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  • 51. Coates, Matthew M.
    et al.
    Kamanda, Mamusu
    Kintuc, Alexander
    Arikpo, Iwara
    Chauque, Alberto
    Mengesha, Melkamu Merid
    Price, Alison J.
    Sifuna, Peter
    Wamukoya, Marylene
    Sacoor, Charfudin N.
    Ogwang, Sheila
    Assefa, Nega
    Crampin, Amelia C.
    Macete, Eusebio, V
    Kyobutungi, Catherine
    Meremikwu, Martin M.
    Otieno, Walter
    Adjaye-Gbewonyo, Kafui
    Marx, Andrew
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Sankoh, Osman
    Bukhman, Gene
    A comparison of all-cause and cause-specific mortality by household socioeconomic status across seven INDEPTH network health and demographic surveillance systems in sub-Saharan Africa2019In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 12, no 1, article id 1608013Article in journal (Refereed)
    Abstract [en]

    Background: Understanding socioeconomic disparities in all-cause and cause-specific mortality can help inform prevention and treatment strategies.

    Objectives: To quantify cause-specific mortality rates by socioeconomic status across seven health and demographic surveillance systems (HDSS) in five countries (Ethiopia, Kenya, Malawi, Mozambique, and Nigeria) in the INDEPTH Network in sub-Saharan Africa.

    Methods: We linked demographic residence data with household survey data containing living standards and education information we used to create a poverty index. Person-years lived and deaths between 2003 and 2016 (periods varied by HDSS) were stratified in each HDSS by age, sex, year, and number of deprivations on the poverty index (0-8). Causes of death were assigned to each death using the InterVA-4 model based on responses to verbal autopsy questionnaires. We estimated rate ratios between socioeconomic groups (2-4 and 5-8 deprivations on our poverty index compared to 0-2 deprivations) for specific causes of death and calculated life expectancy for the deprivation groups.

    Results: Our pooled data contained almost 3.5 million person-years of observation and 25,038 deaths. All-cause mortality rates were higher among people in households with 5-8 deprivations on our poverty index compared to 0-2 deprivations, controlling for age, sex, and year (rate ratios ranged 1.42 to 2.06 across HDSS sites). The poorest group had consistently higher death rates in communicable, maternal, neonatal, and nutritional conditions (rate ratios ranged 1.34-4.05) and for non-communicable diseases in several sites (1.14-1.93). The disparities in mortality between 5-8 deprivation groups and 0-2 deprivation groups led to lower life expectancy in the higher-deprivation groups by six years in all sites and more than 10 years in five sites.

    Conclusions: We show large disparities in mortality on the basis of socioeconomic status across seven HDSS in sub-Saharan Africa due to disparities in communicable disease mortality and from non-communicable diseases in some sites. Life expectancy gaps between socioeconomic groups within sites were similar to the gaps between high-income and lower-middle-income countries. Prevention and treatment efforts can benefit from understanding subpopulations facing higher mortality from specific conditions.

  • 52.
    Coe, Anna-Britt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    The importance of taking into account different perspectives of a health problem: the case of fibromyalgia2017In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, article id 1275189Article in journal (Refereed)
  • 53.
    Collinson, Mark A.
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    White, Michael J.
    Bocquier, Philippe
    McGarvey, Stephen T.
    Afolabi, Sulaimon A.
    Clark, Samuel J.
    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.
    Migration and the epidemiological transition: insights from the Agincourt sub-district of northeast South Africa2014In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, p. 122-136Article in journal (Refereed)
    Abstract [en]

    Background:

    Migration and urbanization are central to sustainable development and health, but data on temporal trends in defined populations are scarce. Healthy men and women migrate because opportunities for employment and betterment are not equally distributed geographically. The disruption can result in unhealthy exposures and environments and income returns for the origin household.

    Objectives: The objectives of the paper are to describe the patterns, levels, and trends of temporary migration in rural northeast South Africa; the mortality trends by cause category over the period 2000-2011; and the associations between temporary migration and mortality by broad cause of death categories.

    Method:

    Longitudinal, Agincourt Health and Demographic Surveillance System data are used in a continuous, survival time, competing-risk model. Findings: In rural, northeast South Africa, temporary migration, which involves migrants relocating mainly for work purposes and remaining linked to the rural household, is more important than age and sex in explaining variations in mortality, whatever the cause. In this setting, the changing relationship between temporary migration and communicable disease mortality is primarily affected by reduced exposure of the migrant to unhealthy conditions. The study suggests that the changing relationship between temporary migration and non-communicable disease mortality is mainly affected by increased livelihood benefits of longer duration migration.

    Conclusion: Since temporary migration is not associated with communicable diseases only, public health policies should account for population mobility whatever the targeted health risk. There is a need to strengthen the rural health care system, because migrants tend to return to the rural households when they need health care.

  • 54.
    Crowe, Jennifer
    et al.
    Central American Institute for Studies in Toxic Substances (IRET) and the Program on Work and Health in Central America (SALTRA) at the Universidad Nacional in Costa Rica.
    van Wendel de Joode, Berna
    Central American Institute for Studies in Toxic Substances (IRET) and the Program on Work and Health in Central America (SALTRA) at the Universidad Nacional in Costa Rica.
    Wesseling, Catharina
    Central American Institute for Studies in Toxic Substances (IRET) and the Program on Work and Health in Central America (SALTRA) at the Universidad Nacional in Costa Rica.
    A pilot field evaluation on heat stress in sugarcane workers in Costa Rica: what to do next?2009In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 2, p. 71-80Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Climate change is producing major impacts including increasing temperatures in tropical countries, like Costa Rica, where the sugarcane industry employs thousands of workers who are exposed to extreme heat.

    OBJECTIVES: This article outlines a pilot qualitative evaluation of working conditions and heat in the sugarcane industry.

    DESIGN: A literature review, direct observations and exploratory interviews with workers were conducted to reach a preliminary understanding of the dimensions of heat-related health issues in the sugarcane industry, as a basis for the design of future studies.

    RESULTS: The industry employs temporary workers from Nicaragua and Costa Rica as well as year-round employees. Temporary employees work 12-hour shifts during the harvest and processing ('zafra') season. In many cases, sugarcane field workers are required to carry their own water and often have no access to shade. Sugar mill workers are exposed to different levels of heat stress depending upon their job tasks, with the most intense heat and workload experienced by the oven ('caldera') cleaners.

