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  • 301. Van Minh, Hoang
    et al.
    Soonthornthada, Kusol
    Ng, Nawi
    Juvekar, Sanjay
    Razzaque, Abdur
    Ashraf, Ali
    Ahmed, Syed Masud
    Bich, Tran Huu
    Kanungsukkasem, Uraiwan
    Blood pressure in adult rural INDEPTH population in Asia2009In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 2, p. 60-67Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: High blood pressure (BP) is a well-known major risk factor for cardiovascular diseases and is a leading contributor to cardiovascular mortality and morbidity worldwide. Reliable population-based BP data from low-middle income countries are sparse.

    OBJECTIVE: This paper reports BP distributions among adults in nine rural populations in five Asian countries and examines the association between high BP and associated risk factors, including gender, age, education, and body mass index.

    METHODS: A multi-site cross-sectional study of the major non-communicable disease risk factors (tobacco and alcohol use, fruit and vegetable intake, physical activity patterns) was conducted in 2005 in nine Health and Demographic Surveillance System (HDSS) sites in five Asian countries, all part of the INDEPTH Network. In addition to the self-report questions on risk factors, height and weight, and BP were measured during household visits using standard protocols of the WHO STEPwise approach to Surveillance.

    RESULTS: In all the study sites (except among men and women in WATCH and among women in Chililab), the mean levels of systolic BP were greater than the optimal threshold (115 mmHg). A considerable proportion of the study populations - especially those in the HDSS in India, Indonesia, and Thailand - had high BP (systolic BP >/= 140 mmHg or diastolic BP >/= 90 mmHg or on treatment with BP medications). A more conservative definition of high BP (systolic BP >/= 160 mmHg or diastolic BP >/= 100 mmHg) substantially reduced the prevalence rate. The marked differences in the proportion of the populations on high BP medication (range between 0.6 and 10.8%) raised problems in comparing the prevalence of high BP across sites when using the commonly used definition of high BP as in this study. In the four HDSS in Bangladesh, women had a higher prevalence of high BP than men; the reverse was true in the other sites (Chililab, Filabavi in Vietnam; Kanchanaburi, Thailand; and Vadu, India) where men experienced higher prevalence than women. Overweight and obesity were significantly associated with high BP, with odds ratio ranging from two in Chililab to five in Filabavi (both in Vietnam HDSS).

    CONCLUSION: The patterns of BP in these nine cross-sectional surveys were complex, reflecting the fact that the Asian countries are at different stages of the epidemiological transition. Actions to prevent the rise of BP levels are urgently required. An emphasis should be placed on cost-effective interventions to reduce salt consumption in the population as an immediate priority.

  • 302. Van Minh, Hoang
    et al.
    Tuan Anh, Tran
    Rocklöv, Joacim
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Bao Giang, Kim
    Trang, Le Quynh
    Sahlen, Klas-Göran
    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.
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Primary healthcare system capacities for responding to storm and flood-related health problems: a case study from a rural district in central Vietnam2014In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, article id 23007Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: As a tropical depression in the East Sea, Vietnam is greatly affected by climate change and natural disasters. Knowledge of the current capacity of the primary healthcare system in Vietnam to respond to health issues associated with storms and floods is very important for policy making in the country. However, there has been little scientific research in this area. OBJECTIVE: This research was to assess primary healthcare system capacities in a rural district in central Vietnam to respond to such health issues. DESIGN: This was a cross-sectional descriptive study using quantitative and qualitative approaches. Quantitative methods used self-administered questionnaires. Qualitative methods (in-depth interviews and focus groups discussions) were used to broaden understanding of the quantitative material and to get additional information on actions taken. RESULTS: 1) Service delivery: Medical emergency services, especially surgical operations and referral systems, were not always available during the storm and flood seasons. 2) Governance: District emergency plans focus largely on disaster response rather than prevention. The plans did not clearly define the role of primary healthcare and had no clear information on the coordination mechanism among different sectors and organizations. 3) Financing: The budget for prevention and control of flood and storm activities was limited and had no specific items for healthcare activities. Only a little additional funding was available, but the procedures to get this funding were usually time-consuming. 4) Human resources: Medical rescue teams were established, but there were no epidemiologists or environmental health specialists to take care of epidemiological issues. Training on prevention and control of climate change and disaster-related health issues did not meet actual needs. 5) Information and research: Data that can be used for planning and management (including population and epidemiological data) were largely lacking. The district lacked a disease early-warning system. 6) Medical products and technology: Emergency treatment protocols were not available in every studied health facility. CONCLUSIONS: The primary care system capacity in rural Vietnam is inadequate for responding to storm and flood-related health problems in terms of preventive and treatment healthcare. Developing clear facility preparedness plans, which detail standard operating procedures during floods and identify specific job descriptions, would strengthen responses to future floods. Health facilities should have contingency funds available for emergency response in the event of storms and floods. Health facilities should ensure that standard protocols exist in order to improve responses in the event of floods. Introduction of a computerized health information system would accelerate information and data processing. National and local policies need to be strengthened and developed in a way that transfers into action in local rural communities.

  • 303. Verguet, Stephane
    et al.
    Jassat, Waasila
    Bertram, Melanie Y
    Tollman, Stephen M
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Murray, Christopher JL
    Jamison, Dean T
    Hofman, Karen J
    Supplementary immunization activities (SIAs) in South Africa: comprehensive economic evaluation of an integrated child health delivery platform2013In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 6, p. 1-9Article in journal (Refereed)
    Abstract [en]

    Background: Supplementary immunization activity (SIA) campaigns provide children with an additional dose of measles vaccine and deliver other interventions, including vitamin A supplements, deworming medications, and oral polio vaccines.

    Objective: To assess the cost-effectiveness of the full SIA delivery platform in South Africa (SA).

    Design: We used an epidemiologic cost model to estimate the cost-effectiveness of the 2010 SIA campaign. We used province-level campaign data sourced from the District Health Information System, SA, and from planning records of provincial coordinators of the Expanded Programme on Immunization. The data included the number of children immunized with measles and polio vaccines, the number of children given vitamin A supplements and Albendazole tablets, and costs.

    Results: The campaign cost $37 million and averted a total of 1,150 deaths (95% uncertainty range: 990-1,360)- This ranged from 380 deaths averted in KwaZulu-Natal to 20 deaths averted in the Northern Cape. Vitamin A supplementation alone averted 820 deaths (95% UR: 670-1,040); measles vaccination alone averted 330 deaths (95% UR: 280-370)- Incremental cost-effectiveness was $27,100 (95% UR: $18, 500-34,400) per death averted nationally, ranging from $11,300 per death averted in the Free State to $91,300 per death averted in the Eastern Cape.

    Conclusions: Cost-effectiveness of the SIA child health delivery platform varies substantially across SA provinces, and it is substantially more cost-effective when vitamin A supplementation is included in the interventions administered. Cost-effectiveness assessments should consider health system delivery platforms that integrate multiple interventions, and they should be conducted at the sub-national level.

  • 304. Vives-Cases, Carmen
    et al.
    Eriksson, Malin
    Goicolea, Isabel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    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).
    Gender and health inequalities: intersections with other relevant axes of oppression2015In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 8, article id 30292Article in journal (Other academic)
  • 305. Vives-Cases, Carmen
    et al.
    Espinar-Ruiz, Eva
    Castellanos-Torres, Esther
    Coe, Anna-Britt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Multiple struggles in fighting violence against women: implications among Romani women leaders in Spain2017In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, article id 1317084Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Violence against women (VAW) is a central issue in gender studies and one that has united feminist activists from around the world. But this does not mean that this struggle is singular: indeed, one can say that there are many, diverse and sometimes even contradictory struggles occurring throughout the world.

