50-58Article in journal (Refereed)
    Abstract [en]

    This study has highlighted distinct clusters of all-cause and cause-specific mortality within the Agincourt subdistrict. It is a first step in prioritizing areas for further, more detailed research as well as for future public health follow-on efforts such as targeting of vertical prevention of HIV/TB and antiretroviral rollout in significant child and adult mortality clusters; and assessment and provision of adequate water and sanitation in the child mortality clusters particularly in south-east where diarrheal mortality appears high. Underlying causative factors need to be identified and accurately quantified. Other questions for more detailed research are discussed.

  • 263.
    Sauerborn, Rainer
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Ebi, Kristie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Stanford University, CA, USA.
    Climate change and natural disasters: integrating science and practice to protect health2012In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 5, p. 1-7Article in journal (Refereed)
    Abstract [en]

    Background: Hydro-meteorological disasters are the focus of this paper. The authors examine, to which extent climate change increases their frequency and intensity. Methods: Review of IPCC-projections of climate-change related extreme weather events and related literature on health effects. Results: Projections show that climate change is likely to increase the frequency, intensity, duration, and spatial distribution of a range of extreme weather events over coming decades. Conclusions: There is a need for strengthened collaboration between climate scientists, the health researchers and policy-makers as well as the disaster community to jointly develop adaptation strategies to protect human.

  • 264.
    Sauerborn, Rainer
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Kjellström, Tord
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Nilsson, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Invited editorial: health as a crucial driver for climate policy2009In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 2Article in journal (Refereed)
  • 265.
    Saulnier, Dell D.
    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).
    Persson, Lars-Åke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Streatfield, Peter Kim
    Icddrb, Dhaka, Bangladesh..
    Faruque, A. S. G.
    Icddrb, Dhaka, Bangladesh..
    Rahman, Anisur
    Icddrb, Dhaka, Bangladesh..
    Using health and demographic surveillance for the early detection of cholera outbreaks: analysis of community- and hospital-based data from Matlab, Bangladesh2016In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 9, article id 30834Article in journal (Refereed)
    Abstract [en]

    Background: Cholera outbreaks are a continuing problem in Bangladesh, and the timely detection of an outbreak is important for reducing morbidity and mortality. In Matlab, the ongoing Health and Demographic Surveillance System (HDSS) data records symptoms of diarrhea in children under the age of 5 years at the community level. Cholera surveillance in Matlab currently uses hospital-based data. Objective: The objective of this study is to determine whether increases in cholera in Matlab can be detected earlier by using HDSS diarrhea symptom data in a syndromic surveillance analysis, when compared to hospital admissions for cholera. Methods: HDSS diarrhea symptom data and hospital admissions for cholera in children under 5 years of age over a 2-year period were analyzed with the syndromic surveillance statistical program EARS (Early Aberration Reporting System). Dates when significant increases in either symptoms or cholera cases occurred were compared to one another. Results: The analysis revealed that there were 43 days over 16 months when the cholera cases or diarrhea symptoms increased significantly. There were 8 months when both data sets detected days with significant increases. In 5 of the 8 months, increases in diarrheal symptoms occurred before increases of cholera cases. The increases in symptoms occurred between 1 and 15 days before the increases in cholera cases. Conclusions: The results suggest that the HDSS survey data may be able to detect an increase in cholera before an increase in hospital admissions is seen. However, there was no direct link between diarrheal symptom increases and cholera cases, and this, as well as other methodological weaknesses, should be taken into consideration.

  • 266.
    Schröders, Julia
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Sutton, Caroline
    Global Health in Action: a call for pictures2015In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 8, article id 30772Article in journal (Other academic)
  • 267.
    Schumann, Barbara
    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).
    Edvinsson, Sören
    Umeå University, Faculty of Social Sciences, Demographic Data Base.
    Evengard, Birgitta
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Rocklöv, Joacim
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    The influence of seasonal climate variability on mortality in pre-industrial Sweden2013In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 6, p. 1-9Article in journal (Refereed)
    Abstract [en]

    Background: Recent studies have shown an association between weather and climatic factors with mortality, cardiovascular and infectious diseases. We used historical data to investigate the impact of seasonal temperature and precipitation on total mortality in Uppsala, Sweden, during the first two stages of the demographic transition, 1749-1859. Design: We retrieved mortality and population numbers of the Uppsala Domkyrka parish from digitised parish records and obtained monthly temperature and precipitation measures recorded in Uppsala during that time. Statistical models were established for year-to-year variability in deaths by annual and seasonal temperature and precipitation, adjusting for longer time trends. In a second step, a model was established for three different periods to study changes in the association of climate variability and mortality over time. Relative risks (RR) with 95% confidence intervals (CI) were calculated. Results: Precipitation during spring and autumn was significantly associated with annual mortality (spring RR 0.982, CI 0.965-1.000; autumn RR 1.018, CI 1.004-1.032, respectively, per centimetre increase of precipitation). Higher springtime temperature decreased annual mortality, while higher summer temperature increased the death toll; however, both were only borderline significant (p = 0.07). The significant effect of springtime precipitation for mortality was present only in the first two periods (1749-1785 and 1786-1824). On the contrary, the overall effect of autumn precipitation was mainly due to its relevance during the last period, 1825-1859 (RR 1.024, CI 0.997-1.052). At that time, higher winter precipitation was found to decrease mortality. Conclusions: In urban Uppsala, during the 18th and 19th century, precipitation appeared to be a stronger predictor for mortality than temperature. Higher spring precipitation decreased and higher autumn precipitation increased the number of deaths. However, this association differed before and during the early stages of industrialisation. Further research shall take age-specific differences into account, as well as changes in socio-economic conditions during that time.

  • 268.
    Scribani, Melissa
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Bassett Healthcare Network, Bassett Research Institute, Cooperstown, NY, USA.
    Norberg, Margareta
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Lindvall, Kristina
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Sorensen, Julie
    Jenkins, Paul
    Sex-specific associations between body mass index and death before life expectancy: a comparative study from the USA and Sweden2019In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 12, no 1, article id 1580973Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Understanding the impact of obesity on premature mortality is critical, as obesity has become a global health issue.

    OBJECTIVE: To contrast the relationship between body mass index (BMI) and premature death (all-cause; circulatory causes) in New York State (USA) and Northern Sweden.

    METHODS: Baseline data were obtained between 1989 and 1999 via questionnaires (USA) and health exams (Sweden), with mortality data from health departments, public sources (USA) and the Swedish Death Register. Premature death was death before life expectancy based on sex and year of birth. Within country and sex, time to premature death was compared across BMI groups (18.5-24.9 kg/m2 (reference), 25-29.9 kg/m2, 30.0-34.9 kg/m2, ≥35.0 kg/m2) using Proportional Hazards regression. Absolute risk (deaths/100,000 person-years) was compared for the same stratifications among nonsmokers.

    RESULTS: 60,600 Swedish (47.8% male) and 31,198 US subjects (47.7% male) were included. Swedish males with BMI≥30 had increased hazards (HR) of all-cause premature death relative to BMI 18.5-24.9 (BMI 30-34.9, HR = 1.71 (95% CI: 1.44, 2.02); BMI≥35, HR = 2.89 (2.16, 3.88)). BMI≥25 had increased hazards of premature circulatory death (BMI 25-29.9, HR = 1.66 (1.32, 2.08); BMI 30-34.9, HR = 3.02 (2.26, 4.03); BMI≥35, HR = 4.91 (3.05, 7.90)). Among US males, only BMI≥35 had increased hazards of all-cause death (HR = 1.63 (1.25, 2.14)), while BMI 30-34.9 (HR = 1.83 (1.20, 2.79)) and BMI≥35 (HR = 3.18 (1.96, 5.15)) had increased hazards for circulatory death. Swedish females showed elevated hazards with BMI≥30 for all-cause (BMI 30-34.9, HR = 1.42 (1.18, 1.71) and BMI≥35, HR = 1.61 (1.21, 2.15) and with BMI≥35 (HR = 3.11 (1.72, 5.63)) for circulatory death. For US women, increased hazards were observed among BMI≥35 (HR = 2.10 (1.60, 2.76) for all-cause and circulatory HR = 3.04 (1.75, 5.30)). Swedish males with BMI≥35 had the highest absolute risk of premature death (762/100,000 person-years).

    CONCLUSIONS: This study demonstrates a markedly increased risk of premature death associated with increasing BMI among Swedish males, a pattern not duplicated among females.

  • 269. Sessions, October M
    et al.
    Khan, Kamran
    Hou, Yan'an
    Meltzer, Eyal
    Quam, Mikkel
    Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
    Schwartz, Eli
    Gubler, Duane J
    Wilder-Smith, Annelies
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
    Exploring the origin and potential for spread of the 2013 dengue outbreak in Luanda, Angola2013In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 6, article id 21822Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Dengue in Africa is underreported. Simultaneous reports of travellers with dengue returning from Luanda, Angola, to six countries on four continents suggest that a major dengue outbreak is currently occurring in Angola, South West Africa.

    METHODS: To identify the origin of the imported dengue virus, we sequenced the virus from Angola and investigated the interconnectivity via air travel between dengue-endemic countries and Angola.

    RESULTS AND CONCLUSION: Our analyses show that the Angola outbreak was most likely caused by an endemic virus strain that had been circulating in West Africa for many years. We also show that Portugal and South Africa are most likely at the highest risk of importation of dengue from Angola due to the large number of air passengers between Angola and these countries.