    CONCLUSIONS: Research is needed to achieve better understanding of the multiple factors driving and interacting with heat exposures in the sugarcane industry in order to improve the health and safety of workers while maintaining worker productivity.

  • 55. Daar, Abdallah S
    et al.
    Jacobs, Marian
    Wall, Stig
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Groenewald, Johann
    Eaton, Julian
    Patel, Vikram
    dos Santos, Palmira
    Kagee, Ashraf
    Gevers, Anik
    Sunkel, Charlene
    Andrews, Gail
    Daniels, Ingrid
    Ndetei, David
    Declaration on mental health in Africa: moving to implementation2014In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, article id 24589Article in journal (Refereed)
    Abstract [en]

    Urgent action is needed to address mental health issues globally. In Africa, where mental health disorders account for a huge burden of disease and disability, and where in general less than 1% of the already small health budgets are spent on these disorders, the need for action is acute and urgent. Members of the World Health Organization, including African countries, have adopted a Comprehensive Mental Health Action Plan. Africa now has an historic opportunity to improve the mental health and wellbeing of its citizens, beginning with provision of basic mental health services and development of national mental health strategic plans (roadmaps). There is need to integrate mental health into primary health care and address stigma and violations of human rights. We advocate for inclusion of mental health into the post-2015 Sustainable Development Goals, and for the convening of a special UN General Assembly High Level Meeting on Mental Health within three years.

  • 56.
    Dahal, Pranab
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Joshi, Sunil Kumar
    Kathmandu Medical College, Nepal.
    Swahnberg, Katarina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    'We are looked down upon and rejected socially': a qualitative study on the experiences of trafficking survivors in Nepal2015In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 8, p. 1-9, article id 29267Article in journal (Refereed)
    Abstract [en]

    Background: The successful reintegration of sexual trafficking survivors into Nepalese society is challenging. This paper aims to explore the trafficking process, abuses faced during sexual slavery, and the challenges faced by women and girl survivors for successful reintegration. Method: This exploratory study used qualitative methods to identify that poverty, illiteracy, lack of opportunities, and varied social stigma initiate the victimization process, and continuity of this vicious circle increases the risk for (re) entrapment. Result: The reasons for sexual trafficking have also become the reasons for restricting survivors from opportunities for growth and mainstreaming. Conclusion: Non-existent support systems, detachment from familial ties, being outcast by society, and an uncertain livelihood make reintegration difficult for survivors.

  • 57.
    Dalmar, Abdirisak Ahmed
    et al.
    Benadir Univ, Fac Med, Mogadishu, Somalia..
    Hussein, Abdullahi Sheik
    Benadir Univ, Fac Med, Mogadishu, Somalia..
    Walhad, Said Ahmed
    Amoud Univ, Coll Hlth Sci, Borama, Somaliland, Somalia..
    Ibrahim, Abdirashid Omer
    Amoud Univ, Coll Hlth Sci, Borama, Somaliland, Somalia..
    Abdi, Abshir Ali
    East Africa Univ, Fac Med, Bosasso, Somalia..
    Ali, Mohamed Khalid
    East Africa Univ, Fac Med, Bosasso, Somalia..
    Ereg, Derie Ismail
    Univ Hargeisa, Coll Med, Hargeisa, Somalia..
    Egal, Khadra Ali
    Univ Hargeisa, Coll Med, Hargeisa, Somalia..
    Shirwa, Abdulkadir Mohamed
    Galkayo Univ, Coll Med, Galkayo, Somalia..
    Aden, Mohamed Hussain
    Puntland Univ Sci & Technol, Med Coll, Galkayo, Somalia..
    Yusuf, Marian Warsame
    Somali Swedish Researchers Assoc, Stockholm, Sweden..
    Abdi, Yakoub Aden
    Somali Swedish Researchers Assoc, Stockholm, Sweden..
    Freij, Lennart
    Somali Swedish Researchers Assoc, Stockholm, Sweden..
    Johansson, Annika
    Somali Swedish Researchers Assoc, Stockholm, Sweden..
    Mohamud, Khalif Bile
    Somali Swedish Researchers Assoc, Stockholm, Sweden..
    Abdulkadir, Yusuf
    Somali Swedish Researchers Assoc, Stockholm, Sweden..
    Emmelin, Maria
    Lund Univ, Unit Social Med & Global Hlth, Lund, Sweden..
    Eriksen, Jaran
    Karolinska Inst, Div Clin Pharmacol, Stockholm, Sweden..
    Erlandsson, Kerstin
    Dalarna Univ, Falun, Sweden..
    Gustafsson, Lars L.
    Karolinska Inst, Div Clin Pharmacol, Stockholm, Sweden..
    Ivarsson, Anneli
    Umea Univ, Unit Epidemiol & Global Hlth, Umea, Sweden..
    Klingberg-Allvin, Marie
    Dalarna Univ, Falun, Sweden..
    Kinsman, John
    Umea Univ, Unit Epidemiol & Global Hlth, Umea, Sweden..
    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).
    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).
    Osman, Fatumo
    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).
    Sahlen, Klas-Goran
    Umea Univ, Unit Epidemiol & Global Hlth, Umea, Sweden..
    Wall, Stig
    Umea Univ, Unit Epidemiol & Global Hlth, Umea, Sweden..
    Rebuilding research capacity in fragile states: the case of a Somali-Swedish global health initiative2017In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, no 1, article id 1348693Article in journal (Refereed)
    Abstract [en]

    This paper presents an initiative to revive the previous Somali-Swedish Research Cooperation, which started in 1981 and was cut short by the civil war in Somalia. A programme focusing on research capacity building in the health sector is currently underway through the work of an alliance of three partner groups: six new Somali universities, five Swedish universities, and Somali diaspora professionals. Somali ownership is key to the sustainability of the programme, as is close collaboration with Somali health ministries. The programme aims to develop a model for working collaboratively across regions and cultural barriers within fragile states, with the goal of creating hope and energy. It is based on the conviction that health research has a key role in rebuilding national health services and trusted institutions.