    OBJECTIVES: To identify and analyze the different struggles faced by women from Roma organizations in Spain in relation to VAW and their work with affected women.

    METHODS: Twelve semi-structured interviews were conducted among women actively involved in Roma associations in different Spanish cities, in 2015. An inductive thematic analysis was used to analyze the empirical materials.

    RESULTS: Our analysis resulted in three themes that captured different struggles that women from Roma organizations have faced: 'between persistence and rupture of restrictive gender norms', 'invisibility and normalization of violence against women' and 'willingness and trust in daily work with women'. The activities related to VAW carried out by the interviewed women were more related to their personal initiatives and abilities than to strategies proposed by the organizations they work for.

    CONCLUSIONS: The results show the need to support the initiatives of Romani women and their own struggles related to identity. This is what makes them true promoters of social change and, more specifically, change related to gender relations both within and outside of their communities.

  • 306.
    von Strauss, Eva
    et al.
    The Swedish Red Cross University College, Department of Health Sciences.
    Paillard-Borg, Stéphanie
    The Swedish Red Cross University College, Department of Health Sciences.
    Holmgren, Jessica
    The Swedish Red Cross University College, Department of Health Sciences.
    Saaristo, Panu
    International Federation of Red Cross and Red Crescent Societies (IFRC), Geneva, Switzerland.
    Global nursing in an Ebola viral haemorrhagic fever outbreak: before, during and after deployment2017In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, no 1, article id 1371427Article in journal (Refereed)
    Abstract [en]

    Background: Nurses are on the forefront and play a key role in global disaster responses. Nevertheless, they are often not prepared for the challenges they are facing and research is scarce regarding the nursing skills required for first responders during a disaster situation.Objectives: To investigate how returnee nursing staff experienced deployment before, during and after having worked for the Red Cross at an Ebola Treatment Center in Kenema, West Africa, and to supply knowledge on how to better prepare and support staff for viral haemorrhagic fever outbreaks.Methods: A descriptive, cross-sectional approach. Questionnaires were administered to nurses having worked with patients suffering from Ebola in 2014 and 2015. Data collection covered aspects of pre-, during and post-deployment on clinical training, personal health, stress management, leadership styles, socio-cultural exposure and knowledge transfer, as well as attitudes from others. Data was analysed using both quantitative and qualitative methods.Results: Response-rate was 88%: forty-four nurses from 15 different countries outside West Africa answered the questionnaire. The respondents identified the following needs for improvement: increased mental health and psychosocial support and hands-on coping strategies with focus on pre- and post-deployment; more pre-deployment task-oriented clinical training; and workload reduction, as exhaustion is a risk for safety.Conclusions: This study supplies knowledge on how to better prepare health care staff for future viral haemorrhagic fever outbreaks and other disasters. Participants were satisfied with their pre-deployment physical health preparation, whereas they stressed the importance of mental health support combined with psychosocial support after deployment. Furthermore, additional pre-clinical training was requested.

  • 307.
    von Strauss, Eva
    et al.
    Röda Korsets Högskola, Hälsovetenskapliga institutionen, Sweden.
    Paillard-Borg, Stéphanie
    Röda Korsets Högskola, Hälsovetenskapliga institutionen, Sweden.
    Holmgren, Jessica
    Röda Korsets Högskola, Hälsovetenskapliga institutionen, Sweden.
    Saaristo, Panu
    International Federation of Red Cross and Red Crescent Societies (IFRC), Geneva, Switzerland.
    Global nursing in an Ebola viral haemorrhagic fever outbreak: before, during and after deployment2017In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, no 1, article id 1371427Article in journal (Refereed)
    Abstract [en]

    Background: Nurses are on the forefront and play a key role in global disaster responses. Nevertheless, they are often not prepared for the challenges they are facing and research is scarce regarding the nursing skills required for first responders during a disaster situation.Objectives: To investigate how returnee nursing staff experienced deployment before, during and after having worked for the Red Cross at an Ebola Treatment Center in Kenema, West Africa, and to supply knowledge on how to better prepare and support staff for viral haemorrhagic fever outbreaks.Methods: A descriptive, cross-sectional approach. Questionnaires were administered to nurses having worked with patients suffering from Ebola in 2014 and 2015. Data collection covered aspects of pre-, during and post-deployment on clinical training, personal health, stress management, leadership styles, socio-cultural exposure and knowledge transfer, as well as attitudes from others. Data was analysed using both quantitative and qualitative methods.Results: Response-rate was 88%: forty-four nurses from 15 different countries outside West Africa answered the questionnaire. The respondents identified the following needs for improvement: increased mental health and psychosocial support and hands-on coping strategies with focus on pre- and post-deployment; more pre-deployment task-oriented clinical training; and workload reduction, as exhaustion is a risk for safety.Conclusions: This study supplies knowledge on how to better prepare health care staff for future viral haemorrhagic fever outbreaks and other disasters. Participants were satisfied with their pre-deployment physical health preparation, whereas they stressed the importance of mental health support combined with psychosocial support after deployment. Furthermore, additional pre-clinical training was requested.

  • 308.
    Wagner, Ryan G.
    et al.
    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, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
    Crowther, Nigel J.
    Gomez-Olive, Xavier
    Kabudula, Chodziwadziwa
    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, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana.
    Mhembere, Memory
    Myakayaka, Zola
    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, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana.
    Wade, Alisha N.
    Sociodemographic, socioeconomic, clinical and behavioural predictors of body mass index vary by sex in rural South African adults-findings from the AWI-Gen study2018In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 11, p. 80-89Article in journal (Refereed)
    Abstract [en]

    Background: Despite increasing obesity in South African adults, data on the prevalence and determinants of body mass index (BMI) from rural communities, home to a significant proportion of the population, are scarce. Objectives: To investigate overall and sex-specific determinants of BMI in a rural adult South African population undergoing rapid social and epidemiological transitions. Methods: Baseline cross-sectional demographic, socioeconomic, anthropometric, clinical and behavioural data were collected between 2015 and 2016 from 1388 individuals aged 40-60 years and resident in the Agincourt sub-district of Mpumalanga province, a setting typical of rural northeast South Africa. A Health and Socio-Demographic Surveillance System (HDSS) underpins the sub-district and contributes to the Africa Wits-INDEPTH partnership for Genomic Studies (AWI-Gen). Linear regression was used to investigate univariate associations between log-transformed BMI and individual variables and multiple linear regression was used to investigate independent predictors of BMI overall and in sex-stratified analyses. Results: Median BMI was significantly higher in females (28.7 kg/m(2) [95% CI 24.2-33.2] vs 23.0 kg/m(2) (95% CI 20.3-26.8tp < 0.001) with male sex associated with 17% lower BMI. In sex-stratified multiple linear regression models, compared to those never married, BMI was 7% higher in currently married males and 6% in currently married females. Current smoking in men and former smoking in women were associated with reductions in BMI of 13% and 26% respectively, compared with non-smokers. Higher educational attainment in women and higher socioeconomic status in men were both associated with higher BMI, while being HIV positive and alcohol consumption in women were associated lower BMI. Conclusions: Female sex strongly predicts higher BMI in this rural African population. While some predictors of higher BMI differ by sex, married individuals in both sexes had a higher BMI, suggesting that, in addition to developing sex-specific interventions to combat overweight and obesity, targeting married couples may result in reduction in population BMI.

  • 309.
    Wahlberg, Anna
    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).
    Källestål, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Lundgren, AnnaCarin
    Essén, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Causes of death among undocumented migrants in Sweden, 1997-20102014In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, p. 24464-Article in journal (Refereed)
    Abstract [en]

    Background: Undocumented migrants are one of the most vulnerable groups in Swedish society, where they generally suffer from poor health and limited health care access. Due to their irregular status, such migrants are an under-researched group and are not included in the country’s Cause of Death Register (CDR).