  • 270.
    Shakya-Vaidya, Suraj
    et al.
    Nepal Medical College Teaching Hospital, Kathmandu, Nepal / Nordic School of Public Health NHV, Gothenburg, Sweden.
    Aryal, Umesh Raj
    Nordic School of Public Health NHV, Gothenburg, Sweden / Kathmandu Medical College, Kathmandu, Nepal.
    Upadhyay, Madan
    B.P. Eye Foundation, Kathmandu, Nepal.
    Krettek, Alexandra
    Nordic School of Public Health NHV, Gothenburg, Sweden / Sahlgrenska Academy at University of Gothenburg, Sweden.
    Do non-communicable diseases such as hypertension and diabetes associate with primary open-angle glaucoma?: Insights from a case-control study in Nepal2013In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 6, p. 22636-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Non-communicable diseases (NCDs) such as hypertension and diabetes are rapidly emerging public health problems worldwide, and they associate with primary open-angle glaucoma (POAG). POAG is the most common cause of irreversible blindness. The most effective ways to prevent glaucoma blindness involve identifying high-risk populations and conducting routine screening for early case detection. This study investigated whether POAG associates with hypertension and diabetes in a Nepalese population.

    METHODS: To explore the history of systemic illness, our hospital-based case-control study used non-random consecutive sampling in the general eye clinics in three hospitals across Nepal to enroll patients newly diagnosed with POAG and controls without POAG. The study protocol included history taking, ocular examination, and interviews with 173 POAG cases and 510 controls. Data analysis comprised descriptive and inferential statistics. Descriptive statistics computed the percentage, mean, and standard deviation (SD); inferential statistics used McNemar's test to measure associations between diseases.

    RESULTS: POAG affected males more frequently than females. The odds of members of the Gurung ethnic group having POAG were 2.05 times higher than for other ethnic groups. Hypertension and diabetes were strongly associated with POAG. The overall odds of POAG increased 2.72-fold among hypertensive and 3.50-fold among diabetic patients.

    CONCLUSION: POAG associates significantly with hypertension and diabetes in Nepal. Thus, periodic glaucoma screening for hypertension and diabetes patients in addition to opportunistic screening at eye clinics may aid in detecting more POAG cases at an early stage and hence in reducing avoidable blindness.

  • 271.
    Shakya-Vaidya, Suraj
    et al.
    Sahlgrenska Academy, University of Gothenburg, Sweden.
    Povlsen, Lene
    Nordic School of Public Health NHV, Gothenburg, Sweden .
    Shrestha, Binjwala
    Sahlgrenska Academy University of, Gothenburg, Sweden / Tribhuvan University, Maharajgunj, Kathmandu, Nepal .
    Grjibovski, Andrej M
    Norweigan Institute of Public Health, Oslo, Norway .
    Krettek, Alexandra
    Sahlgrenska Academy, University of Gothenburg, Sweden / Nordic School of Public Health NHV, Gothenburg Sweden.
    Understanding and living with glaucoma and non-communicable diseases like hypertension and diabetes in the Jhaukhel-Duwakot Health Demographic Surveillance Site:: a qualitative study from Nepal2014In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, p. 25358-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Primary open-angle glaucoma (POAG) is one of the most common causes of irreversible blindness. A possible association between POAG and non-communicable diseases such as hypertension and diabetes suggests that the incidence of POAG may increase. People with POAG in Nepal usually present late to hospital and have poor knowledge of glaucoma.

    OBJECTIVES: Anticipating a knowledge gap regarding these diseases, this study aimed to explore the knowledge of POAG, hypertension, and diabetes in the community and barriers to health care.

    DESIGN: We conducted this qualitative study in the Jhaukhel-Duwakot Health Demographic Surveillance Site (JD-HDSS), a peri-urban community near Kathmandu, a capital city of Nepal. To study how disease influences knowledge, we conducted focus group discussions separately for men and women with and without pre-existing POAG, hypertension, and diabetes. Data were analyzed using the framework analysis approach.

    RESULTS: Although people suffering from POAG, hypertension, and/or diabetes exhibited adequate knowledge of hypertension and diabetes, they lacked in-depth knowledge of POAG. People believed mostly in internal health locus of control. Perception of disease consequences and impact of disease on daily life was influenced by pre-existing POAG, hypertension, and/or diabetes but only in men. Gender disparity was observed regarding health literacy, health perception, and health barriers, which put women in a more difficult situation to tackle their health. We also revealed a gap between knowledge, attitude, and practice of health among women and healthy men.

    CONCLUSION: Although people in JD-HDSS exhibited adequate knowledge regarding hypertension and diabetes, they lacked in-depth knowledge about POAG. This study demonstrated gender difference in health literacy and access to health care, making women more vulnerable towards disease. We also demonstrated a gap between knowledge, attitude, and practice of health. However, tailored health literacy programs may bring changes in the health status in the community.

  • 272.
    Sharma, Bharati
    et al.
    Indian Inst Management, Ctr Management Hlth Serv, Ahmadabad 380015, Gujarat, India.
    Hildingsson, Ingegerd
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences. Uppsala Univ, Dept Womens & Childrens Hlth, Uppsala, Sweden.
    Johansson, Eva
    Karolinska Inst, Global Hlth, Solna, Sweden.
    Prakasamma, Malvarappu
    Acad Nursing Studies & Womens Empowerment Res, Hyderabad, Andhra Pradesh, India.
    Ramani, K. V.
    Indian Inst Management, Ctr Management Hlth Serv, Ahmadabad 380015, Gujarat, India.
    Christensson, Kyllike
    Karolinska Inst, Dept Womens & Childrens Hlth, Solna, Sweden.
    Do the pre-service education programmes for midwives in India prepare confident 'registered midwives'?: A survey from India2015In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 8, article id 29553Article in journal (Refereed)
    Abstract [en]

    Objective: The graduates of the diploma and degree programmes of nursing and midwifery in India are considered skilled birth attendants (SBAs). This paper aimed to assess the confidence of final-year students from pre-service education programmes (diploma and bachelor's) in selected midwifery skills from the list of midwifery competencies of the International Confederation of Midwives (ICM). Design: A cross-sectional survey was conducted in Gujarat, India, involving 633 final-year students from 25 educational institutions (private or government), randomly selected, stratified by the type of programme (diploma and bachelor's). Students assessed their confidence on a four-point scale, in four midwifery competency domains - antepartum, intrapartum, postpartum, and newborn care. Explorative factor analysis was used to reduce skill statements into separate subscales for each domain. Results: Overall, 25-40% of students scored above the 75th percentile and 38-50% below the 50th percentile of confidence in all subscales for antepartum, intrapartum, postpartum, and newborn care. The majority had not attended the required number of births prescribed by the Indian Nursing Council. Conclusions: The pre-service education offered in the diploma and bachelor's programmes in Gujarat does not prepare confident SBAs, as measured on selected midwifery competencies of the ICM. One of the underlying reasons was less clinical experience during their education. The duration, content, and pedagogy of midwifery education within the integrated programmes need to be reviewed.

  • 273.
    Sharma, Bharati
    et al.
    Karolinska Inst, Dept Womens & Childrens Hlth, Solna, Sweden.;Indian Inst Management, Ctr Management Hlth Serv, Ahmadabad 380015, Gujarat, India..
    Hildingsson, Ingegerd
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology. Karolinska Inst, Dept Womens & Childrens Hlth, Solna, Sweden.;Mid Sweden Univ, Dept Nursing, Sundsvall, Sweden..
    Johansson, Eva
    Karolinska Inst, Global Hlth, Solna, Sweden..
    Prakasamma, Malvarappu
    Acad Nursing Studies & Womens Empowerment Res, Hyderabad, Andhra Pradesh, India..
    Ramani, K. V.
    Indian Inst Management, Ctr Management Hlth Serv, Ahmadabad 380015, Gujarat, India..
    Christensson, Kyllike
    Karolinska Inst, Dept Womens & Childrens Hlth, Solna, Sweden..
    Do the pre-service education programmes for midwives in India prepare confident 'registered midwives'?: A survey from India2015In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 8, article id 29553Article in journal (Refereed)
    Abstract [en]

    Objective: The graduates of the diploma and degree programmes of nursing and midwifery in India are considered skilled birth attendants (SBAs). This paper aimed to assess the confidence of final-year students from pre-service education programmes (diploma and bachelor's) in selected midwifery skills from the list of midwifery competencies of the International Confederation of Midwives (ICM). Design: A cross-sectional survey was conducted in Gujarat, India, involving 633 final-year students from 25 educational institutions (private or government), randomly selected, stratified by the type of programme (diploma and bachelor's). Students assessed their confidence on a four-point scale, in four midwifery competency domains - antepartum, intrapartum, postpartum, and newborn care. Explorative factor analysis was used to reduce skill statements into separate subscales for each domain. Results: Overall, 25-40% of students scored above the 75th percentile and 38-50% below the 50th percentile of confidence in all subscales for antepartum, intrapartum, postpartum, and newborn care. The majority had not attended the required number of births prescribed by the Indian Nursing Council. Conclusions: The pre-service education offered in the diploma and bachelor's programmes in Gujarat does not prepare confident SBAs, as measured on selected midwifery competencies of the ICM. One of the underlying reasons was less clinical experience during their education. The duration, content, and pedagogy of midwifery education within the integrated programmes need to be reviewed.