  • 58. Dalmar, Abdirisak Ahmed
    et al.
    Hussein, Abdullahi Sheik
    Walhad, Said Ahmed
    Ibrahim, Abdirashid Omer
    Abdi, Abshir Ali
    Ali, Mohamed Khalid
    Ereg, Derie Ismail
    Egal, Khadra Ali
    Shirwa, Abdulkadir Mohamed
    Aden, Mohamed Hussain
    Yusuf, Marian Warsame
    Abdi, Yakoub Aden
    Freij, Lennart
    Johansson, Annika
    Mohamud, Khalif Bile
    Abdulkadir, Yusuf
    Emmelin, Maria
    Eriksen, Jaran
    Erlandsson, Kerstin
    Gustafsson, Lars L.
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Klingberg-Allvin, Marie
    Kinsman, John
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Källestål, Carina
    Målqvist, Mats
    Osman, Fatumo
    Persson, Lars-Åke
    Sahlén, Klas-Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Wall, Stig
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Rebuilding research capacity in fragile states: the case of a Somali-Swedish global health initiative2017In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, no 1, article id 1348693Article in journal (Refereed)
    Abstract [en]

    This paper presents an initiative to revive the previous Somali-Swedish Research Cooperation, which started in 1981 and was cut short by the civil war in Somalia. A programme focusing on research capacity building in the health sector is currently underway through the work of an alliance of three partner groups: six new Somali universities, five Swedish universities, and Somali diaspora professionals. Somali ownership is key to the sustainability of the programme, as is close collaboration with Somali health ministries. The programme aims to develop a model for working collaboratively across regions and cultural barriers within fragile states, with the goal of creating hope and energy. It is based on the conviction that health research has a key role in rebuilding national health services and trusted institutions.

  • 59. Dalmar, Abdirisak Ahmed
    et al.
    Hussein, Abdullahi Sheik
    Walhad, Said Ahmed
    Ibrahim, Abdirashid Omer
    Abdi, Abshir Ali
    Ali, Mohamed Khalid
    Erlandsson, Kerstin
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Klingberg-Allvin, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Osman, Fatumo
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Wall, Stig
    Rebuilding research capacity in fragile states: the case of a Somali-Swedish global health initiative2017In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, no 1, article id 1348693Article in journal (Refereed)
    Abstract [en]

    This paper presents an initiative to revive the previous Somali-Swedish Research Cooperation, which started in 1981 and was cut short by the civil war in Somalia. A programme focusing on research capacity building in the health sector is currently underway through the work of an alliance of three partner groups: six new Somali universities, five Swedish universities, and Somali diaspora professionals. Somali ownership is key to the sustainability of the programme, as is close collaboration with Somali health ministries. The programme aims to develop a model for working collaboratively across regions and cultural barriers within fragile states, with the goal of creating hope and energy. It is based on the conviction that health research has a key role in rebuilding national health services and trusted institutions.

  • 60. Dambach, Peter
    et al.
    Sie, Ali
    Lacaux, Jean-Pierre
    Vignolles, Cecile
    Machault, Vanessa
    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, Heidelberg, Germany.
    Using high spatial resolution remote sensing for risk mapping of malaria occurrence in the Nouna district, Burkina Faso2009In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 2, p. 149-155Article in journal (Refereed)
    Abstract [en]

    Introduction: Malaria control measures such as early diagnosis and treatment, intermittent treatment of pregnant women, impregnated bed nets, indoor spraying and larval control measures are difficult to target specifically because of imprecise estimates of risk at a small-scale level. Ways of estimating local risks for malaria are therefore important.

    Methods: A high-resolution satellite view from the SPOT 5 satellite during 2008 was used to generate a land cover classification in the malaria endemic lowland of North-Western Burkina Faso. For the area of a complete satellite view of 60 x 60 km, a supervised land cover classification was carried out. Ten classes were built and correlated to land cover types known for acting as Anopheles mosquito breeding sites.

    Results: According to known correlations of Anopheles larvae presence and surface water-related land cover, cultivated areas in the riverine vicinity of Kossi River were shown to be one of the most favourable sites for Anopheles production. Similar conditions prevail in the South of the study region, where clayey soils and higher precipitations benefit the occurrence of surface water. Besides pools, which are often directly detectable, rice fields and occasionally flooded crops represent most appropriate habitats. On the other hand, forests, elevated regions on porous soils, grasslands and the dryer, sandy soils in the north-western part turned out to deliver fewer mosquito breeding opportunities.

    Conclusions: Potential high and low risks for malaria at the village level can be differentiated from satellite data. While much remains to be done in terms of establishing correlations between remotely sensed risks and malaria disease patterns, this is a potentially useful approach which could lead to more focused disease control programmes.

  • 61.
    D'Ambruoso, Lucia
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Relating the construction and maintenance of maternal ill-health in rural Indonesia2012In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 5, p. 17989-Article, review/survey (Refereed)
    Abstract [en]

    Estimates suggest that over 350,000 deaths and more than 20 million severe disabilities result from the complications of pregnancy, childbirth or its management each year. Death and disability occur predominately among disadvantaged women in resource-poor settings and are largely preventable with adequate delivery care. This paper presents the substantive findings and policy implications from a programme of PhD research, of which the overarching objective was to assess quality of, and access to, care in obstetric emergencies. Three critical incident audits were conducted in two rural districts on Java, Indonesia: a confidential enquiry, a verbal autopsy survey, and a community-based review. The studies examined cases of maternal mortality and severe morbidity from the perspectives of local service users and health providers. A range of inter-related determining factors was identified. When unexpected delivery complications occurred, women and families were often uninformed, unprepared, found care unavailable, unaffordable, and many relied on traditional providers. Midwives in villages made important contributions by stabilising women and facilitating referrals but were often scarce in remote areas and lacked sufficient clinical competencies and payment incentives to treat the poor. Emergency transport was often unavailable and private transport was unreliable and incurred costs. In facilities, there was a reluctance to admit poorer women and those accepted were often admitted to ill-equipped, under-staffed wards. As a result, referrals between hospitals were also common. Otherwise, social health insurance, designed to reduce financial barriers, was particularly problematic, constraining quality and access within and outside facilities. Health workers and service users provided rich and explicit assessments of care and outcomes. These were used to develop a conceptual model in which quality and access are conceived of as social processes, observable through experience and reflective of the broader relationships between individuals and health systems. According to this model, differential quality and access can become both socially legitimate (imposed by structural arrangements) and socially legitimised (reciprocally maintained through the actions of individuals). This interpretation suggests that in a context of commodified care provision, adverse obstetric outcomes will occur and recur for disadvantaged women. Health system reform should focus on the unintended effects of market-based service provision to exclude those without the ability to pay for delivery care directly.