    Objective: To determine the causes of death among undocumented migrants in Sweden and to ascertain whether there are patterns in causes of death that differ between residents and undocumented migrants.

    Design: This is a cross-sectional study of death certificates issued from 1997 to 2010 but never included in the CDR from which we established our study sample of undocumented migrants. As age adjustments could not be performed due to lack of data, comparisons between residents and undocumented migrants were made at specific age intervals, based on the study sample’s mean age at death±a half standard deviation.

    Results: Out of 7,925 individuals surveyed, 860 were classified as likely to have been undocumented migrants. External causes (49.8%) were the most frequent cause of death, followed by circulatory system diseases, and then neoplasms. Undocumented migrants had a statistically significant increased risk of dying from external causes (odds ratio [OR] 3.57, 95% confidence interval [CI]: 2.83–4.52) and circulatory system diseases (OR 2.20, 95% CI: 1.73–2.82) compared to residents, and a lower risk of dying from neoplasms (OR 0.07, 95% CI: 0.04–0.14).

    Conclusions: We believe our study is the first to determine national figures on causes of death of undocumented migrants. We found inequity in health as substantial differences in causes of death between undocumented migrants and residents were seen. Legal ambiguities regarding health care provision must be addressed if equity in health is to be achieved in a country otherwise known for its universal health coverage.

  • 310.
    Waiswa, Peter
    et al.
    Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Akuze, Joseph
    Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda.
    Peterson, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Kerber, Kate
    Saving Newborn Lives, Save the Children, Cape Town, South Africa.
    Tetui, Moses
    Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda.
    Forsberg, Birger C
    Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Hanson, Claudia
    Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Differences in essential newborn care at birth between private and public health facilities in eastern Uganda2015In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 8, article id 24251Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    In Uganda and elsewhere, the private sector provides an increasing and significant proportion of maternal and child health services. However, little is known whether private care results in better quality services and improved outcomes compared to the public sector, especially regarding care at the time of birth.

    OBJECTIVE:

    To describe the characteristics of care-seekers and assess newborn care practices and services received at public and private facilities in rural eastern Uganda.

    DESIGN:

    Within a community-based maternal and newborn care intervention with health systems strengthening, we collected data from mothers with infants at baseline and endline using a structured questionnaire. Descriptive, bivariate, and multivariate data analysis comparing nine newborn care practices and three composite newborn care indicators among private and public health facilities was conducted.

    RESULTS:

    The proportion of women giving birth at private facilities decreased from 25% at baseline to 17% at endline, whereas overall facility births increased. Private health facilities did not perform significantly better than public health facilities in terms of coverage of any essential newborn care interventions, and babies were more likely to receive thermal care practices in public facilities compared to private (68% compared to 60%, p=0.007). Babies born at public health facilities received an average of 7.0 essential newborn care interventions compared to 6.2 at private facilities (p<0.001). Women delivering in private facilities were more likely to have higher parity, lower socio-economic status, less education, to seek antenatal care later in pregnancy, and to have a normal delivery compared to women delivering in public facilities.

    CONCLUSIONS:

    In this setting, private health facilities serve a vulnerable population and provide access to service for those who might not otherwise have it. However, provision of essential newborn care practices was slightly lower in private compared to public facilities, calling for quality improvement in both private and public sector facilities, and a greater emphasis on tracking access to and quality of care in private sector facilities.

  • 311.
    Waiswa, Peter
    et al.
    Department of Health Policy, Planning and Management, School of Public Health, College of Health Science, Makerere University, Kampala, Uganda.
    Namazzi, Gertrude
    Department of Health Policy, Planning and Management, School of Public Health, College of Health Science, Makerere University, Kampala, Uganda.
    Kerber, Kate
    Saving Newborn Lives, Save the Children, Cape Town, South Africa.
    Peterson, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Designing for action: adapting and implementing a community-based newborn care package to affect national change in Uganda2015In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 8, article id 24250Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    There is a lack of literature on how to adapt new evidence-based interventions for maternal and newborn care into local health systems and policy for rapid scale-up, particularly for community-based interventions in low-income settings. The Uganda Newborn Study (UNEST) was a cluster randomised control trial to test a community-based care package which was rapidly taken up at national level. Understanding this process may help inform other studies looking to design and evaluate with scale-up in mind.

    OBJECTIVE:

    This study aimed to describe the process of using evidence to design a community-based maternal and newborn care package in rural eastern Uganda, and to determine the dissemination and advocacy approaches used to facilitate rapid policy change and national uptake.

    DESIGN:

    We reviewed UNEST project literature including meeting reports and minutes, supervision reports, and annual and midterm reports. National stakeholders, project and district staff were interviewed regarding their role in the study and perceptions of what contributed to uptake of the package under evaluation. Data related to UNEST formative research, study design, implementation and policy influence were extracted and analysed.

    RESULTS:

    An advisory committee of key players in development of maternal and newborn policies and programmes in Uganda was constituted from many agencies and disciplines. Baseline qualitative and quantitative data collection was done at district, community and facility level to examine applicability of aspects of a proposed newborn care package to the local setting. Data were summarised and presented to stakeholders to adapt the intervention that was ultimately tested. Quarterly monitoring of key activities and events around the interventions were used to further inform implementation. The UNEST training package, home visit schedule and behaviour change counselling materials were incorporated into the national Village Health Team and Integrated Community Case Management packages while the study was ongoing.

    CONCLUSIONS:

    Designing interventions for national scale-up requires strategies and planning from the outset. Use of evidence alongside engagement of key stakeholders and targeted advocacy about the burden and potential solutions is important when adapting interventions to local health systems and communities. This approach has the potential to rapidly translate research into policy, but care must be taken not to exceed available evidence while seizing the policy opportunity.

  • 312.
    Waiswa, Peter
    et al.
    Department of Health Policy, Planning and Management, School of Public Health, College of Health Science, Makerere University, Kampala, Uganda.
    Pariyo, George
    Department of Health Policy, Planning and Management, School of Public Health, College of Health Science, Makerere University, Kampala, Uganda.
    Kallander, Karin
    Department of Health Policy, Planning and Management, School of Public Health, College of Health Science, Makerere University, Kampala, Uganda.
    Akuze, Joseph
    Department of Health Policy, Planning and Management, School of Public Health, College of Health Science, Makerere University, Kampala, Uganda.
    Namazzi, Gertrude
    Department of Health Policy, Planning and Management, School of Public Health, College of Health Science, Makerere University, Kampala, Uganda.
    Ekirapa-Kiracho, Elizabeth
    Department of Health Policy, Planning and Management, School of Public Health, College of Health Science, Makerere University, Kampala, Uganda.
    Kerber, Kate
    Save the Children, Cape Town, South Africa.
    Sengendo, Hanifah
    Save the Children, Cape Town, South Africa.
    Aliganyira, Patrick
    Save the Children, Cape Town, South Africa.
    Lawn, Joy E
    MARCH Unit, London School of Hygiene and Tropical Medicine, London, UK.
    Peterson, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Effect of the Uganda Newborn Study on care-seeking and care practices: a cluster-randomised controlled trial2015In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 8, article id 24584Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Care for women and babies before, during, and after the time of birth is a sensitive measure of the functionality of any health system. Engaging communities in preventing newborn deaths is a promising strategy to achieve further progress in child survival in sub-Saharan Africa.

    OBJECTIVE:

    To assess the effect of a home visit strategy combined with health facility strengthening on uptake of newborn care-seeking, practices and services, and to link the results to national policy and scale-up in Uganda.