  • 274.
    Shrestha, Binjwala
    et al.
    Tribhuvan University, Kathmandu, Nepal / Sahlgrenska Academy at University of Gothenburg.
    Onta, Sharad
    Tribhuvan University, Kathmandu, Nepal.
    Choulagai, Bishnu
    Tribhuvan University, Kathmandu, Nepal / Sahlgrenska Academy at University of Gothenburg.
    Paudel, Rajan
    Tribhuvan University, Kathmandu, Nepal.
    Petzold, Max
    University of Gothenburg / University of the Witwatersrand, Johannesburg, South Africa.
    Krettek, Alexandra
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Sahlgrenska Academy at University of Gothenburg / UiT The Arctic University of Norway.
    Uterine prolapse and its impact on quality of life in the Jhaukhel-Duwakot Health Demographic Surveillance Site, Bhaktapur, Nepal2015In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 8, p. 1-9, article id 28771Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Uterine prolapse (UP) is a reproductive health problem and public health issue in low-income countries including Nepal.

    OBJECTIVE: We aimed to identify the contributing factors and stages of UP and its impact on quality of life in the Jhaukhel-Duwakot Health Demographic Surveillance Site of Bhaktapur, Nepal.

    DESIGN: Our three-phase study used descriptive cross-sectional analysis to assess quality of life and stages of UP and case-control analysis to identify contributing factors. First, a household survey explored the prevalence of self-reported UP (Phase 1). Second, we used a standardized tool in a 5-day screening camp to determine quality of life among UP-affected women (Phase 2). Finally, a 1-month community survey traced self-reported cases from Phase 1 (Phase 3). To validate UP diagnoses, we reviewed participants' clinical records, and we used screening camp records to trace women without UP.

    RESULTS: Among 48 affected women in Phase 1, 32 had Stage II UP and 16 had either Stage I or Stage III UP. Compared with Stage I women (4.62%), almost all women with Stage III UP reported reduced quality of life. Decreased quality of life correlated significantly with Stages I-III. Self-reported UP prevalence (8.7%) included all treated and non-treated cases. In Phase 3, 277 of 402 respondents reported being affected by UP and 125 were unaffected. The odds of having UP were threefold higher among illiterate women compared with literate women (OR=3.02, 95% CI 1.76-5.17), 50% lower among women from nuclear families compared with extended families (OR=0.56, 95% CI 0.35-0.90) and lower among women with 1-2 parity compared to >5 parity (OR=0.33, 95% CI 0.14-0.75).

    CONCLUSIONS: The stages of UP correlated with quality of life resulting from varied perceptions regarding physical health, emotional stress, and social limitation. Parity, education, age, and family type associated with UP. Our results suggest the importance of developing policies and programs that are focused on early health care for UP. Through family planning and health education programs targeting women, as well as women empowerment programs for prevention of UP, it will be possible to restore quality of life related to UP.

  • 275. Sié, Ali
    et al.
    Louis, Valérie R
    Gbangou, Adjima
    Müller, Olaf
    Niamba, Louis
    Stieglbauer, Gabriele
    Yé, Maurice
    Kouyaté, Bocar
    Sauerborn, Rainer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Becher, Heiko
    The health and demographic surveillance system (HDSS) in Nouna, Burkina Faso, 1993-20072010In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 3Article in journal (Refereed)
    Abstract [en]

    The Nouna Health and Demographic Surveillance System (HDSS) is located in rural Burkina Faso and has existed since 1992. Currently, it has about 78,000 inhabitants. It is a member of the International Network for the Demographic Evaluation of Populations and Their Health in Developing Countries (INDEPTH), a global network of members who conducts longitudinal health and demographic evaluation of populations in low- and middle-income countries. The health facilities consist of one hospital and 13 basic health centres (locally known as CSPS). The Nouna HDSS has been used as a sampling frame for numerous studies in the fields of clinical research, epidemiology, health economics, and health systems research. In this paper we review some of the main findings, and we describe the effects that almost 20 years of health research activities have shown in the population in general and in terms of the perception, economic implications, and other indicators. Longitudinal data analyses show that childhood, as well as overall mortality, has significantly decreased over the observation period 1993-2007. The under-five mortality rate dropped from about 40 per 1,000 person-years in the mid-1990s to below 30 per 1,000 in 2007. Further efforts are needed to meet goal four of the Millennium Development Goals, which is to reduce the under-five mortality rate by two-thirds between 1990 and 2015.

  • 276.
    Skogmar, Sten
    et al.
    Lund University, Sweden .
    Balcha, Taye T.
    Lund University, Sweden Minist Heatlh, Ethiopia .
    Jemal, Zelalem H.
    ORHB, Ethiopia .
    Bjork, Jonas
    Skåne University Hospital, Sweden .
    Deressa, Wakgari
    University of Addis Ababa, Ethiopia .
    Schön, Thomas
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences. Department of Clinical Microbiology and Infectious Diseases, Kalmar County Hospital, Sweden.
    Bjorkman, Per
    Lund University, Sweden .
    Development of a clinical scoring system for assessment of immunosuppression in patients with tuberculosis and HIV infection without access to CD4 cell testing - results from a cross-sectional study in Ethiopia2014In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, no 23105Article in journal (Refereed)
    Abstract [en]

    Background: Currently, antiretroviral therapy (ART) is recommended for all HIV-positive patients with tuberculosis (TB). The timing of ART during the course of anti-TB treatment is based on CD4 cell counts. Access to CD4 cell testing is not universally available; this constitutes an obstacle for the provision of ART in low-income countries. Objective: To determine clinical variables associated with HIV co-infection in TB patients and to identify correlations between clinical variables and CD4 cell strata in HIV/TB co-infected subjects, with the aim of developing a clinical scoring system for the assessment of immunosuppression. Design: Cross-sectional study of adults with TB (with and without HIV co-infection) recruited in Ethiopian outpatient clinics. Clinical variables potentially associated with immunosuppression were recorded using a structured questionnaire, and they were correlated to CD4 cell strata used to determine timing of ART initiation. Variables found to be significant in multivariate analysis were used to construct a scoring system. Results: Among 1,116 participants, the following findings were significantly more frequent in 307 HIV-positive patients compared to 809 HIV-negative subjects: diarrhea, odynophagia, conjunctival pallor, herpes zoster, oral candidiasis, skin rash, and mid-upper arm circumference (MUAC) less than20 cm. Among HIV-positive patients, conjunctival pallor, MUAC less than20 cm, dyspnea, oral hairy leukoplakia (OHL), oral candidiasis, and gingivitis were significantly associated with less than350 CD4 cells/mm(3). A scoring system based on these variables had a negative predictive value of 87% for excluding subjects with CD4 cell counts less than100 cells/mm(3); however, the positive predictive value for identifying such individuals was low (47%). Conclusions: Clinical variables correlate with CD4 cell strata in HIV-positive patients with TB. The clinical scoring system had adequate negative predictive value for excluding severe immunosuppression. Clinical scoring systems could be of use to categorize TB/HIV co-infected patients with regard to the timing of ART initiation in settings with limited access to laboratory facilities.

  • 277.
    Sköld, Peter
    et al.
    Umeå University, Faculty of Arts, Centre for Sami Research.
    Axelsson, Per
    Umeå University, Faculty of Arts, Centre for Sami Research.
    Karlsson, Lena
    Umeå University, Faculty of Arts, Centre for Sami Research.
    Smith, Len
    Australian Demographic and Social Research Institute, Australian National University, Canberra, Australia.
    Infant mortality of Sami and settlers in Northern Sweden: the era of colonization 1750–19002011In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 4, p. 8441-Article in journal (Refereed)
    Abstract [en]

    The study deals with infant mortality (IMR) that is one of the most important aspects of indigenous vulnerability. Background: The Sami are one of very few indigenous peoples with an experience of a positive mortality transition. Objective: Using unique mortality data from the period 1750-1900 Sami and the colonizers in northern Sweden are compared in order to reveal an eventual infant mortality transition. Findings: The results show ethnic differences with the Sami having higher IMR, although the differences decrease over time. There were also geographical and cultural differences within the Sami, with significantly lower IMR among the South Sami. Generally, parity has high explanatory value, where an increased risk is noted for children born as number five or higher among siblings. Conclusion: There is a striking trend of decreasing IMR among the Sami after 1860, which, however, was not the result of professional health care. Other indigenous peoples of the Arctic still have higher mortality rates, and IMR below 100 was achieved only after 1950 in most countries. The decrease in Sami infant mortality was certainly an important factor in their unique health transition, but the most significant change occurred after 1900.

  • 278.
    Stordalen, Gunhild A.
    et al.
    Stordalen Foundation, Oslo, Norway.
    Rocklöv, Joacim
    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.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Only an integrated approach across academia, enterprise, governments, and global agencies can tackle the public health impact of climate change2013In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 6Article in journal (Refereed)
    Abstract [en]

    Background: Despite considerable global attention to the issues of climate change, relatively little priority has been given to the likely effects on human health of current and future changes in the global climate. We identify three major societal determinants that influence the impact of climate change on human health, namely the application of scholarship and knowledge; economic and commercial considerations; and actions of governments and global agencies. Discussion: The three major areas are each discussed in terms of the ways in which they facilitate and frustrate attempts to protect human health from the effects of climate change. Academia still pays very little attention to the effects of climate on health in poorer countries. Enterprise is starting to recognise that healthy commerce depends on healthy people, and so climate change presents long-term threats if it compromises health. Governments and international agencies are very active, but often face immovable vested interests in other sectors. Overall, there tends to be too little interaction between the three areas, and this means that potential synergies and co-benefits are not always realised. Conclusion: More attention from academia, enterprise, and international agencies needs to be given to the potential threats the climate change presents to human health. However, there needs to also be much closer collaboration between all three areas in order to capitalise on possible synergies that can be achieved between them.