  • 62.
    D'Ambruoso, Lucia
    et al.
    Immpact, University of Aberdeen, UK.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. University of Aberdeen, Dept Publ Hlth, Aberdeen, UK.
    Qomariyan, Siti Nurul
    Univ Indonesia, Fac Publ Hlth, Ctr Family Welf, W Java, Indonesia.
    Can the right to health inform public health planning in developing countries?: A case study for maternal healthcare from Indonesia2008In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 1, p. 10-Article in journal (Refereed)
    Abstract [en]

    Background: Maternal mortality remains unacceptably high in developing countries despite international advocacy, development targets, and simple, affordable and effective interventions. Human rights are powerful advocacy tools, which have become prominent in health and development. In recent years, regard for maternal mortality as a human rights issue as well as one that pertains to health, has emerged.

    Objective: We study a case of maternal death using a theoretical framework derived from the right to health to examine access to and quality of maternal healthcare. Our objective was to explore the potential of rights-based frameworks to inform public health planning from a human rights perspective.

    Design: Information was elicited as part of a verbal autopsy survey investigating maternal deaths in rural settings in Indonesia. The deceased's relatives were interviewed to collect information on medical signs, symptoms and the social, cultural and health systems circumstances surrounding the death.

    Results: In this case, a prolonged, severe fever and a complicated series of referrals culminated in the death of a 19-year-old primagravida at 7 months gestation. The cause of death was acute infection. The woman encountered a range of barriers to access; behavioural, socio-cultural, geographic and economic. Several serious health system failures were also apparent.. The theoretical framework derived from the right to health identified that none of the essential elements of the right were upheld.

    Conclusion: The rights-based approach could identify how and where to improve services. However, there are fundamental and inherent conflicts between the public health tradition (collective and preventative) and the right to health (individualistic and curative). As a result, and in practice, the right to health is likely to be ineffective for public health planning from a human rights perspective. Collective rights such as the right to development may provide a more suitable means to achieve equity and social justice in health planning.

  • 63.
    Dapi, Léonie N
    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.
    Nguefack-Tsague, Georges
    Tetanye, Ekoe
    Kjellström, Tord
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Heat impact on schoolchildren in Cameroon, Africa: potential health threat from climate change2010In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 3, p. Article nr 5610-Article in journal (Refereed)
    Abstract [en]

    Background: Health impacts related to climate change are potentially an increasing problem in Cameroon, especially during hot seasons when there are no means for protective and adaptive actions.

    Objective: To describe environmental conditions in schools and to evaluate the impact of heat on schoolchildren’s health during school days in the Cameroon cities of Yaounde´ and Douala.

    Methods: Schoolchildren (N=285) aged 12=16 years from public secondary schools completed a questionnaire about their background, general symptoms, and hot feelings in a cross-sectional study. In Yaounde´, 50 schoolchildren were individually interviewed during school days about hourly symptoms (fatigue, headache, and feeling very hot) and performance. Lascar dataloggers were used to measure indoor classroom temperatures and humidity.

    Results: There was a significant correlation between daily indoor temperature and the percentages of schoolchildren who felt very hot, had fatigue, and headaches in Yaounde´. A high proportion of schoolchildren felt very hot (48%), had fatigue (76%), and headaches (38%) in Yaounde´. Prevalences (%) were higher among girls than boys for headaches (58 vs 39), feeling ‘very hot overall’ (37 vs 21), and ‘very hot in head’ (21 vs 18). Up to 62% were absentminded and 45% had slow writing speed. High indoor temperatures of 32.58C in Yaounde´ and 36.68C in Douala were observed in school.

    Conclusions: Headache, fatigue, and feeling very hot associated with high indoor air temperature were observed among schoolchildren in the present study. Longitudinal data in schools are needed to confirm these results. School environmental conditions should be improved in order to enhance learning.

  • 64.
    Dapi Nzefa, Leonie
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Rocklöv, Joacim
    Nguefack-Tsague, Georges
    Tetanye, Ekoe
    Kjellstrom, Tord
    Heat impact on schoolchildren in Cameroon, Africa: potential health threat from climate change.2010In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 3Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Health impacts related to climate change are potentially an increasing problem in Cameroon, especially during hot seasons when there are no means for protective and adaptive actions.

    OBJECTIVE: To describe environmental conditions in schools and to evaluate the impact of heat on schoolchildren's health during school days in the Cameroon cities of Yaoundé and Douala.

    METHODS: Schoolchildren (N = 285) aged 12-16 years from public secondary schools completed a questionnaire about their background, general symptoms, and hot feelings in a cross-sectional study. In Yaoundé, 50 schoolchildren were individually interviewed during school days about hourly symptoms (fatigue, headache, and feeling very hot) and performance. Lascar dataloggers were used to measure indoor classroom temperatures and humidity.

    RESULTS: There was a significant correlation between daily indoor temperature and the percentages of schoolchildren who felt very hot, had fatigue, and headaches in Yaoundé. A high proportion of schoolchildren felt very hot (48%), had fatigue (76%), and headaches (38%) in Yaoundé. Prevalences (%) were higher among girls than boys for headaches (58 vs 39), feeling 'very hot overall' (37 vs 21), and 'very hot in head' (21 vs 18). Up to 62% were absentminded and 45% had slow writing speed. High indoor temperatures of 32.5°C in Yaoundé and 36.6°C in Douala were observed in school.

    CONCLUSIONS: Headache, fatigue, and feeling very hot associated with high indoor air temperature were observed among schoolchildren in the present study. Longitudinal data in schools are needed to confirm these results. School environmental conditions should be improved in order to enhance learning.