    DESIGN:

    The Uganda Newborn Study (UNEST) was a two-arm cluster-randomised controlled trial in rural eastern Uganda. In intervention villages volunteer community health workers (CHWs) were trained to identify pregnant women and make five home visits (two during pregnancy and three in the first week after birth) to offer preventive and promotive care and counselling, with extra visits for sick and small newborns to assess and refer. Health facility strengthening was done in all facilities to improve quality of care. Primary outcomes were coverage of key essential newborn care behaviours (breastfeeding, thermal care, and cord care). Analyses were by intention to treat. This study is registered as a clinical trial, number ISRCTN50321130.

    RESULTS:

    The intervention significantly improved essential newborn care practices, although many interventions saw major increases in both arms over the study period. Immediate breastfeeding after birth and exclusive breastfeeding were significantly higher in the intervention arm compared to the control arm (72.6% vs. 66.0%; p=0.016 and 81.8% vs. 75.9%, p=0.042, respectively). Skin-to-skin care immediately after birth and cord cutting with a clean instrument were marginally higher in the intervention arm versus the control arm (80.7% vs. 72.2%; p=0.071 and 88.1% vs. 84.4%; p=0.023, respectively). Half (49.6%) of the mothers in the intervention arm waited more than 24 hours to bathe the baby, compared to 35.5% in the control arm (p<0.001). Dry umbilical cord care was also significantly higher in intervention areas (63.9% vs. 53.1%, p<0.001). There was no difference in care-seeking for newborn illness, which was high (around 95%) in both arms. Skilled attendance at delivery increased in both the intervention (by 21%) and control arms (by 19%) between baseline and endline, but there was no significant difference in coverage across arms at endline (79.6% vs. 78.9%; p=0.717). Home visits were pro-poor, with more women in the poorest quintile visited by a CHW compared to families in the least poor quintile, and more women who delivered at home visited by a CHW after birth (73.6%) compared to those who delivered in a hospital or health facility (59.7%) (p<0.001). CHWs visited 62.8% of women and newborns in the first week after birth, with 40.2% receiving a visit on the critical first day of life.

    CONCLUSION:

    Consistent with results from other community newborn care studies, volunteer CHWs can be effective in changing long-standing practices around newborn care. The home visit strategy may provide greater benefit to poorer families. However, CHW strategies require strong linkages with and concurrent improvement of quality through health system strengthening, especially in settings with high and increasing demand for facility-based services.

  • 313.
    Wall, Stig
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Global Health Action: Fuelling a hands-on approach to global health challenges2008In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 1Article in journal (Refereed)
  • 314.
    Wall, Stig
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Bindslev, Anne
    Our infancy period2009In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 2Article in journal (Refereed)
  • 315.
    Wall, Stig
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Bindslev, Anne
    Sutton, Caroline
    Supplements used to advantage2010In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Global health action, ISSN 1654-9880, Vol. 3, p. Article nr 5166-Article in journal (Refereed)
    Abstract [en]

    A recent (January 2010) editorial in The Lancet addressing the “perils of journal and supplement publishing” states in no unclear terms that the publishing of commercially sponsored supplements is “firmly off the agenda” for The Lancet. The editorial notes that although supplements and custom publications are an established element in journal publishing, supplemental material “is usually much inferior to that of any parent title” and is generally problematic for editors and reviewers. On this note, The Lancet goes on to identify examples of commercial supplement publications that support this view, including a recent example that had fallen into their own hands.

  • 316. Wallis, Lee
    et al.
    Hasselberg, Marie
    Barkman, Catharina
    Bogoch, Isaac
    Broomhead, Sean
    Dumont, Guy
    Groenewald, Johann
    Lundin, Johan
    Bergendahl, Johan Norell
    Nyasulu, Peter
    Olofsson, Maud
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Laflamme, Lucie
    A roadmap for the implementation of mHealth innovations for image-based diagnostic support in clinical and public-health settings: a focus on front-line health workers and health-system organizations2017In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, article id 1340254Article in journal (Refereed)
    Abstract [en]

    Background: Diagnostic support for clinicians is a domain of application of mHealth technologies with a slow uptake despite promising opportunities, such as image-based clinical support. The absence of a roadmap for the adoption and implementation of these types of applications is a further obstacle. Objectives: This article provides the groundwork for a roadmap to implement image-based support for clinicians, focusing on how to overcome potential barriers affecting front-line users, the health-care organization and the technical system. Methods: A consensual approach was used during a two-day roundtable meeting gathering a convenience sample of stakeholders (n = 50) from clinical, research, policymaking and business fields and from different countries. A series of sessions was held including small group discussions followed by reports to the plenary. Session moderators synthesized the reports in a number of theme-specific strategies that were presented to the participants again at the end of the meeting for them to determine their individual priority. Results: There were four to seven strategies derived from the thematic sessions. Once reviewed and prioritized by the participants some received greater priorities than others. As an example, of the seven strategies related to the front-line users, three received greater priority: the need for any system to significantly add value to the users; the usability of mHealth apps; and the goodness-of-fit into the work flow. Further, three aspects cut across the themes: ease of integration of the mHealth applications; solid ICT infrastructure and support network; and interoperability. Conclusions: Research and development in image-based diagnostic pave the way to making health care more accessible and more equitable. The successful implementation of those solutions will necessitate a seamless introduction into routines, adequate technical support and significant added value.

  • 317. Wanduru, Phillip
    et al.
    Tetui, Moses
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Makerere University School of Public Health (MakSPH), Makerere University, Kampala, Uganda.
    Tuhebwe, Doreen
    Ediau, Michael
    Okuga, Monica
    Nalwadda, Christine
    Ekirapa-Kiracho, Elizabeth
    Waiswa, Peter
    Rutebemberwa, Elizeus
    The performance of community health workers in the management of multiple childhood infectious diseases in Lira, northern Uganda: a mixed methods cross-sectional study2016In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 9, article id 33194Article in journal (Refereed)
    Abstract [en]

    Background: Community health workers (CHWs) have the potential to reduce child mortality by improving access to care, especially in remote areas. Uganda has one of the highest child mortality rates globally. Moreover, rural areas bear the highest proportion of this burden. The optimal performance of CHWs is critical. In this study, we assess the performance of CHWs in managing malaria, pneumonia, and diarrhea in the rural district of Lira, in northern Uganda.

    Designs: A cross-sectional mixed methods study was undertaken to investigate the performance of 393 eligible CHWs in the Lira district of Uganda. Case scenarios were conducted with a medical officer observing CHWs in their management of children suspected of having malaria, pneumonia, or diarrhea. Performance data were collected using a pretested questionnaire with a checklist used by the medical officer to score the CHWs. The primary outcome, CHW performance, is defined as the ability to diagnose and treat malaria, diarrhea, and pneumonia appropriately. Participants were described using a three group performance score (good vs. moderate vs. poor). A binary measure of performance (good vs. poor) was used in multivariable logistic regression to show an association between good performance and a range of independent variables. The qualitative component comprised seven key informant interviews with experts who had informed knowledge with regard to the functionality of CHWs in Lira district.

    Results: Overall, 347 CHWs (88.3%) had poor scores in managing malaria, diarrhea, and pneumonia, 26 (6.6%) had moderate scores, and 20 (5.1%) had good scores. The factors that were positively associated with performance were secondary-level education (adjusted odds ratio [AOR] 2.72; 95% confidence interval [CI] 1.50-4.92) and meeting with supervisors in the previous month (AOR 2.52; 95% CI 1.12-5.70). Those factors negatively associated with CHW performance included: serving 100-200 households (AOR 0.24; 95% CI 0.12-0.50), serving more than 200 households (AOR 0.22; 95% CI 0.10-0.48), and an initial training duration lasting 2-3 days (AOR 0.13; 95% CI 0.04-0.41). The qualitative findings reinforced the quantitative results by indicating that refresher training, workload, and in-kind incentives were important determinants of performance.