  • 279. Streatfield, P Kim
    et al.
    Alam, Nurul
    Compaoré, Yacouba
    Rossier, Clementine
    Soura, Abdramane B
    Bonfoh, Bassirou
    Jaeger, Fabienne
    Ngoran, Eliezer K
    Utzinger, Juerg
    Gomez, Pierre
    Jasseh, Momodou
    Ansah, Akosua
    Debpuur, Cornelius
    Oduro, Abraham
    Williams, John
    Addei, Sheila
    Gyapong, Margaret
    Kukula, Vida A
    Bauni, Evasius
    Mochamah, George
    Ndila, Carolyne
    Williams, Thomas N
    Desai, Meghna
    Moige, Hellen
    Odhiambo, Frank O
    Ogwang, Sheila
    Beguy, Donatien
    Ezeh, Alex
    Oti, Samuel
    Chihana, Menard
    Crampin, Amelia
    Price, Alison
    Delaunay, Valérie
    Diallo, Aldiouma
    Douillot, Laetitia
    Sokhna, Cheikh
    Collinson, Mark A
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Kahn, Kathleen
    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.
    Herbst, Kobus
    Mossong, Joël
    Emina, Jacques B O
    Sankoh, Osman A
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Pregnancy-related mortality in Africa and Asia: evidence from INDEPTH Health and Demographic Surveillance System sites2014In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, article id 25368Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Women continue to die in unacceptably large numbers around the world as a result of pregnancy, particularly in sub-Saharan Africa and Asia. Part of the problem is a lack of accurate, population-based information characterising the issues and informing solutions. Population surveillance sites, such as those operated within the INDEPTH Network, have the potential to contribute to bridging the information gaps.

    OBJECTIVE: To describe patterns of pregnancy-related mortality at INDEPTH Network Health and Demographic Surveillance System sites in sub-Saharan Africa and southeast Asia in terms of maternal mortality ratio (MMR) and cause-specific mortality rates.

    DESIGN: Data on individual deaths among women of reproductive age (WRA) (15-49) resident in INDEPTH sites were collated into a standardised database using the INDEPTH 2013 population standard, the WHO 2012 verbal autopsy (VA) standard, and the InterVA model for assigning cause of death.

    RESULTS: These analyses are based on reports from 14 INDEPTH sites, covering 14,198 deaths among WRA over 2,595,605 person-years observed. MMRs varied between 128 and 461 per 100,000 live births, while maternal mortality rates ranged from 0.11 to 0.74 per 1,000 person-years. Detailed rates per cause are tabulated, including analyses of direct maternal, indirect maternal, and incidental pregnancy-related deaths across the 14 sites.

    CONCLUSIONS: As expected, these findings confirmed unacceptably high continuing levels of maternal mortality. However, they also demonstrate the effectiveness of INDEPTH sites and of the VA methods applied to arrive at measurements of maternal mortality that are essential for planning effective solutions and monitoring programmatic impacts.

  • 280. Streatfield, P. Kim
    et al.
    Khan, Wasif A.
    Bhuiya, Abbas
    Alam, Nurul
    Sié, Ali
    Soura, Abdramane B.
    Bonfoh, Bassirou
    Ngoran, Eliezer K.
    Weldearegawi, Berhe
    Jasseh, Momodou
    Oduro, Abraham
    Gyapong, Margaret
    Kant, Shashi
    Juvekar, Sanjay
    Wilopo, Siswanto
    Williams, Thomas N.
    Odhiambo, Frank O.
    Beguy, Donatien
    Ezeh, Alex
    Kyobutungi, Catherine
    Crampin, Amelia
    Delaunay, Valérie
    Tollman, Stephen M.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Herbst, Kobus
    Chuc, Nguyen T. K.
    Sankoh, Osman A.
    Tanner, Marcel
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Cause-specific mortality in Africa and Asia: evidence from INDEPTH health and demographic surveillance system sites2014In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, p. 25362-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Because most deaths in Africa and Asia are not well documented, estimates of mortality are often made using scanty data. The INDEPTH Network works to alleviate this problem by collating detailed individual data from defined Health and Demographic Surveillance sites. By registering all deaths over time and carrying out verbal autopsies to determine cause of death across many such sites, using standardised methods, the Network seeks to generate population-based mortality statistics that are not otherwise available.

    OBJECTIVE: To build a large standardised mortality database from African and Asian sites, detailing the relevant methods, and use it to describe cause-specific mortality patterns.

    DESIGN: Individual demographic and verbal autopsy (VA) data from 22 INDEPTH sites were collated into a standardised database. The INDEPTH 2013 population was used for standardisation. The WHO 2012 VA standard and the InterVA-4 model were used for assigning cause of death.

    RESULTS: A total of 111,910 deaths occurring over 12,204,043 person-years (accumulated between 1992 and 2012) were registered across the 22 sites, and for 98,429 of these deaths (88.0%) verbal autopsies were successfully completed. There was considerable variation in all-cause mortality between sites, with most of the differences being accounted for by variations in infectious causes as a proportion of all deaths.

    CONCLUSIONS: This dataset documents individual deaths across Africa and Asia in a standardised way, and on an unprecedented scale. While INDEPTH sites are not constructed to constitute a representative sample, and VA may not be the ideal method of determining cause of death, nevertheless these findings represent detailed mortality patterns for parts of the world that are severely under-served in terms of measuring mortality. Further papers explore details of mortality patterns among children and specifically for NCDs, external causes, pregnancy-related mortality, malaria, and HIV/AIDS. Comparisons will also be made where possible with other findings on mortality in the same regions. Findings presented here and in accompanying papers support the need for continued work towards much wider implementation of universal civil registration of deaths by cause on a worldwide basis.

  • 281. Streatfield, P. Kim
    et al.
    Khan, Wasif A.
    Bhuiya, Abbas
    Hanifi, Syed M. A.
    Alam, Nurul
    Bagagnan, Cheik H.
    Sié, Ali
    Zabré, Pascal
    Lankoandé, Bruno
    Rossier, Clementine
    Soura, Abdramane B.
    Bonfoh, Bassirou
    Kone, Siaka
    Ngoran, Eliezer K.
    Utzinger, Juerg
    Haile, Fisaha
    Melaku, Yohannes A.
    Weldearegawi, Berhe
    Gomez, Pierre
    Jasseh, Momodou
    Ansah, Patrick
    Debpuur, Cornelius
    Oduro, Abraham
    Wak, George
    Adjei, Alexander
    Gyapong, Margaret
    Sarpong, Doris
    Kant, Shashi
    Misra, Puneet
    Rai, Sanjay K.
    Juvekar, Sanjay
    Lele, Pallavi
    Bauni, Evasius
    Mochamah, George
    Ndila, Carolyne
    Williams, Thomas N.
    Laserson, Kayla F.
    Nyaguara, Amek
    Odhiambo, Frank O.
    Phillips-Howard, Penelope
    Ezeh, Alex
    Kyobutungi, Catherine
    Oti, Samuel
    Crampin, Amelia
    Nyirenda, Moffat
    Price, Alison
    Delaunay, Valérie
    Diallo, Aldiouma
    Douillot, Laetitia
    Sokhna, Cheikh
    Gómez-Olivé, F. Xavier
    Kahn, Kathleen
    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.
    Herbst, Kobus
    Mossong, Joël
    Chuc, Nguyen T. K.
    Bangha, Martin
    Sankoh, Osman A.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Adult non-communicable disease mortality in Africa and Asia: evidence from INDEPTH Health and Demographic Surveillance System sites2014In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, article id 25365Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Mortality from non-communicable diseases (NCDs) is a major global issue, as other categories of mortality have diminished and life expectancy has increased. The World Health Organization's Member States have called for a 25% reduction in premature NCD mortality by 2025, which can only be achieved by substantial reductions in risk factors and improvements in the management of chronic conditions. A high burden of NCD mortality among much older people, who have survived other hazards, is inevitable. The INDEPTH Network collects detailed individual data within defined Health and Demographic Surveillance sites. By registering deaths and carrying out verbal autopsies to determine cause of death across many such sites, using standardised methods, the Network seeks to generate population-based mortality statistics that are not otherwise available.

    OBJECTIVE: To describe patterns of adult NCD mortality from INDEPTH Network sites across Africa and Asia, according to the WHO 2012 verbal autopsy (VA) cause categories, with separate consideration of premature (15-64 years) and older (65+ years) NCD mortality.

    DESIGN: All adult deaths at INDEPTH sites are routinely registered and followed up with VA interviews. For this study, VA archives were transformed into the WHO 2012 VA standard format and processed using the InterVA-4 model to assign cause of death. Routine surveillance data also provide person-time denominators for mortality rates.

    RESULTS: A total of 80,726 adult (over 15 years) deaths were documented over 7,423,497 person-years of observation. NCDs were attributed as the cause for 35.6% of these deaths. Slightly less than half of adult NCD deaths occurred in the 15-64 age group. Detailed results are presented by age and sex for leading causes of NCD mortality. Per-site rates of NCD mortality were significantly correlated with rates of HIV/AIDS-related mortality.

    CONCLUSIONS: These findings present important evidence on the distribution of NCD mortality across a wide range of African and Asian settings. This comes against a background of global concern about the burden of NCD mortality, especially among adults aged under 70, and provides an important baseline for future work.