  • 65.
    Darj, Elisabeth
    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). Norwegian Univ Sci & Technol, NTNU, Dept Publ Hlth & Nursing, Trondheim, Norway.;St Olavs Hosp, Dept Obstet & Gynecol, Trondheim, Norway..
    Wijewardena, Kumudu
    Univ Sri Jayewardenepura, Dept Community Med Hlth, Colombo, Sri Lanka..
    Lindmark, Gunilla
    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).
    Axemo, Pia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    'Even though a man takes the major role, he has no right to abuse': future male leaders' views on gender-based violence in Sri Lanka2017In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, no 1, article id 1348692Article in journal (Refereed)
    Abstract [en]

    Background: Distinct gender roles influence gender inequality and build the foundation for gender-based violence. Violence against women is a major public health problem in all societies, and a violation of human rights. Prevalence surveys on gender-based violence have been published from Sri Lanka, but qualitative studies on men's perceptions are lacking. Objectives: The aim of this study was to explore young educated Sri Lankan men's perceptions of violence against women. Methods: Seven focus-group discussions were held. Men at the end of their university studies were purposefully selected. A topic guide was used, covering various scenarios of violence against women. Qualitative content analysis was carried out. Results: Four categories were developed through the analytic process: fixed gender roles patriarchal values are accepted in society, female mobility control, and slowly changing attitudes; violence not accepted but still exists - sexual harassment exists everywhere, different laws for different people, female tolerance of violence, and men's right to punish; multiple factors cause violence - alcohol, violent behavior is inherited, violence culturally accepted, low education, and lack of communication; and prevention of violence against women - both parents must engage and socialize girls and boys equally, life skills education, premarital counselling, working places value clarification, and more women in politics and boards are suggested. Conclusions: Medical and management students, possible future male leaders of the country, have suggestions of prevention strategies in life skills to reduce gender-based violence and to increase knowledge of health consequences with the aim of changing attitudes.

  • 66. de Savigny, Don
    et al.
    Riley, Ian
    Chandramohan, Daniel
    Odhiambo, Frank
    Nichols, Erin
    Notzon, Sam
    AbouZahr, Carla
    Mitra, Raj
    Munoz, Daniel Cobos
    Firth, Sonja
    Maire, Nicolas
    Sankoh, Osman
    Bronson, Gay
    Setel, Philip
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. WHO Collaborating Centre for Verbal Autopsy; MRC-Wits Rural Public Health and Health Transitions Unit (Agincourt), School of Public Health, University of Witwatersrand, Johannesburg, South Africa.
    Jakob, Robert
    Boerma, Ties
    Lopez, Alan D.
    Integrating community-based verbal autopsy into civil registration and vital statistics (CRVS): system-level considerations2017In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, article id 1272882Article in journal (Refereed)
    Abstract [en]

    Background: Reliable and representative cause of death (COD) statistics are essential to inform public health policy, respond to emerging health needs, and document progress towards Sustainable Development Goals. However, less than one-third of deaths worldwide are assigned a cause. Civil registration and vital statistics (CRVS) systems in low-and lowermiddle-income countries are failing to provide timely, complete and accurate vital statistics, and it will still be some time before they can provide physician-certified COD for every death.

    Proposals: Verbal autopsy (VA) is a method to ascertain the probable COD and, although imperfect, it is the best alternative in the absence of medical certification. There is extensive experience with VA in research settings but only a few examples of its use on a large scale. Data collection using electronic questionnaires on mobile devices and computer algorithms to analyse responses and estimate probable COD have increased the potential for VA to be routinely applied in CRVS systems. However, a number of CRVS and health system integration issues should be considered in planning, piloting and implementing a system-wide intervention such as VA. These include addressing the multiplicity of stakeholders and sub-systems involved, integration with existing CRVS work processes and information flows, linking VA results to civil registration records, information technology requirements and data quality assurance.

    Conclusions: Integrating VA within CRVS systems is not simply a technical undertaking. It will have profound system-wide effects that should be carefully considered when planning for an effective implementation. This paper identifies and discusses the major system-level issues and emerging practices, provides a planning checklist of system-level considerations and proposes an overview for how VA can be integrated into routine CRVS systems.

  • 67.
    Degerstedt, Frida
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Wiklund, Maria
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Enberg, Birgit
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Physiotherapeutic interventions and physical activity for children in Northern Sweden with cerebral palsy: a register study from equity and gender perspectives2017In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, article id 1272236Article in journal (Refereed)
    Abstract [en]

    Background: Young people with disabilities, especially physical disabilities, report worse health than others. This may be because of the disability, lower levels of physical activity, and discrimination. For children with cerebral palsy, access to physiotherapy and physical activity is a crucial prerequisite for good health and function. To date, there is limited knowledge regarding potential gender bias and inequity in habilitation services.

    Objectives: To map how physiotherapeutic interventions (PTI), physical leisure activity, and physical education are allocated for children with cerebral palsy regarding sex, age, level of gross motor function, and county council affiliation. This was done from a gender and equity perspective.

    Methods: A register study using data from the Cerebral Palsy follow-Up Program (CPUP). Data included 313 children ≤18 years with cerebral palsy from the five northern counties in Sweden during 2013. Motor impairment of the children was classified according to the expanded and revised Gross Motor Function Classification System (GMFCS).

    Results: In three county councils, boys received more physiotherapy interventions and received them more frequently than girls did. Differences between county councils were seen for frequency and reasons for physiotherapy interventions (p < 0.001). The physiotherapist was involved more often with children who had lower motor function and with children who had low physical leisure activity. Children with lower motor function level participated in physical leisure activity less often than children with less motor impairment (p < 0.001). Boys participated more frequently in physical education than did girls (p = 0.028).

    Conclusion: Gender and county council affiliation affect the distribution of physiotherapy interventions for children with cerebral palsy, and there are associations between gender and physical activity. Thus, the intervention is not always determined by the needs of the child or the degree of impairment. A gender-bias is indicated. Further studies are needed to ensure fair interventions.

  • 68.
    Dewi, Fatwa Sari Tetra
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Stenlund, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Öhman, Ann
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hakimi, Mohammad
    Center for Health and Nutrition Research Laboratory, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia.
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Mobilising a disadvantaged community for a cardiovascular intervention: designing PRORIVA in Yogyakarta, Indonesia2010In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 3, p. 4661-Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Cardiovascular disease (CVD) is a burden for developing countries, yet few CVD intervention studies have been conducted in developing countries such as Indonesia. This paper outlines the process of designing a community intervention programme to reduce CVD risk factors, and discusses experiences with regard to design issues for a small-scale intervention.