    Conclusions: The performance of CHWs in Lira was inadequate. There is a need to consider pre-qualification testing before CHWs are appointed. Providing ongoing support and supervision, and ensuring that CHWs have at least secondary education can be helpful in improving their performance. Health system managers also need to ensure that the CHWs' workload is moderated as work overload will reduce performance. Finally, although short training programs are beneficial to some degree, they are not sufficient and should be followed up with regular refresher training.

  • 318.
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Foreword2013In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 6, p. 1-1Article in journal (Other academic)
  • 319.
    Wiklund, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Department of Public Health and Caring Sciences, Public Health, Uppsala University, Uppsala, Sweden.
    Ahlgren, Christina
    Department of Public Health and Caring Sciences, Public Health, Uppsala University, Uppsala, Sweden.
    Hammarström, Anne
    Department of Public Health and Caring Sciences, Public Health, Uppsala University, Uppsala, Sweden.
    Constructing respectability from disfavoured social positions: exploring young femininities and health as shaped by marginalisation and social context. A qualitative study in Northern Sweden2018In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 11, no sup3, article id 1519960Article in journal (Refereed)
    Abstract [en]

    Background: Gender, class and living conditions shape health and illness. However, few studies have investigated constructs of femininity in relation to health and living conditions among young women who are unemployed and marginalised at an early age.

    Objective: The aim of this research was to elucidate constructs of femininities in relation to structuring living conditions and expressions of health in Northern Swedish women. The time period of interest was the transition from unemployed teenagers to young adults in a social context of high unemployment and societal change across the critical ‘school-to-work-transition’ period of the life course.

    Methods: Qualitative content analysis was used to analyse data from repeated interviews with unemployed young women, aged 16–33 years, during the 1980s and 1990s. These longitudinal interviews were part of a cohort study in a ‘remote’ municipality in Northern Sweden that began in 1981. All girls who were not in education, employment, or training were selected for interview. An inductive analysis phase was followed by a theoretically informed phase. The contextual frame is the Nordic welfare-state model and the ‘caring state’ with its particular focus on basic and secondary education, and women’s participation in the labour market. This focus paralleled high rates of youth unemployment in northern Sweden during the study period.

    Results: The results are presented as the theme of ‘constructing respectability from disfavoured social positions’. Within this theme, and framed by dominant norms of patriarchal femininity, we explored the constructs of normative and altruistic, norm-breaking, and troubled femininity.

    Conclusions: Gender-sensitive interventions are needed to strengthen young women’s further education and positions in the labour market and to preventing exposure to violence. More research on health experiences related to the multitude of constructs of femininities in various social contexts and across the life course is needed to help design and implement such interventions.

  • 320.
    Wiklund, Maria
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. Department of Community Medicine and Rehabilitation, Physiotherapy , Umeå University , Umeå , Sweden.
    Ahlgren, Christina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Hammarström, Anne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Constructing respectability from disfavoured social positions: exploring young femininities and health as shaped by marginalisation and social context. A qualitative study in Northern Sweden.2018In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 11, no sup3, article id 1519960Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Gender, class and living conditions shape health and illness. However, few studies have investigated constructs of femininity in relation to health and living conditions among young women who are unemployed and marginalised at an early age.

    OBJECTIVE: The aim of this research was to elucidate constructs of femininities in relation to structuring living conditions and expressions of health in Northern Swedish women. The time period of interest was the transition from unemployed teenagers to young adults in a social context of high unemployment and societal change across the critical 'school-to-work-transition' period of the life course.

    METHODS: Qualitative content analysis was used to analyse data from repeated interviews with unemployed young women, aged 16-33 years, during the 1980s and 1990s. These longitudinal interviews were part of a cohort study in a 'remote' municipality in Northern Sweden that began in 1981. All girls who were not in education, employment, or training were selected for interview. An inductive analysis phase was followed by a theoretically informed phase. The contextual frame is the Nordic welfare-state model and the 'caring state' with its particular focus on basic and secondary education, and women's participation in the labour market. This focus paralleled high rates of youth unemployment in northern Sweden during the study period.

    RESULTS: The results are presented as the theme of 'constructing respectability from disfavoured social positions'. Within this theme, and framed by dominant norms of patriarchal femininity, we explored the constructs of normative and altruistic, norm-breaking, and troubled femininity.

    CONCLUSIONS: Gender-sensitive interventions are needed to strengthen young women's further education and positions in the labour market and to preventing exposure to violence. More research on health experiences related to the multitude of constructs of femininities in various social contexts and across the life course is needed to help design and implement such interventions.

  • 321.
    Wiklund, Maria
    et al.
    Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden; Umeå Centre for Gender Studies in Medicine, Umeå University, Umeå, Sweden; Department of Public Health and Clinical Medicine, Social Medicine, Umeå University, Umeå, Sweden.
    Fjellman-Wiklund, Anncristine
    Umeå universitet, Fysioterapi.
    Stålnacke, Britt-Marie
    Umeå Centre for Gender Studies in Medicine, Umeå University, Umeå, Sweden; Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden.
    Hammarström, Anne
    Umeå Centre for Gender Studies in Medicine, Umeå University, Umeå, Sweden; Department of Public Health and Clinical Medicine, Social Medicine, Umeå University, Umeå, Sweden.
    Lehti, Arja
    Umeå Centre for Gender Studies in Medicine, Umeå University, Umeå, Sweden; Department of Clinical Sciences, Professional Development, Umeå University, Umeå, Sweden.
    Access to rehabilitation: patient perceptions of inequalities in access to specialty pain rehabilitation from a gender and intersectional perspective2016In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 9, article id 31542Article in journal (Refereed)
    Abstract [en]

    Background: Long-term musculoskeletal pain is common, particularly among women. Pain conditions are a concern in primary health care, and people with severe and complex pain are referred to specialty health care. There is gender bias in access, counselling, assessment, and treatment of long-term pain.

    Objective: This study explores patient accounts and perceptions about important (social) factors for accessing specialised pain rehabilitation from gender and intersectional equality perspectives. We aimed to identify potential biases and inequalities in accessing rehabilitation resources at a specialised rehabilitation clinic.

    Design: Individual semi-structured interviews were conducted with 10 adults after an assessment or completion of a specialised rehabilitation programme in northern Sweden. Qualitative content analysis was used to explore patients’ perceptions of important factors for accessing rehabilitation.

    Results: One main theme was formulated as Access to rehab – not a given. Three categories of perceived inequality were demonstrated: power of gender, power of social status, and power of diagnosis. Participants perceived rehabilitation as a resource that is not equally available, but dependent on factors such as gender, socio-economic status, ability to work, ethnicity, or age, and more subtle aspects of social status and habitus (e.g. appearance, fitness, and weight). The character of diagnosis received (medical versus psychiatric or social) was also noted.

    Conclusions: It is crucial that professionals are aware of how potential inequalities related to gender, social status, and diagnosis, and their intersections, can be created, perceived, and have influence on the processes of assessment and treatment. Reduction of social determinants of health and biases remain important within global, national, and local contexts.

  • 322.
    Wiklund, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Social medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Social medicine. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Lehti, Arja
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Professionell Development. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Access to rehabilitation: patient perceptions of inequalities in access to specialty pain rehabilitation from a gender and intersectional perspective2016In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 9, article id 31542Article in journal (Refereed)
    Abstract [en]

    Background: Long-term musculoskeletal pain is common, particularly among women. Pain conditions are a concern in primary health care, and people with severe and complex pain are referred to specialty health care. There is gender bias in access, counselling, assessment, and treatment of long-term pain.