  • 282. Streatfield, P Kim
    et al.
    Khan, Wasif A
    Bhuiya, Abbas
    Hanifi, Syed M A
    Alam, Nurul
    Diboulo, Eric
    Niamba, Louis
    Sié, Ali
    Lankoandé, Bruno
    Millogo, Roch
    Soura, Abdramane B
    Bonfoh, Bassirou
    Kone, Siaka
    Ngoran, Eliezer K
    Utzinger, Juerg
    Ashebir, Yemane
    Melaku, Yohannes A
    Weldearegawi, Berhe
    Gomez, Pierre
    Jasseh, Momodou
    Azongo, Daniel
    Oduro, Abraham
    Wak, George
    Wontuo, Peter
    Attaa-Pomaa, Mary
    Gyapong, Margaret
    Manyeh, Alfred K
    Kant, Shashi
    Misra, Puneet
    Rai, Sanjay K
    Juvekar, Sanjay
    Patil, Rutuja
    Wahab, Abdul
    Wilopo, Siswanto
    Bauni, Evasius
    Mochamah, George
    Ndila, Carolyne
    Williams, Thomas N
    Khaggayi, Christine
    Nyaguara, Amek
    Obor, David
    Odhiambo, Frank O
    Ezeh, Alex
    Oti, Samuel
    Wamukoya, Marylene
    Chihana, Menard
    Crampin, Amelia
    Collinson, Mark A
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. INDEPTH Network, Accra, Ghana.
    Kabudula, Chodziwadziwa W
    Wagner, Ryan
    INDEPTH Network, Accra, Ghana.
    Herbst, Kobus
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. INDEPTH Network, Accra, Ghana.
    Mossong, Joël
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. INDEPTH Network, Accra, Ghana.
    Emina, Jacques B O
    Sankoh, Osman A
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Mortality from external causes in Africa and Asia: evidence from INDEPTH Health and Demographic Surveillance System Sites2014In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, article id 25366Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Mortality from external causes, of all kinds, is an important component of overall mortality on a global basis. However, these deaths, like others in Africa and Asia, are often not counted or documented on an individual basis. Overviews of the state of external cause mortality in Africa and Asia are therefore based on uncertain information. The INDEPTH Network maintains longitudinal surveillance, including cause of death, at population sites across Africa and Asia, which offers important opportunities to document external cause mortality at the population level across a range of settings.

    OBJECTIVE: To describe patterns of mortality from external causes at INDEPTH Network sites across Africa and Asia, according to the WHO 2012 verbal autopsy (VA) cause categories.

    DESIGN: All deaths at INDEPTH sites are routinely registered and followed up with VA interviews. For this study, VA archives were transformed into the WHO 2012 VA standard format and processed using the InterVA-4 model to assign cause of death. Routine surveillance data also provide person-time denominators for mortality rates.

    RESULTS: A total of 5,884 deaths due to external causes were documented over 11,828,253 person-years. Approximately one-quarter of those deaths were to children younger than 15 years. Causes of death were dominated by childhood drowning in Bangladesh, and by transport-related deaths and intentional injuries elsewhere. Detailed mortality rates are presented by cause of death, age group, and sex.

    CONCLUSIONS: The patterns of external cause mortality found here generally corresponded with expectations and other sources of information, but they fill some important gaps in population-based mortality data. They provide an important source of information to inform potentially preventive intervention designs.

  • 283. Streatfield, P. Kim
    et al.
    Khan, Wasif A.
    Bhuiya, Abbas
    Hanifi, Syed M. A.
    Alam, Nurul
    Diboulo, Eric
    Sié, Ali
    Yé, Maurice
    Compaoré, Yacouba
    Soura, Abdramane B.
    Bonfoh, Bassirou
    Jaeger, Fabienne
    Ngoran, Eliezer K.
    Utzinger, Juerg
    Melaku, Yohannes A.
    Mulugeta, Afework
    Weldearegawi, Berhe
    Gomez, Pierre
    Jasseh, Momodou
    Hodgson, Abraham
    Oduro, Abraham
    Welaga, Paul
    Williams, John
    Awini, Elizabeth
    Binka, Fred N.
    Gyapong, Margaret
    Kant, Shashi
    Misra, Puneet
    Srivastava, Rahul
    Chaudhary, Bharat
    Juvekar, Sanjay
    Wahab, Abdul
    Wilopo, Siswanto
    Bauni, Evasius
    Mochamah, George
    Ndila, Carolyne
    Williams, Thomas N.
    Hamel, Mary J.
    Lindblade, Kim A.
    Odhiambo, Frank O.
    Slutsker, Laurence
    Ezeh, Alex
    Kyobutungi, Catherine
    Wamukoya, Marylene
    Delaunay, Valérie
    Diallo, Aldiouma
    Douillot, Laetitia
    Sokhna, Cheikh
    Gómez-Olivé, F. Xavier
    Kabudula, Chodziwadziwa W.
    Mee, Paul
    Herbst, Kobus
    Mossong, Joël
    Chuc, Nguyen T. K.
    Arthur, Samuelina S.
    Sankoh, Osman A.
    Tanner, Marcel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Byass, Peter
    School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
    Malaria mortality in Africa and Asia: evidence from INDEPTH health and demographic surveillance system sites2014In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, p. 25369-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Malaria continues to be a major cause of infectious disease mortality in tropical regions. However, deaths from malaria are most often not individually documented, and as a result overall understanding of malaria epidemiology is inadequate. INDEPTH Network members maintain population surveillance in Health and Demographic Surveillance System sites across Africa and Asia, in which individual deaths are followed up with verbal autopsies.

    OBJECTIVE: To present patterns of malaria mortality determined by verbal autopsy from INDEPTH sites across Africa and Asia, comparing these findings with other relevant information on malaria in the same regions.

    DESIGN: From a database covering 111,910 deaths over 12,204,043 person-years in 22 sites, in which verbal autopsy data were handled according to the WHO 2012 standard and processed using the InterVA-4 model, over 6,000 deaths were attributed to malaria. The overall period covered was 1992-2012, but two-thirds of the observations related to 2006-2012. These deaths were analysed by site, time period, age group and sex to investigate epidemiological differences in malaria mortality.

    RESULTS: Rates of malaria mortality varied by 1:10,000 across the sites, with generally low rates in Asia (one site recording no malaria deaths over 0.5 million person-years) and some of the highest rates in West Africa (Nouna, Burkina Faso: 2.47 per 1,000 person-years). Childhood malaria mortality rates were strongly correlated with Malaria Atlas Project estimates of Plasmodium falciparum parasite rates for the same locations. Adult malaria mortality rates, while lower than corresponding childhood rates, were strongly correlated with childhood rates at the site level.

    CONCLUSIONS: The wide variations observed in malaria mortality, which were nevertheless consistent with various other estimates, suggest that population-based registration of deaths using verbal autopsy is a useful approach to understanding the details of malaria epidemiology.

  • 284. Streatfield, P Kim
    et al.
    Khan, Wasif A
    Bhuiya, Abbas
    Hanifi, Syed M A
    Alam, Nurul
    Millogo, Ourohiré
    Sié, Ali
    Zabré, Pascal
    Rossier, Clementine
    Soura, Abdramane B
    Bonfoh, Bassirou
    Kone, Siaka
    Ngoran, Eliezer K
    Utzinger, Juerg
    Abera, Semaw F
    Melaku, Yohannes A
    Weldearegawi, Berhe
    Gomez, Pierre
    Jasseh, Momodou
    Ansah, Patrick
    Azongo, Daniel
    Kondayire, Felix
    Oduro, Abraham
    Amu, Alberta
    Gyapong, Margaret
    Kwarteng, Odette
    Kant, Shashi
    Pandav, Chandrakant S
    Rai, Sanjay K
    Juvekar, Sanjay
    Muralidharan, Veena
    Wahab, Abdul
    Wilopo, Siswanto
    Bauni, Evasius
    Mochamah, George
    Ndila, Carolyne
    Williams, Thomas N
    Khagayi, Sammy
    Laserson, Kayla F
    Nyaguara, Amek
    Van Eijk, Anna M
    Ezeh, Alex
    Kyobutungi, Catherine
    Wamukoya, Marylene
    Chihana, Menard
    Crampin, Amelia
    Price, Alison
    Delaunay, Valérie
    Diallo, Aldiouma
    Douillot, Laetitia
    Sokhna, Cheikh
    Gómez-Olivé, F Xavier
    Mee, Paul
    Tollman, Stephen M
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Herbst, Kobus
    Mossong, Joël
    Chuc, Nguyen T K
    Arthur, Samuelina S
    Sankoh, Osman A
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    HIV/AIDS-related mortality in Africa and Asia: evidence from INDEPTH health and demographic surveillance system sites2014In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, article id 25370Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: As the HIV/AIDS pandemic has evolved over recent decades, Africa has been the most affected region, even though a large proportion of HIV/AIDS deaths have not been documented at the individual level. Systematic application of verbal autopsy (VA) methods in defined populations provides an opportunity to assess the mortality burden of the pandemic from individual data.

    OBJECTIVE: To present standardised comparisons of HIV/AIDS-related mortality at sites across Africa and Asia, including closely related causes of death such as pulmonary tuberculosis (PTB) and pneumonia.

    DESIGN: Deaths related to HIV/AIDS were extracted from individual demographic and VA data from 22 INDEPTH sites across Africa and Asia. VA data were standardised to WHO 2012 standard causes of death assigned using the InterVA-4 model. Between-site comparisons of mortality rates were standardised using the INDEPTH 2013 standard population.

    RESULTS: The dataset covered a total of 10,773 deaths attributed to HIV/AIDS, observed over 12,204,043 person-years. HIV/AIDS-related mortality fractions and mortality rates varied widely across Africa and Asia, with highest burdens in eastern and southern Africa, and lowest burdens in Asia. There was evidence of rapidly declining rates at the sites with the heaviest burdens. HIV/AIDS mortality was also strongly related to PTB mortality. On a country basis, there were strong similarities between HIV/AIDS mortality rates at INDEPTH sites and those derived from modelled estimates.