    DESIGN PROCESS: THE DESIGN PROCESS FOR THE PRESENT COMMUNITY INTERVENTION CONSISTED OF SIX STAGES: (1) a baseline risk factor survey, (2) design of a small-scale intervention by using both baseline survey and qualitative data, (3) implementation of the small-scale intervention, (4) evaluation of the small-scale intervention and design of a broader CVD intervention in the Yogyakarta municipality, (5) implementation of the broader intervention and (6) evaluation of the broader CVD intervention. According to the baseline survey, 60% of the men were smokers, more than 30% of the population had insufficient fruit and vegetable intake and more than 30% of the population were physically inactive, this is why a small-scale population intervention approach was chosen, guided both by the findings in the quantitative and the qualitative study.

    EXPERIENCES: A quasi-experimental study was designed with a control group and pre- and post-testing. In the small-scale intervention, two sub-districts were selected and randomly assigned as intervention and control areas. Within them, six intervention settings (two sub-villages, two schools and two workplaces) and three control settings (a sub-village, a school and a workplace) were selected. Health promotion activities targeting the whole community were implemented in the intervention area. During the evaluation, more activities were performed in the low socioeconomic status sub-village and at the civil workplace.

  • 69.
    Dewi, Fatwa Sari Tetra
    et al.
    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.
    Öhman, Ann
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    'Maintaining balance and harmony': Javanese perceptions of health and cardiovascular disease2010In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 3Article in journal (Refereed)
    Abstract [en]

    Community intervention programmes to reduce cardiovascular disease (CVD) risk factors within urban communities in developing countries are rare. One possible explanation is the difficulty of designing an intervention that corresponds to the local context and culture.

    Objectives: To understand people’s perceptions of health and CVD, and how people prevent CVD in an urban setting in Yogyakarta, Indonesia.

    Methods: A qualitative study was performed through focus group discussions and individual research interviews. Participants were selected purposively in terms of socio-economic status (SES), lay people, community leaders and government officers. Data were analysed by using content analysis.

    Results: Seven categories were identified: (1) heart disease is dangerous, (2) the cause of heart disease, (3) men have no time for health, (4) women are caretakers for health, (5) different information-seeking patterns, (6) the role of community leaders and (7) patterns of lay people’s action. Each category consists of sub-categories according to the SES of participants. The main theme that emerged was one of balance and harmony, indicating the necessity of assuring a balance between ‘good’ and ‘bad’ habits.

    Conclusions: The basic concepts of balance and harmony, which differ between low and high SES groups, must be understood when tailoring community interventions to reduce CVD risk factors. The basic concepts of balance and harmony, which differ between low and high SES groups, must be understood when tailoring community interventions to reduce CVD risk factors.

  • 70.
    Deyessa Kabeta, Negussie
    et al.
    School of Public Health, Addis Ababa University, Ethiopia .
    Berhane, Yemane
    Addis Continental Institute of Public Health, Ethiopia .
    Ellsberg, Mary
    International Center for Research on Women, Washington DC, United States .
    Emmelin, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Högberg, Ulf
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Violence against women in relation to literacy and area of residence2010In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 3, no 2070Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: This study explores violence against women in a low-income setting in relation to residency and literacy. SETTING: The study was conducted within the Butajira Rural Health Programme (a Health and Demographic Surveillance Site), which includes rural and semi-urban settings in south-central Ethiopia. DESIGN: This is a community-based cross-sectional study and is part of the WHO Women's Health and Life Events multi-country study. It included 1,994 randomly selected married women. METHODS: A standardised WHO questionnaire was used to measure physical violence, residency, literacy of the woman and her spouse, and attitudes of women about gender roles and violence. Analyses present prevalence with 95% confidence intervals and odds ratios derived from bivariate and multivariate logistic regression models. RESULTS: In urban and rural areas of the study area, the women were of varying ages, had varying levels of literacy and had spouses with varying levels of literacy. Women in the overall study area had beliefs and norms favouring violence against women, and women living in rural communities and illiterate women were more likely to accept such attitudes. In general, violence against women was more prevalent in rural communities. In particular, violence against rural literate women and rural women who married a literate spouse was more prevalent. Literate rural women who were married to an illiterate spouse had the highest odds (Adj. OR = 3.4; 95% CI: 1.7-6.9) of experiencing physical violence by an intimate partner. CONCLUSION: Semi-urban lifestyle and literacy promote changes in attitudes and norms against intimate partner violence; however, within the rural lifestyle, literate women married to illiterate husbands were exposed to the highest risks of violence.

  • 71.
    Deyessa, Negussie
    et al.
    School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
    Berhane, Yemane
    School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
    Ellsberg, Mary
    Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Emmelin, Maria
    Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Kullgren, Gunnar
    Psychiatry, Department of Clinical Science, Umeå University, Umeå, Sweden.
    Högberg, Ulf
    Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Violence against women in relation to literacy and area of residence in Ethiopia.2010In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 3, no 2070Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: This study explores violence against women in a low-income setting in relation to residency and literacy.

    SETTING: The study was conducted within the Butajira Rural Health Programme (a Health and Demographic Surveillance Site), which includes rural and semi-urban settings in south-central Ethiopia.

    DESIGN: This is a community-based cross-sectional study and is part of the WHO Women's Health and Life Events multi-country study. It included 1,994 randomly selected married women.

    METHODS: A standardised WHO questionnaire was used to measure physical violence, residency, literacy of the woman and her spouse, and attitudes of women about gender roles and violence. Analyses present prevalence with 95% confidence intervals and odds ratios derived from bivariate and multivariate logistic regression models.

    RESULTS: In urban and rural areas of the study area, the women were of varying ages, had varying levels of literacy and had spouses with varying levels of literacy. Women in the overall study area had beliefs and norms favouring violence against women, and women living in rural communities and illiterate women were more likely to accept such attitudes. In general, violence against women was more prevalent in rural communities. In particular, violence against rural literate women and rural women who married a literate spouse was more prevalent. Literate rural women who were married to an illiterate spouse had the highest odds (Adj. OR = 3.4; 95% CI: 1.7-6.9) of experiencing physical violence by an intimate partner.

    CONCLUSION: Semi-urban lifestyle and literacy promote changes in attitudes and norms against intimate partner violence; however, within the rural lifestyle, literate women married to illiterate husbands were exposed to the highest risks of violence.