    Objective: This study explores patient accounts and perceptions about important (social) factors for accessing specialised pain rehabilitation from gender and intersectional equality perspectives. We aimed to identify potential biases and inequalities in accessing rehabilitation resources at a specialised rehabilitation clinic.

    Design: Individual semi-structured interviews were conducted with 10 adults after an assessment or completion of a specialised rehabilitation programme in northern Sweden. Qualitative content analysis was used to explore patients’ perceptions of important factors for accessing rehabilitation.

    Results: One main theme was formulated as Access to rehab – not a given. Three categories of perceived inequality were demonstrated: power of gender, power of social status, and power of diagnosis. Participants perceived rehabilitation as a resource that is not equally available, but dependent on factors such as gender, socio-economic status, ability to work, ethnicity, or age, and more subtle aspects of social status and habitus (e.g. appearance, fitness, and weight). The character of diagnosis received (medical versus psychiatric or social) was also noted.

    Conclusions: It is crucial that professionals are aware of how potential inequalities related to gender, social status, and diagnosis, and their intersections, can be created, perceived, and have influence on the processes of assessment and treatment. Reduction of social determinants of health and biases remain important within global, national, and local contexts.

  • 323.
    Wilder-Smith, Annelies
    et al.
    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 ; Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
    Cohn, Emily
    Lloyd, David C.
    Tozan, Yesim
    Brownstein, John S.
    Internet-based media coverage on dengue in Sri Lanka between 2007 and 20152016In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 9, p. 1-5, article id 31620Article in journal (Refereed)
    Abstract [en]

    Background: Internet-based media coverage to explore the extent of awareness of a disease and perceived severity of an outbreak at a national level can be used for early outbreak detection. Dengue has emerged as a major public health problem in Sri Lanka since 2009. Objective: To compare Internet references to dengue in Sri Lana with references to other diseases (malaria and influenza) in Sri Lanka and to compare Internet references to dengue in Sri Lanka with notified cases of dengue in Sri Lanka. Design: We examined Internet-based news media articles on dengue queried from Health Map for Sri Lanka, for the period January 2007 to November 2015. For comparative purposes, we compared hits on dengue with hits on influenza and malaria. Results: There were 565 hits on dengue between 2007 and 2015, with a rapid rise in 2009 and followed by a rising trend ever since. These hits were highly correlated with the national epidemiological trend of dengue. The volume of digital media coverage of dengue was much higher than of influenza and malaria. Conclusions: Dengue in Sri Lanka is receiving increasing media attention. Our findings underpin previous claims that digital media reports reflect national epidemiological trends, both in annual trends and inter-annual seasonal variation, thus acting as proxy biosurveillance to provide early warning and situation awareness of emerging infectious diseases.

  • 324.
    Wilder-Smith, Annelies
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Preet, Raman
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Renhorn, Karl-Erik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Ximenes, R. A.
    Rodrigues, L. C.
    Solomon, T.
    Neyts, J.
    Lambrechts, L.
    Willison, H.
    Peeling, R.
    Falconar, A. K.
    Precioso, A. R.
    Logan, J.
    Lang, T.
    Endtz, H. P.
    Erasmus, M. C.
    Massad, E.
    ZikaPLAN: Zika Preparedness Latin American Network2017In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, no 1, article id 1398485Article in journal (Refereed)
    Abstract [en]

    The ongoing Zika virus (ZIKV) outbreak in Latin America, the Caribbean, and the Pacific Islands has underlined the need for a coordinated research network across the whole region that can respond rapidly to address the current knowledge gaps in Zika and enhance research preparedness beyond Zika. The European Union under its Horizon 2020 Research and Innovation Programme awarded three research consortia to respond to this need. Here we present the ZikaPLAN (Zika Preparedness Latin American Network) consortium. ZikaPLAN combines the strengths of 25 partners in Latin America, North America, Africa, Asia, and various centers in Europe. We will conduct clinical studies to estimate the risk and further define the full spectrum and risk factors of congenital Zika virus syndrome (including neurodevelopmental milestones in the first 3 years of life), delineate neurological complications associated with ZIKV due to direct neuroinvasion and immune-mediated responses in older children and adults, and strengthen surveillance for birth defects and Guillain-Barré Syndrome. Laboratory-based research to unravel neurotropism and investigate the role of sexual transmission, determinants of severe disease, and viral fitness will underpin the clinical studies. Social messaging and engagement with affected communities, as well as development of wearable repellent technologies against Aedes mosquitoes will enhance the impact. Burden of disease studies, data-driven vector control, and vaccine modeling as well as risk assessments on geographic spread of ZIKV will form the foundation for evidence-informed policies. While addressing the research gaps around ZIKV, we will engage in capacity building in laboratory and clinical research, collaborate with existing and new networks to share knowledge, and work with international organizations to tackle regulatory and other bottlenecks and refine research priorities. In this way, we can leverage the ZIKV response toward building a long-term emerging infectious diseases response capacity in the region to address future challenges.

  • 325.
    Wilder-Smith, Annelies
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Renhorn, Karl-Erik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Tissera, Hasitha
    Abu Bakar, Sazaly
    Alphey, Luke
    Kittayapong, Pattamaporn
    Lindsay, Steve
    Logan, James
    Hatz, Christoph
    Reiter, Paul
    Rocklöv, Joacim
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Louis, Valerie R.
    Tozan, Yesim
    Massad, Eduardo
    Tenorio, Antonio
    Lagneau, Christophe
    L'Ambert, Gregory
    Brooks, David
    Wegerdt, Johannah
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Gubler, Duane
    DengueTools: innovative tools and strategies for the surveillance and control of dengue2012In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 5, p. 17273-Article in journal (Refereed)
    Abstract [en]

    Dengue fever is a mosquito-borne viral disease estimated to cause about 230 million infections worldwide every year, of which 25,000 are fatal. Global incidence has risen rapidly in recent decades with some 3.6 billion people, over half of the world's population, now at risk, mainly in urban centres of the tropics and subtropics. Demographic and societal changes, in particular urbanization, globalization, and increased international travel, are major contributors to the rise in incidence and geographic expansion of dengue infections. Major research gaps continue to hamper the control of dengue. The European Commission launched a call under the 7th Framework Programme with the title of 'Comprehensive control of Dengue fever under changing climatic conditions'. Fourteen partners from several countries in Europe, Asia, and South America formed a consortium named 'DengueTools' to respond to the call to achieve better diagnosis, surveillance, prevention, and predictive models and improve our understanding of the spread of dengue to previously uninfected regions (including Europe) in the context of globalization and climate change. The consortium comprises 12 work packages to address a set of research questions in three areas: Research area 1: Develop a comprehensive early warning and surveillance system that has predictive capability for epidemic dengue and benefits from novel tools for laboratory diagnosis and vector monitoring. Research area 2: Develop novel strategies to prevent dengue in children. Research area 3: Understand and predict the risk of global spread of dengue, in particular the risk of introduction and establishment in Europe, within the context of parameters of vectorial capacity, global mobility, and climate change. In this paper, we report on the rationale and specific study objectives of 'DengueTools'. DengueTools is funded under the Health theme of the Seventh Framework Programme of the European Community, Grant Agreement Number: 282589 Dengue Tools.