    CONCLUSIONS: Measuring HIV/AIDS-related mortality continues to be a challenging issue, all the more so as anti-retroviral treatment programmes alleviate mortality risks. The congruence between these results and other estimates adds plausibility to both approaches. These data, covering some of the highest mortality observed during the pandemic, will be an important baseline for understanding the future decline of HIV/AIDS.

  • 285. Streatfield, P. Kim
    et al.
    Khan, Wasif A.
    Bhuiya, Abbas
    Hanifi, Syed M. A.
    Alam, Nurul
    Ouattara, Mamadou
    Sanou, Aboubakary
    Sié, Ali
    Lankoandé, Bruno
    Soura, Abdramane B.
    Bonfoh, Bassirou
    Jaeger, Fabienne
    Ngoran, Eliezer K.
    Utzinger, Juerg
    Abreha, Loko
    Melaku, Yohannes A.
    Weldearegawi, Berhe
    Ansah, Akosua
    Hodgson, Abraham
    Oduro, Abraham
    Welaga, Paul
    Gyapong, Margaret
    Narh, Clement T.
    Narh-Bana, Solomon A.
    Kant, Shashi
    Misra, Puneet
    Rai, Sanjay K.
    Bauni, Evasius
    Mochamah, George
    Ndila, Carolyne
    Williams, Thomas N.
    Hamel, Mary J.
    Ngulukyo, Emmanuel
    Odhiambo, Frank O.
    Sewe, Maquins
    Beguy, Donatien
    Ezeh, Alex
    Oti, Samuel
    Diallo, Aldiouma
    Douillot, Laetitia
    Sokhna, Cheikh
    Delaunay, Valérie
    Collinson, Mark A.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Kabudula, Chodziwadziwa W.
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Herbst, Kobus
    Mossong, Joël
    Chuc, Nguyen T. K.
    Bangha, Martin
    Sankoh, Osman A.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Cause-specific childhood mortality in Africa and Asia: evidence from INDEPTH health and demographic surveillance system sites2014In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, article id 25363Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Childhood mortality, particularly in the first 5 years of life, is a major global concern and the target of Millennium Development Goal 4. Although the majority of childhood deaths occur in Africa and Asia, these are also the regions where such deaths are least likely to be registered. The INDEPTH Network works to alleviate this problem by collating detailed individual data from defined Health and Demographic Surveillance sites. By registering deaths and carrying out verbal autopsies to determine cause of death across many such sites, using standardised methods, the Network seeks to generate population-based mortality statistics that are not otherwise available.

    OBJECTIVE: To present a description of cause-specific mortality rates and fractions over the first 15 years of life as documented by INDEPTH Network sites in sub-Saharan Africa and south-east Asia.

    DESIGN: All childhood deaths at INDEPTH sites are routinely registered and followed up with verbal autopsy (VA) interviews. For this study, VA archives were transformed into the WHO 2012 VA standard format and processed using the InterVA-4 model to assign cause of death. Routine surveillance data also provided person-time denominators for mortality rates. Cause-specific mortality rates and cause-specific mortality fractions are presented according to WHO 2012 VA cause groups for neonatal, infant, 1-4 year and 5-14 year age groups.

    RESULTS: A total of 28,751 childhood deaths were documented during 4,387,824 person-years over 18 sites. Infant mortality ranged from 11 to 78 per 1,000 live births, with under-5 mortality from 15 to 152 per 1,000 live births. Sites in Vietnam and Kenya accounted for the lowest and highest mortality rates reported.

    CONCLUSIONS: Many children continue to die from relatively preventable causes, particularly in areas with high rates of malaria and HIV/AIDS. Neonatal mortality persists at relatively high, and perhaps sometimes under-documented, rates. External causes of death are a significant childhood problem in some settings.

  • 286.
    Tetui, Moses
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Department of Health Policy, Planning and Management, Makerere University College of Health Sciences, School of Public Health (MakCHS-SPH), Kampala, Uganda.
    Coe, Anna-Britt
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Hurtig, Anna-Karin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Ekirapa-Kiracho, Elizabeth
    Kiwanuka, Suzanne N.
    Experiences of using a participatory action research approach to strengthen district local capacity in Eastern Uganda2017In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, article id 1346038Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: To achieve a sustained improvement in health outcomes, the way health interventions are designed and implemented is critical. A participatory action research approach is applauded for building local capacity such as health management. Thereby increasing the chances of sustaining health interventions.

    OBJECTIVE: This study explored stakeholder experiences of using PAR to implement an intervention meant to strengthen the local district capacity.

    METHODS: This was a qualitative study featuring 18 informant interviews and a focus group discussion. Respondents included politicians, administrators, health managers and external researchers in three rural districts of eastern Uganda where PAR was used. Qualitative content analysis was used to explore stakeholders' experiences.

    RESULTS: 'Being awakened' emerged as an overarching category capturing stakeholder experiences of using PAR. This was described in four interrelated and sequential categories, which included: stakeholder involvement, being invigorated, the risk of wide stakeholder engagement and balancing the risk of wide stakeholder engagement. In terms of involvement, the stakeholders felt engaged, a sense of ownership, felt valued and responsible during the implementation of the project. Being invigorated meant being awakened, inspired and supported. On the other hand, risks such as conflict, stress and uncertainty were reported, and finally these risks were balanced through tolerance, risk-awareness and collaboration.

    CONCLUSIONS: The PAR approach was desirable because it created opportunities for building local capacity and enhancing continuity of interventions. Stakeholders were awakened by the approach, as it made them more responsive to systems challenges and possible local solutions. Nonetheless, the use of PAR should be considered in full knowledge of the undesirable and complex experiences, such as uncertainty, conflict and stress. This will enable adequate preparation and management of stakeholder expectations to maximize the benefits of the approach.

  • 287. Thomsen, Sarah
    et al.
    Biao, Xu
    Kusnanto, Hari
    Mavalankar, Dileep
    Malqvist, Mats
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Diwan, Vinod
    The world we want: focus on the most disadvantaged2013In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 6, p. 20919-Article in journal (Other academic)
  • 288.
    Thomsen, Sarah
    et al.
    Karolinska Institutet, Solna, Sweden.
    Biao, Xu
    Fudan University, Shanghai, China.
    Kusnanto, Hari
    University of Gadja Madah, Yogyakarta, Indonesia.
    Mavalankar, Dileep
    Indian Institute of Public Health, Kolkata, India.
    Målqvist, Mats
    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).
    Ng, Nawi
    Umeå University, Umea, Sweden.
    Diwan, Vinod
    Karolinska Institutet, Solna, Sweden.
    The world we want: focus on the most disadvantaged2013In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 6, p. 20919-Article in journal (Other academic)
    Abstract [en]

    The global commitment to the Millennium Development Goal (MDG) process has resulted in significant, positive changes in health-related MDGs on the global and country levels since 1990. However, while overall progress has been made, gaps in achievements between and within many countries have not decreased, with the poorest and most disadvantaged communities being the least likely to have benefitted. This is particularly the case in many emerging economies where the gap between the rich and poor, educated and uneducated, and minority and majority ethnic populations is actually increasing. For example, in India, where the Gross National Income in purchasing power parity in 2010 was $3,468, use of antenatal care services increased by 12% from 1996 to 2008, but only 0.1% among the poor. In Indonesia, infant mortality rates are on the decline in all regions of the country except for the Eastern regions where they remain high. In Vietnam, inequity in home deliveries between poor, rural Kinh (majority) and minority mothers has increased in the last 5 years during a period of rapid economic growth. In urban China, domestic rural-to-urban migrants account for a significant proportion of notified cases of infectious diseases such as tuberculosis, which is mainly associated with the low-income, poor living conditions, limited access to health care and vulnerability to poor health of this population, and their exclusion from benefits for local residents such as health insurance.

  • 289. Thomsen, Sarah
    et al.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Biao, Xu
    Bondjers, Goran
    Kusnanto, Hari
    Liem, Nguyen Tanh
    Mavalankar, Dileep
    Malqvist, Mats
    Diwan, Vinod
    Bringing evidence to policy to achieve health-related MDGs for all: justification and design of the EPI-4 project in China, India, Indonesia, and Vietnam2013In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 6, p. 1-10Article in journal (Refereed)
    Abstract [en]

    Background: The Millennium Development Goals (MDGs) are monitored using national-level statistics, which have shown substantial improvements in many countries. These statistics may be misleading, however, and may divert resources from disadvantaged populations within the same countries that are showing progress. The purpose of this article is to set out the relevance and design of the "Evidence for Policy and Implementation project (EPI-4)". EPI-4 aims to contribute to the reduction of inequities in the achievement of health-related MDGs in China, India, Indonesia and Vietnam through the promotion of research-informed policymaking. Methods: Using a framework provided by the Commission on the Social Determinants of Health (CSDH), we compare national-level MDG targets and results, as well as their social and structural determinants, in China, India, Indonesia and Vietnam. Results: To understand country-level MDG achievements it is useful to analyze their social and structural determinants. This analysis is not sufficient, however, to understand within-country inequities. Specialized analyses are required for this purpose, as is discussion and debate of the results with policymakers, which is the aim of the EPI-4 project. Conclusion: Reducing health inequities requires sophisticated analyses to identify disadvantaged populations within and between countries, and to determine evidence-based solutions that will make a difference. The EPI-4 project hopes to contribute to this goal.