  • 72. Diboulo, Eric
    et al.
    Sie, Ali
    Rocklöv, Joacim
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Niamba, Louis
    Ye, Maurice
    Bagagnan, Cheik
    Sauerborn, Rainer
    Univ Heidelberg, Inst Publ Hlth, Heidelberg, Germany.
    Weather and mortality: a 10 year retrospective analysis of the Nouna Health and Demographic Surveillance System, Burkina Faso2012In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 5, p. 19078-Article in journal (Refereed)
    Abstract [en]

    Background: A growing body of evidence points to the emission of greenhouse gases from human activity as a key factor in climate change. This in turn affects human health and wellbeing through consequential changes in weather extremes. At present, little is known about the effects of weather on the health of sub-Saharan African populations, as well as the related anticipated effects of climate change partly due to scarcity of good quality data. We aimed to study the association between weather patterns and daily mortality in the Nouna Health and Demographic Surveillance System (HDSS) area during 1999-2009. Methods: Meteorological data were obtained from a nearby weather station in the Nouna HDSS area and linked to mortality data on a daily basis. Time series Poisson regression models were established to estimate the association between the lags of weather and daily population-level mortality, adjusting for time trends. The analyses were stratified by age and sex to study differential population susceptibility. Results: We found profound associations between higher temperature and daily mortality in the Nouna HDSS, Burkina Faso. The short-term direct heat effect was particularly strong on the under-five child mortality rate. We also found independent coherent effects and strong associations between rainfall events and daily mortality, particularly in elderly populations. Conclusion: Mortality patterns in the Nouna HDSS appear to be closely related to weather conditions. Further investigation on cause-specific mortality, as well as on vulnerability and susceptibility is required. Studies on local adaptation and mitigation measures to avoid health impacts from weather and climate change is also needed to reduce negative effects from weather and climate change on population health in rural areas of the sub-Saharan Africa.

  • 73.
    Do, Loan Minh
    et al.
    Outpatient Department, National Hospital of Paediatrics, Hanoi, Vietnam / Section for Epidemiology and Social Medicine (EPSO), Department of Public Health and Community Medicine, Institute of Medicine at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Larsson, Viveca
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Tran, Toan Khanh
    Family Medicine Department, Hanoi Medical University, Hanoi, Vietnam.
    Nguyen, Huong Thanh
    Faculty of Social Sciences, Behaviour and Health Education, Hanoi School of Public Health, Hanoi, Vietnam.
    Eriksson, Bo
    Health Metrics, Department of Public Health and Community Medicine, Institute of Medicine at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Ascher, Henry
    Section for Epidemiology and Social Medicine (EPSO), Department of Public Health and Community Medicine, Institute of Medicine at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden / Angered Hospital, Gothenburg, Sweden.
    Vietnamese mother's conceptions of childhood overweight: Findings from a qualitative study2016In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 9, article id 30215Article in journal (Refereed)
    Abstract [en]

    Background: Childhood overweight and obesity is a new and emerging problem in Vietnam. The so far observed prevalence increases have pointed to the need for public health intervention strategies with parents as crucial resources for change. Objective: The aim of this study was to understand mothers' conceptions of childhood overweight. Design: Four focus group discussions were conducted with a total of 33 mothers of preschool children, 4-6 years old, living in urban and rural districts of Hanoi, Vietnam. The discussions were audio taped and transcribed verbatim. The obtained data were analyzed using the principles of phenomenography. Results: Four main categories with 13 subcategories emerged in the process of analysis. The first category, called 'Concept of overweight', contained mothers' views on childhood overweight. A major concern was the negative aspects of overweight such as impaired social interaction and health problems. The second category, 'Identification of overweight', described the ways mothers use to recognize overweight in children: own experience, growth chart, and public or health care system's information. The third category, 'Causes of overweight', showed mothers' understanding of factors possibly contributing to overweight development: unhealthy food and lifestyle, genetic susceptibility, parent's lack of knowledge, and limited time to take care of children as well as economic improvement. The fourth category, 'Management of overweight', described the ways mothers use to manage a child's weight problem: control of their food intake, increasing their physical activity, and encouraging their child self-control. However, they find such strategies difficult to implement and their intentions are sometimes challenged by the child's grandparents. Conclusions: The study gives an understanding of the mothers' conceptions of four important and practically useful aspects of overweight in children. The findings highlight the roles of media and the health care system in enhancing a social awareness of the problem and the need for prevention. Growth charts need to be used more regularly and consciously in child health care for early detection of children at risk and as a tool for information to parents. When designing intervention programs, the entire extended families, especially grandparents and their roles, need to be considered.

  • 74.
    Duc, Duong M.
    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). Hanoi Sch Publ Hlth, Fac Social Sci Behav & Hlth Educ, 138 Giang Vo St, Hanoi, Vietnam.
    Bergström, Anna
    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). UCL, Inst Global Hlth, London, England..
    Eriksson, Leif
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Selling, Katarina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Ha, Bui Thi Thu
    Faculty of Social Science - Behaviours and Health Education, Hanoi School of Public Health, Hanoi, Vietnam.
    Wallin, Lars
    Dalarna Univ, Sch Educ Hlth & Social Studies, Falun, Sweden.;Karolinska Inst, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden..
    Response process and test-retest reliability of the Context Assessment for Community Health tool in Vietnam2016In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 9, article id 31572Article in journal (Refereed)
    Abstract [en]

    Background: The recently developed Context Assessment for Community Health (COACH) tool aims to measure aspects of the local healthcare context perceived to influence knowledge translation in low-and middle-income countries. The tool measures eight dimensions (organizational resources, community engagement, monitoring services for action, sources of knowledge, commitment to work, work culture, leadership, and informal payment) through 49 items. Objective: The study aimed to explore the understanding and stability of the COACH tool among health providers in Vietnam. Designs: To investigate the response process, think-aloud interviews were undertaken with five community health workers, six nurses and midwives, and five physicians. Identified problems were classified according to Conrad and Blair's taxonomy and grouped according to an estimation of the magnitude of the problem's effect on the response data. Further, the stability of the tool was examined using a test-retest survey among 77 respondents. The reliability was analyzed for items (intraclass correlation coefficient (ICC) and percent agreement) and dimensions (ICC and Bland-Altman plots). Results: In general, the think-aloud interviews revealed that the COACH tool was perceived as clear, well organized, and easy to answer. Most items were understood as intended. However, seven prominent problems in the items were identified and the content of three dimensions was perceived to be of a sensitive nature. In the test-retest survey, two-thirds of the items and seven of eight dimensions were found to have an ICC agreement ranging from moderate to substantial (0.5-0.7), demonstrating that the instrument has an acceptable level of stability. Conclusions: This study provides evidence that the Vietnamese translation of the COACH tool is generally perceived to be clear and easy to understand and has acceptable stability. There is, however, a need to rephrase and add generic examples to clarify some items and to further review items with low ICC.