  • 326.
    Wilder-Smith, Annelies
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Tissera, Hasitha
    AbuBakar, Sazaly
    Kittayapong, Pattamaporn
    Logan, James
    Neumayr, Andreas
    Rocklöv, Joacim
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Louis, Valerie R.
    Tozan, Yesim
    Massad, Eduardo
    Preet, Raman
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Novel tools for the surveillance and control of dengue: findings by the dengueTools research consortium2018In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 11, no 1, article id 1549930Article, review/survey (Refereed)
    Abstract [en]

    Background: Dengue fever persists as a major global disease burden, and may increase as a consequence of climate change. Along with other measures, research actions to improve diagnosis, surveillance, prevention, and predictive models are highly relevant. The European Commission funded the DengueTools consortium to lead a major initiative in these areas, and this review synthesises the outputs and findings of this work conducted from 2011 to 2016. Research areas: DengueTools organised its work into three research areas, namely [1] Early warning and surveillance systems; [2] Strategies to prevent dengue in children; and [3] Predictive models for the global spread of dengue. Research area 1 focused on case-studies undertaken in Sri Lanka, including developing laboratory-based sentinel surveillance, evaluating economic impact, identifying drivers of transmission intensity, evaluating outbreak prediction capacity and developing diagnostic capacity. Research area 2 addressed preventing dengue transmission in school children, with case-studies undertaken in Thailand. Insecticide-treated school uniforms represented an intriguing potential approach, with some encouraging results, but which were overshadowed by a lack of persistence of insecticide on the uniforms with repeated washing. Research area 3 evaluated potential global spread of dengue, particularly into dengue-naive areas such as Europe. The role of international travel, changing boundaries of vectors, developing models of vectorial capacity under different climate change scenarios and strategies for vector control in outbreaks was all evaluated. Concluding remarks: DengueTools was able to make significant advances in methods for understanding and controlling dengue transmission in a range of settings. These will have implications for public health agendas to counteract dengue, including vaccination programmes. Outlook: Towards the end of the DengueTools project, Zika virus emerged as an unexpected epidemic in the central and southern America. Given the similarities between the dengue and Zika viruses, with vectors in common, some of the DengueTools thinking translated readily into the Zika situation.

  • 327. Williams, Jill
    et al.
    Ibisomi, Latifat
    Sartorius, Benn
    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, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana.
    Collinson, Mark
    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, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana.
    Tollman, Stephen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana.
    Garenne, Michel
    Convergence in fertility of South Africans and Mozambicans in rural South Africa, 1993-20092013In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 6, no 1, p. 20-26Article in journal (Refereed)
    Abstract [en]

    Background: Although there are significant numbers of people displaced by war in Africa, very little is known about long-term changes in the fertility of refugees. Refugees of the Mozambican civil war (1977-1992) settled in many neighbouring countries, including South Africa. A large number of Mozambican refugees settled within the Agincourt sub-district, underpinned by a Health and Socio-demographic Surveillance Site (AHDSS), established in 1992, and have remained there. The AHDSS data provide a unique opportunity to study changes in fertility over time and the role that the fertility of self-settled refugee populations plays in the overall fertility level of the host community, a highly relevant factor in many areas of sub-Saharan Africa.

    Objectives: To examine the change in fertility of former Mozambican self-settled refugees over a period of 16 years and to compare the overall fertility and fertility patterns of Mozambicans to host South Africans.

    Methods: Prospective data from the AHDSS on births from 1993 to 2009 were used to compare fertility trends and patterns and to examine socio-economic factors that may be associated with fertility change.

    Results: There has been a sharp decline in fertility in the Mozambican population and convergence in fertility patterns of Mozambican and local South African women. The convergence of fertility patterns coincides with a convergence in other socio-economic factors.

    Conclusion: The fertility of Mozambicans has decreased significantly and Mozambicans are adopting the childbearing patterns of South African women. The decline in Mozambican fertility has occurred alongside socio-economic gains. There remains, however, high unemployment and endemic poverty in the area and fertility is not likely to decrease further without increased delivery of family planning to adolescents and increased education and job opportunities for women.

  • 328.
    Wrammert, Johan
    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).
    Zetterlund, Camilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    KC, Ashish
    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).
    Ewald, Uwe
    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).
    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).
    Resuscitation practices of low and normal birth weight infants in Nepal: an observational study using video camera recordings2017In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, no 1, article id 1322372Article in journal (Other academic)
    Abstract [en]

    Background: The global burden of stillbirth and neonatal deaths remains achallenge in low-income countries. Training in neonatal resuscitation canreduce intrapartum stillbirth and early neonatal mortality. Previous resultsdemonstrate that infants who previously would have been registered asstillbirths are successfully resuscitated after such training, suggesting thatthere is a process of selection for resuscitation that needs to be explored.

    Objective: To compare neonatal resuscitation of low birth weight andnormal birth weight infants born at a facility in a low-income setting.

    Methods: Motion-triggered video cameras were installed above theresuscitation tables at a maternity health facility during an interventionstudy (ISRCTN97846009) employing the Helping Babies Breatheresuscitation protocol in Kathmandu, Nepal. Recordings were analysed,noting crying, stimulation, ventilation, suctioning and oxygenadministration during resuscitation. Birth weight, Apgar scores and sex ofthe infant were retrieved from matched hospital registers. The results wereanalysed by chi-square and logistic regression.

    Results: A total of 2253 resuscitation cases were recorded. Low birthweight infants in need of resuscitation had higher odds of receivingventilation (aOR 1.73), and lower odds of receiving suctioning (aOR 0.53)after adjustment for the Helping Babies Breathe intervention, sex of theinfant and place of resuscitation within the facility. The rate of stimulationand administration of oxygen was the same in both groups.

    Conclusions: Low birth weight was associated with more ventilation andless suctioning during neonatal resuscitation in a low-income setting. Asventilation is the most important intervention when the infant does notinitiate breathing after birth, low birth weight was not a predictor for thedecision to withhold resuscitation. Frequent routine use of suctioning of thelower airways continues to be a problem in the studied context, even afterthe introduction of the Helping Babies Breathe protocol.

  • 329. Xuan, Le Thi Thanh
    et al.
    Egondi, Thaddaeus
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. African Population and Health Research Center, Nairobi, Kenya.
    Ngoan, Le Tran
    Toan, Do Thi Thanh
    Huong, Le Thi
    Seasonality in mortality and its relationship to temperature among the older population in Hanoi, Vietnam2014In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, article id 23115Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Several studies have established a relationship between temperature and mortality. In particular, older populations have been shown to be vulnerable to temperature effects. However, little information exists on the temperature-mortality relationship in Vietnam. OBJECTIVES: This article aims to examine the monthly temperature-mortality relationship among older people in Hanoi, Vietnam, over the period between 2005 and 2010, and estimate seasonal patterns in mortality. METHODS: We employed Generalized Additive Models, including smooth functions, to model the temperature-mortality relationships. A quasi-Poisson distribution was used to model overdispersion of death counts. Temporal trends, seasonality, and population size were adjusted for while estimating changes in monthly mortality over the study period. A cold month was defined as a month with a mean temperature below 19 degrees C. RESULTS: This study found that the high peak of mortality coincided with low temperatures in the month of February 2008, during which the mean temperature was the lowest in the whole study period. There was a significant relationship between mean monthly temperature and mortality among the older people (pB0.01). Overall, there was a significant decrease in the number of deaths in the year 2009 during the study period. There was a 21% increase in the number of deaths during the cold season compared to the warm season. The increase in mortality during the cold period was higher among females compared to males (female: IRR [incidence relative risk] = 1.23; male: IRR = 1.18). CONCLUSIONS: Cold temperatures substantially increased mortality among the older population in Hanoi, Vietnam, and there were gender differences. Necessary preventive measures are required to mitigate temperature effects with greater attention to vulnerable groups.