  • 290.
    Thomsen, Sarah
    et al.
    Karolinska Institutet, Sweden.
    Ng, Nawi
    Umeå University, Sweden.
    Biao, Xu
    Fudan University, China.
    Bondjers, Göran
    Gothenburg University, Sweden.
    Kusnanto, Hari
    University of Gadja Madah, Indonesia.
    Liem, Nguyen Tanh
    National Pediatrics Hospital, Viet Nam .
    Mavalankar, Dileep
    Indian Institute of Public Health Ghandinagar, India.
    Målqvist, Mats
    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).
    Diwan, Vinod
    Karolinska Institutet, Sweden.
    Bringing evidence to policy to achieve health-related MDGs for all: justification and design of the EPI-4 project in China, India, Indonesia, and Vietnam2013In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 6, p. 1-10Article in journal (Refereed)
    Abstract [en]

    Background:

    The Millennium Development Goals (MDGs) are monitored using national-level statistics, which have shown substantial improvements in many countries. These statistics may be misleading, however, and may divert resources from disadvantaged populations within the same countries that are showing progress. The purpose of this article is to set out the relevance and design of the "Evidence for Policy and Implementation project (EPI-4)". EPI-4 aims to contribute to the reduction of inequities in the achievement of health-related MDGs in China, India, Indonesia and Vietnam through the promotion of research-informed policymaking.

    Methods:

    Using a framework provided by the Commission on the Social Determinants of Health (CSDH), we compare national-level MDG targets and results, as well as their social and structural determinants, in China, India, Indonesia and Vietnam.

    Results:

    To understand country-level MDG achievements it is useful to analyze their social and structural determinants. This analysis is not sufficient, however, to understand within-country inequities. Specialized analyses are required for this purpose, as is discussion and debate of the results with policymakers, which is the aim of the EPI-4 project.

    Conclusion:

    Reducing health inequities requires sophisticated analyses to identify disadvantaged populations within and between countries, and to determine evidence-based solutions that will make a difference. The EPI-4 project hopes to contribute to this goal.

  • 291. Toan, Do Thi Thanh
    et al.
    Kien, Vu Duy
    Bao Giang, Kim
    Van Minh, Hoang
    Wright, Pamela
    Perceptions of climate change and its impact on human health: an integrated quantitative and qualitative approach.2014In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, p. 23025-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The World Health Organization emphasized that climate change is a significant and emerging threat to public health, especially in lower income populations and tropical/subtropical countries. However, people in Asia and Africa were the least likely to perceive global warming as a threat. In Vietnam, little research has been conducted concerning the perceptions of effects of climate change on human health.

    OBJECTIVE: The aim of this study was to explore the perceptions on climate change and its impact on human health among people in Hanoi.

    DESIGN: We applied a combined quantitative and qualitative approach to study perceptions on climate change among people in Hanoi. A total of 1,444 people were recruited, including 754 people living in non-slum areas and 690 people living in slum areas of Hanoi. A structured questionnaire was used to collect quantitative data on their perceptions. In a parallel qualitative study, two focus group discussions and 12 in-depth interviews (IDs) were carried out involving 24 people from both slum and non-slum areas.

    RESULTS: The majority of the respondents in the study had heard about climate change and its impact on human health (79.3 and 70.1% in non-slum and slum areas, respectively). About one third of the respondents reported that members of their family had experienced illness in the recent summer and winter compared to the same seasons 5 years ago. The most common symptoms reported during hot weather were headaches, fatigue, and dizziness; hypertension and other cardiovascular diseases were also reported. During cold weather, people reported experiencing cough, fever, and influenza, as well as pneumonia and emerging infectious diseases such as dengue and Japanese encephalitis.

    CONCLUSIONS: The observed high level of awareness on the links between climate change and human health may help to increase the success of the National Prevention Program on Climate Change. Moreover, understanding the concerns of the people may help policy makers to develop and implement effective and sustainable adaptation measures for Hanoi City as well as for Vietnam as a whole.

  • 292. Todd, Jim
    et al.
    Slaymaker, Emma
    Zaba, Basia
    Mahy, Mary
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Measuring HIV-related mortality in the first decade of anti-retroviral therapy in sub-Saharan Africa2014In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, p. 24787-Article in journal (Refereed)
    Abstract [en]

    For the past 30 years, many communities and countries in sub-Saharan Africa have suffered from the ravages of the HIV epidemic. During this time the mortality rates in HIV-infected people have been 10–20 times higher than in HIV-uninfected people. Since the advent of anti-retroviral therapy (ART), mortality and morbidity have decreased considerably. However, it has been difficult to get reliable estimates of the impact of ART in population-based studies. The measurement of the impact of ART on mortality requires long-term follow-up in communities where regular HIV testing allows the estimation of mortality by HIV status, such as the population cohorts in the network for Analysing Longitudinal Population-based HIV data in Africa (ALPHA). An alternative estimation from verbal autopsy (VA) requires reliable tools and consistent interpretation of causes of death, which have been taken forward by recent standards from the World Health Organization (WHO) and the development of the corresponding InterVA-4 model for cause of death assignment.

  • 293.
    Torres, Virgilio Mariano Salazar
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Center for Demography and Health Research, Nicaraguan National Autonomous University, León, Nicaragua.
    Goicolea, Isabel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Edin, Kerstin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    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).
    'Expanding your mind': the process of constructing gender-equitable masculinities in young Nicaraguan men participating in reproductive health or gender training programs2012In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 5Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Traditional forms of masculinity strongly influence men's and women's wellbeing.

    OBJECTIVE: This study has two aims: (i) to explore notions of various forms of masculinities in young Nicaraguan men participating in programs addressing sexual health, reproductive health, and/or gender equality and (ii) to find out how these young men perceive their involvement in actions aimed at reducing violence against women (VAW).

    DESIGN: A qualitative grounded theory study. Data were collected through six focus groups and two in-depth interviews with altogether 62 young men.

    RESULTS: Our analysis showed that the informants experienced a process of change, labeled 'Expanding your mind', in which we identified four interrelated subcategories: The apprentice, The responsible/respectful man, The proactive peer educator, and 'The feminist man'. The process showed how an increased awareness of gender inequities facilitated the emergence of values (respect and responsibility) and behavior (thoughtful action) that contributed to increase the informant's critical thinking and agency at individual, social, and political levels. The process was influenced by individual and external factors.

    CONCLUSIONS: Multiple progressive masculinities can emerge from programs challenging patriarchy in this Latin American setting. The masculinities identified in this study show a range of attitudes and behaviors; however, all lean toward more equitable gender relations. The results suggest that learning about sexual and reproductive health does not directly imply developing more gender-equitable attitudes and behaviors or a greater willingness to prevent VAW. It is paramount that interventions to challenge machismo in this setting continue and are expanded to reach more young men.

  • 294.
    Trang, Phan Minh
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Rocklöv, Joacim
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Giang, Kim Bao
    Nilsson, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Seasonality of hospital admissions for mental disorders in Hanoi, Vietnam2016In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 9, article id 32116Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Some studies have shown a relationship between seasonality in weather patterns and depressive and behavioural disorders, especially in temperate climate regions. However, there is a lack of studies describing the seasonal patterns of hospital admissions for a variety of mental disorders in tropical and subtropical nations. The aim of this study has been to examine the relationship between seasons and daily hospital admissions for mental disorders in Hanoi, Vietnam.

    DESIGNS: A 5-year database (2008-2012) compiled by Hanoi Mental Hospital covering mental disorder admissions diagnosed by the International Classification of Diseases 10 was analysed. A negative binominal regression model was applied to estimate the associations between seasonality and daily hospital admissions for mental disorders, for all causes and for specific diagnoses.

    RESULTS: The summer season indicated the highest relative risk (RR=1.24, confidence interval (CI)=1.1-1.39) of hospital admission for mental disorders, with a peak in these cases in June (RR=1.46, CI=1.19-1.7). Compared to other demographic groups, males and the elderly (aged over 60 years) were more sensitive to seasonal risk changes. In the summer season, the RR of hospital visits among men increased by 26% (RR=1.26, CI=1.12-1.41) and among the elderly by 23% (RR=1.23, CI=1.03-1.48). Furthermore, when temperatures including minimum, mean, and maximum increased 1°C, the number of cases for mental disorders increased by 1.7%, 2%, and 2.1%, respectively.

    CONCLUSION: The study results showed a correlation between hospital admission for mental disorders and season.

  • 295. Twine, Rhian
    et al.
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. 1 MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa ; INDEPTH Network, Accra, Ghana.
    Scholtz, Alexandra
    Norris, Shane A.
    Involvement of stakeholders in determining health priorities of adolescents in rural South Africa2016In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 9, p. 1-9, article id 29162Article in journal (Refereed)
    Abstract [en]

    Background: When developing intervention research, it is important to explore issues from the community perspective. Interventions that promote adolescent health in South Africa are urgently needed, and Project Ntshembo ('hope') aims to improve the health of young women and their offspring in the Agincourt sub-district of rural northeast South Africa, actively using stakeholder involvement throughout the research process.

    Objective: This study aimed to determine adolescent health priorities according to key stakeholders, to align stakeholder and researcher priorities, and to form a stakeholder forum, which would be active throughout the intervention.

    Design: Thirty-two stakeholders were purposefully identified as community members interested in the health of adolescents. An adapted Delphi incorporating face-to-face discussions, as well as participatory visualisation, was used in a series of three workshops. Consensus was determined through non-parametric analysis.

    Results: Stakeholders and researchers agreed that peer pressure and lack of information, or having information but not acting on it, were the root causes of adolescent health problems. Pregnancy, HIV, school dropout, alcohol and drug abuse, not accessing health services, and unhealthy lifestyle (leading to obesity) were identified as priority adolescent health issues. A diagram was developed showing how these eight priorities relate to one another, which was useful in the development of the intervention. Astakeholder forum was founded, comprising 12 of the stakeholders involved in the stakeholder involvement process.