  • 330. Yamamoto, Shelby
    et al.
    Sie, Ali
    Sauerborn, Rainer
    Institute of Public Health, University of Heidelberg .
    Cooking fuels and the push for cleaner alternatives: a case study from Burkina Faso2009In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 2, p. 156-164Article in journal (Refereed)
    Abstract [en]

    Introduction: More than 95% of the population in Burkina Faso uses some form of solid biomass fuel. When these fuels are burned in traditional, inefficient stoves, pollutant levels within and outside the home can be very high. This can have important consequences for both health and climate change. Thus, the push to switch to cleaner burning fuels is advantageous. However, there are several considerations that need to be taken into account when considering the use and promotion of different fuel types.

    Objective: In the setting of the semi-urban area of Nouna, Burkina Faso, we examine the common fuel types used (wood, charcoal and liquid petroleum gas (LPG)) in terms of consumption, energy, availability, air pollution and climate change.

    Results and conclusion: Although biomass solid fuel does offer some advantages over LPG, the disadvantages make this option much less desirable. Lower energy efficiencies, higher pollutant emission levels, the associated health consequences and climate change effects favour the choice of LPG over solid biomass fuel use. Further studies specific to Burkina Faso, which are lacking in this region, should also be undertaken in this area to better inform policy decisions.

  • 331. Ye, Yazoume
    et al.
    Hoshen, Moshe
    Kyobutungi, Catherine
    Louis, Valerie R
    Sauerborn, Rainer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. University of Heidelberg, Department of Tropical Hygiene & Public Health, Medical school, Heidelberg, Germany.
    Local scale prediction of Plasmodium falciparum malaria transmission in an endemic region using temperature and rainfall2009In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 2, p. 103-115Article in journal (Refereed)
    Abstract [en]

    Background: To support malaria control strategies, prior knowledge of disease risk is necessary. Developing a model to explain the transmission of malaria, in endemic and epidemic regions, is of high priority in developing health system interventions. We develop, fit and validate a non-spatial dynamic model driven by meteorological conditions that can capture seasonal malaria transmission dynamics at the village level in a malaria holoendemic area of north-western Burkina Faso.

    Methods: A total of 676 children aged 6-59 months took part in this study. Trained interviewers visited children at home weekly from December 2003 to November 2004 for Plasmodium falciparum malaria infection detection. Anopheles daily biting rate, mortality rate and growth rate were evaluated. Digital meteorological stations measured ambient temperature, humidity and rainfall in each site.

    Results: The overall P. falciparum malaria infection incidence was 1.1 episodes per person year. There was strong seasonal variation in P. falciparum malaria infection incidence with a peak observed in August and September, corresponding to the rainy season and a high number of mosquitoes. The model estimates of monthly mosquito abundance and the incidence of malaria infection correlated well with observed values. The fit was sensitive to daily mosquito survival and daily human parasite clearance.

    Conclusion: The model has demonstrated potential for local scale seasonal prediction of P. falciparum malaria infection. It could therefore be used to understand malaria transmission dynamics using meteorological parameters as the driving force and to help district health managers in identifying high-risk periods for more focused interventions.

  • 332.
    Zelaya Blandon, Elmer
    et al.
    Asociac Desarrollo Econ & Sostenible El Espino AP, Chinandega, Nicaragua.;UNAN Leon, Leon, Nicaragua..
    Källestål, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Peña, Rodolfo
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Pan Amer Hlth Org, San Salvador, El Salvador..
    Pérez, Wilton
    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).
    Berglund, Staffan
    Malmo Univ, Fac Hlth & Soc, Malmo, Sweden..
    Contreras, Mariela
    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). London Sch Hyg & Trop Med, Dept Infect Dis Epidemiol, London, England..
    Breaking the cycles of poverty: Strategies, achievements, and lessons learned in Los Cuatro Santos, Nicaragua, 1990-20142017In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, article id 1272884Article in journal (Refereed)
    Abstract [en]

    Background: In a post-war frontier area in north-western Nicaragua that was severely hit by Hurricane Mitch in 1998, local stakeholders embarked on and facilitated multi-dimensional development initiatives to break the cycles of poverty. Objective: The aim of this paper is to describe the process of priority-setting, and the strategies, guiding principles, activities, achievements, and lessons learned in these local development efforts from 1990 to 2014 in the Cuatro Santos area, Nicaragua. Methods: Data were derived from project records and a Health and Demographic Surveillance System that was initiated in 2004. The area had 25,893 inhabitants living in 5,966 households in 2014. Results: A participatory process with local stakeholders and community representatives resulted in a long-term strategic plan. Guiding principles were local ownership, political reconciliation, consensus decision-making, social and gender equity, an environmental and public health perspective, and sustainability. Local data were used in workshops with communities to re-prioritise and formulate new goals. The interventions included water and sanitation, house construction, microcredits, environmental protection, school breakfasts, technical training, university scholarships, home gardening, breastfeeding promotion, and maternity waiting homes. During the last decade, the proportion of individuals living in poverty was reduced from 79 to 47%. Primary school enrolment increased from 70 to 98% after the start of the school breakfast program. Under-five mortality was around 50 per 1,000 live births in 1990 and again peaked after Hurricane Mitch and was approaching 20 per 1,000 in 2014. Several of the interventions have been scaled up as national programs. Conclusions: The lessons learned from the Cuatro Santos initiative underline the importance of a bottom- up approach and local ownership of the development process, the value of local data for monitoring and evaluation, and the need for multi-dimensional local interventions to break the cycles of poverty and gain better health and welfare.

  • 333.
    Åhman, Annika
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Kidanto, Hussein Lesio
    Ngarina, Matilda
    Edvardsson, Kristina
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology. Judith Lumley Centre, La Trobe University, Melbourne, VIC, Australia.
    Small, Rhonda
    Mogren, Ingrid
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    'Essential but not always available when needed': an interview study of physicians' experiences and views regarding use of obstetric ultrasound in Tanzania2016In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 9, article id 31062Article in journal (Refereed)
    Abstract [en]

    Background: The value of obstetric ultrasound in high-income countries has been extensively explored but evidence is still lacking regarding the role of obstetric ultrasound in low-income countries.

    Objective: We aimed to explore experiences and views among physicians working in obstetric care in Tanzania, on the role of obstetric ultrasound in relation to clinical management.

    Design: A qualitative study design was applied. Data were collected in 2015, through 16 individual interviews with physicians practicing in obstetric care at hospitals in an urban setting in Tanzania. Data were analyzed using qualitative content analysis.

    Results: Use of obstetric ultrasound in the management of complicated pregnancy was much appreciated by participating physicians, although they expressed considerable concern about the lack of ultrasound equipment and staff able to conduct the examinations. These limitations were recognized as restricting physicians' ability to manage complications adequately during pregnancy and birth. Better availability of ultrasound was requested to improve obstetric management. Concerns were also raised regarding pregnant women's lack of knowledge and understanding of medical issues which could make counseling in relation to obstetric ultrasound difficult. Although the physicians perceived a positive attitude toward ultrasound among most pregnant women, occasionally they came across women who feared that ultrasound might harm the fetus.

    Conclusions: There seems to be a need to provide more physicians in antenatal care in Tanzania with ultrasound training to enable them to conduct obstetric ultrasound examinations and interpret the results themselves. Physicians also need to acquire adequate counseling skills as counseling can be especially challenging in this setting where many expectant parents have low levels of education. Providers of obstetric care and policy makers in Tanzania will need to take measures to ensure appropriate use of the scarce resources in the Tanzanian health care system and prevent the potential risk of overuse of ultrasound in pregnancy.

  • 334.
    Öhman, Ann
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Eriksson, Malin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Goicolea, Isabel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Gender and health: aspects of importance for understanding health and illness in the world2015In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 8, article id 26908Article in journal (Refereed)
4567 301 - 334 of 334
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