    Conclusions: The process brought researchers and stakeholders to consensus on the most important health issues facing adolescents, and a stakeholder forum was developed within which to address the issues. Stakeholder involvement as part of a research engagement strategy can be of mutual benefit to the researchers and the community in which the research is taking place.

  • 296.
    Usynina, Anna A.
    et al.
    Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway / International School of Public Health, Northern State Medical University, Arkhangelsk, Russia.
    Grjibovski, Andrej M.
    International School of Public Health, Northern State Medical University, Arkhangelsk, Russia / Department of Preventive Medicine, International Kazakh-Turkish University, Turkestan, Kazakhstan / Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway / Department of Public Health, Hygiene and Bioethics, Institute of Medicine, North-Eastern Federal University, Yakutsk, Russia.
    Krettek, Alexandra
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway / Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Odland, Jon Øyvind
    Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway / Department of Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
    Kudryavtsev, Alexander V.
    Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway / International School of Public Health, Northern State Medical University, Arkhangelsk, Russia.
    Anda, Erik Eik
    Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
    Risk factors for perinatal mortality in Murmansk County, Russia: a registry-based study2017In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, no 1, p. 1-10, article id 1270536Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Factors contributing to perinatal mortality (PM) in Northwest Russia remain unclear. This study investigated possible associations between selected maternal and fetal characteristics and PM based on data from the population-based Murmansk County Birth Registry.

    OBJECTIVE: This study investigated possible associations between selected maternal and fetal characteristics and PM based on data from the population-based Murmansk County Birth Registry.

    METHODS: The study population consisted of all live- and stillbirths registered in the Murmansk County Birth Registry during 2006-2011 (n = 52,806). We excluded multiple births, births prior to 22 and after 45 completed weeks of gestation, infants with congenital malformations, and births with missing information regarding gestational age (a total of n = 3,666) and/or the studied characteristics (n = 2,356). Possible associations between maternal socio-demographic and lifestyle characteristics, maternal pre-pregnancy characteristics, pregnancy characteristics, and PM were studied by multivariable logistic regression. Crude and adjusted odds ratios with 95% confidence intervals were calculated.

    RESULTS: Of the 49,140 births eligible for prevalence analysis, 338 were identified as perinatal deaths (6.9 per 1,000 births). After adjustment for other factors, maternal low education level, prior preterm delivery, spontaneous or induced abortions, antepartum hemorrhage, antenatally detected or suspected fetal growth retardation, and alcohol abuse during pregnancy all significantly increased the risk of PM. We observed a higher risk of PM in unmarried women, as well as overweight or obese mothers. Maternal underweight reduced the risk of PM.

    CONCLUSIONS: Our results suggest that both social and medical factors are important correlates of perinatal mortality in Northwest Russia.

  • 297. Van Minh, Hoang
    et al.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Chuc, Nguyen Thi Kim
    Wall, Stig
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Patterns of health status and quality of life among older people in rural Viet Nam2010In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 3, no Supplement 2, p. 64-69Article in journal (Refereed)
    Abstract [en]

    The findings reveal problems of inequality in health status and QoL among older adults in the study setting by sex, age, education and socio-economic status. Given the findings, actions targeted towards improving the health of disadvantaged people (women, older people and lower education and economic status) are needed in this setting.

  • 298. Van Minh, Hoang
    et al.
    Oh, Juhwan
    Giang, Kim Bao
    Kien, Vu Duy
    Center for Population Health Sciences, Hanoi School of Public Health, Hanoi, Vietnam.
    Nam, You-Seon
    Lee, Chul Ou
    Huong, Tran Thi Giang
    Hoat, Luu Ngoc
    Multiple vulnerabilities and maternal healthcare in Vietnam: findings from the Multiple Indicator Cluster Surveys, 2000, 2006, and 20112016In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 9, article id 29386Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Knowledge of the aggregate effects of multiple socioeconomic vulnerabilities is important for shedding light on the determinants of growing health inequalities and inequities in maternal healthcare.

    OBJECTIVE: This paper describes patterns of inequity in maternal healthcare utilization and analyzes associations between inequity and multiple socioeconomic vulnerabilities among women in Vietnam.

    DESIGN: This is a repeated cross-sectional study using data from the Vietnam Multiple Indicator Cluster Surveys 2000, 2006, and 2011. Two maternal healthcare indicators were selected: (1) skilled antenatal care and (2) skilled delivery care. Four types of socioeconomic vulnerabilities - low education, ethnic minority, poverty, and rural location - were assessed both as separate explanatory variables and as composite indicators (combinations of three and four vulnerabilities). Pairwise comparisons and adjusted odds ratios were used to assess socioeconomic inequities in maternal healthcare.

    RESULTS: In all three surveys, there were increases across the survey years in both the proportions of women who received antenatal care by skilled staff (68.6% in 2000, 90.8% in 2006, and 93.7% in 2011) and the proportions of women who gave birth with assistance from skilled staff (69.9% in 2000, 87.7% in 2006, and 92.9% in 2011). The receipt of antenatal care by skilled staff and birth assistance from skilled health personnel were less common among vulnerable women, especially those with multiple vulnerabilities.

    CONCLUSIONS: Even though Vietnam has improved its coverage of maternal healthcare on average, policies should target maternal healthcare utilization among women with multiple socioeconomic vulnerabilities. Both multisectoral social policies and health policies are needed to tackle multiple vulnerabilities more effectively by identifying those who are poor, less educated, live in rural areas, and belong to ethnic minority groups.

  • 299. Van Minh, Hoang
    et al.
    Oh, Juhwan
    Hoat, Luu Ngoc
    Lee, Jong-Koo
    Stewart Williams, Jennifer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Millennium Development Goals in Vietnam: Taking Multi-sectoral Action to Improve Health and Address the Social Determinants2016In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 9, article id 31271Article in journal (Refereed)
  • 300.
    Van Minh, Hoang
    et al.
    Hanoi Med Univ, Dept Hlth Econ, Hanoi, Vietnam.
    Pocock, Nicola Suyin
    London Sch Hyg & Trop Med, London WC1, England.
    Chaiyakunapruk, Nathorn
    Monash Univ Malaysia, Sch Pharm, Selangor, Malaysia; Naresuan Univ, Fac Pharmaceut Sci, Dept Pharm Practice, Ctr Pharmaceut Outcomes Res, Phitsanulok, Thailand; Univ Queensland, Sch Populat Hlth, Brisbane, Qld 4072, Australia.
    Chhorvann, Chhea
    Natl Inst Publ Hlth, Phnom Penh, Cambodia.
    Duc, Ha Anh
    Minist Hlth, Hanoi, Vietnam.
    Hanvoravongchai, Piya
    Chulalongkorn Univ, Fac Med, Bangkok 10330, Thailand.
    Lim, Jeremy
    Oliver Wyman, Hlth & Life Sci Practice, New York, NY USA.
    Lucero-Prisno, Don Eliseo
    Xian Jiaotong Liverpool Univ, Dept Publ Hlth, Suzhou, Peoples R China; Open Univ, Univ Philippines, Fac Management & Dev Studies, Los Banos, Philippines.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Phaholyothin, Natalie
    Rockefeller Fdn, Bangkok, Thailand.
    Phonvisay, Alay
    Natl Univ Laos, Viangchan, Laos.
    Soe, Kyaw Min
    Mahidol Univ, Fac Publ Hlth, Bangkok 10700, Thailand.
    Sychareun, Vanphanom
    Univ Hlth Sci, Viangchan, Laos.
    Progress toward universal health coverage in ASEAN2014In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, article id 25856Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The Association of Southeast Asian Nations (ASEAN) is characterized by much diversity in terms of geography, society, economic development, and health outcomes. The health systems as well as healthcare structure and provisions vary considerably. Consequently, the progress toward Universal Health Coverage (UHC) in these countries also varies. This paper aims to describe the progress toward UHC in the ASEAN countries and discuss how regional integration could influence UHC.

    DESIGN: Data reported in this paper were obtained from published literature, reports, and gray literature available in the ASEAN countries. We used both online and manual search methods to gather the information and 'snowball' further data.

    RESULTS: We found that, in general, ASEAN countries have made good progress toward UHC, partly due to relatively sustained political commitments to endorse UHC in these countries. However, all the countries in ASEAN are facing several common barriers to achieving UHC, namely 1) financial constraints, including low levels of overall and government spending on health; 2) supply side constraints, including inadequate numbers and densities of health workers; and 3) the ongoing epidemiological transition at different stages characterized by increasing burdens of non-communicable diseases, persisting infectious diseases, and reemergence of potentially pandemic infectious diseases. The ASEAN Economic Community's (AEC) goal of regional economic integration and a single market by 2015 presents both opportunities and challenges for UHC. Healthcare services have become more available but health and healthcare inequities will likely worsen as better-off citizens of member states might receive more benefits from the liberalization of trade policy in health, either via regional outmigration of health workers or intra-country health worker movement toward private hospitals, which tend to be located in urban areas. For ASEAN countries, UHC should be explicitly considered to mitigate deleterious effects of economic integration. Political commitments to safeguard health budgets and increase health spending will be necessary given liberalization's risks to health equity as well as migration and population aging which will increase demand on health systems. There is potential to organize select health services regionally to improve further efficiency.

    CONCLUSIONS: We believe that ASEAN has significant potential to become a force for better health in the region. We hope that all ASEAN citizens can enjoy higher health and safety standards, comprehensive social protection, and improved health status. We believe economic and other integration efforts can further these aspirations.

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