  • 75. Duc, Duong M
    et al.
    Bergström, Anna
    Eriksson, Leif
    Selling, Katarina
    Thi Thu Ha, Bui
    Wallin, Lars
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska institutet.
    Response process and test-retest reliability of the Context Assessment for Community Health tool in Vietnam2016In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 9, article id 31572Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The recently developed Context Assessment for Community Health (COACH) tool aims to measure aspects of the local healthcare context perceived to influence knowledge translation in low- and middle-income countries. The tool measures eight dimensions (organizational resources, community engagement, monitoring services for action, sources of knowledge, commitment to work, work culture, leadership, and informal payment) through 49 items.

    OBJECTIVE: The study aimed to explore the understanding and stability of the COACH tool among health providers in Vietnam.

    DESIGNS: To investigate the response process, think-aloud interviews were undertaken with five community health workers, six nurses and midwives, and five physicians. Identified problems were classified according to Conrad and Blair's taxonomy and grouped according to an estimation of the magnitude of the problem's effect on the response data. Further, the stability of the tool was examined using a test-retest survey among 77 respondents. The reliability was analyzed for items (intraclass correlation coefficient (ICC) and percent agreement) and dimensions (ICC and Bland-Altman plots).

    RESULTS: In general, the think-aloud interviews revealed that the COACH tool was perceived as clear, well organized, and easy to answer. Most items were understood as intended. However, seven prominent problems in the items were identified and the content of three dimensions was perceived to be of a sensitive nature. In the test-retest survey, two-thirds of the items and seven of eight dimensions were found to have an ICC agreement ranging from moderate to substantial (0.5-0.7), demonstrating that the instrument has an acceptable level of stability.

    CONCLUSIONS: This study provides evidence that the Vietnamese translation of the COACH tool is generally perceived to be clear and easy to understand and has acceptable stability. There is, however, a need to rephrase and add generic examples to clarify some items and to further review items with low ICC.

  • 76.
    Ebi, Kristie L
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå Centre for Global Health Research.
    Rocklöv, Joacim
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå Centre for Global Health Research.
    Climate change and health modeling: horses for courses2014In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, p. 24154-Article in journal (Refereed)
    Abstract [en]

    Mathematical and statistical models are needed to understand the extent to which weather, climate variability, and climate change are affecting current and may affect future health burdens in the context of other risk factors and a range of possible development pathways, and the temporal and spatial patterns of any changes. Such understanding is needed to guide the design and the implementation of adaptation and mitigation measures. Because each model projection captures only a narrow range of possible futures, and because models serve different purposes, multiple models are needed for each health outcome ('horses for courses'). Multiple modeling results can be used to bracket the ranges of when, where, and with what intensity negative health consequences could arise. This commentary explores some climate change and health modeling issues, particularly modeling exposure-response relationships, developing early warning systems, projecting health risks over coming decades, and modeling to inform decision-making. Research needs are also suggested.

  • 77.
    Edin, Kerstin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS). Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Nilsson, Bo
    Umeå University, Faculty of Arts, Department of culture and media studies. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Between desire and rape - narratives about being intimate partners and becoming pregnant in a violent relationship2013In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 6, p. 20984-Article in journal (Refereed)
    Abstract [en]

    Background: Women subjected to intimate partner violence (IPV) experience different forms of abuse. Sexual violence is often under-reported because physically abused women, in particular, might see forced sex as an obligatory part of the sexual interplay. Accordingly, abused women have less sexual autonomy and experience unplanned pregnancies more often than other women. Objective: To describe and analyse nine Swedish women's retrospective stories about IPV with a focus on power and coping strategies as intimate partners, particularly regarding experiences of sex, contraception, and becoming pregnant. Design: Nine qualitative interviews were carried out with women who had been subjected to very severe violence in their intimate relationships and during at least one pregnancy. The stories were analysed using 'Narrative method' with the emphasis on the women's lived experiences. Results: Despite the violence and many contradictory and ambivalent feelings, two of the women described having sex as desirable, reciprocal and as a respite from the rest of the relationship. The other seven women gave a negative and totally different picture, and they viewed sex either as obligatory or as a necessity to prevent or soothe aggression or referred to it as rape and as something that was physically forced upon them. The women's descriptions of their pregnancies ranged from being carefully planned and mostly wanted to completely unwelcome and including flawed contraceptive efforts with subsequent abortions. Conclusions: Women subjected to IPV have diverse and complex experiences that have effects on all parts of the relationship. Intimacy might for some turn into force and rape, but for others sex does not necessarily exclude pleasure and desire and can be a haven of rest from an otherwise violent relationship. Accordingly, women may tell stories that differ from the ones expected as 'the typical abuse story', and this complexity needs to be recognized and dealt with when women seek healthcare, especially concerning contraceptives, abortions, and pregnancies.

  • 78.
    Edvardsson, Kristina
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Graner, Sophie
    Thi, Lan Pham
    Åhman, Annika
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Small, Rhonda
    Lalos, Ann
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Mogren, Ingrid
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    'Women think pregnancy management means obstetric ultrasound': Vietnamese obstetricians' views on the use of ultrasound during pregnancy2015In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 8, p. 1-10, article id 28405Article in journal (Refereed)
    Abstract [en]

    Objective: To explore Vietnamese obstetricians' experiences and views on the role of obstetric ultrasound in clinical management of complicated pregnancy and in situations where maternal and fetal health interests conflict. Design: Seventeen obstetricians in northern Vietnam were interviewed as part of the CROss-Country Ultrasound Study (CROCUS) project in 2013. Data were analysed using qualitative content analysis. Results: The participants described ultrasound as a central tool in prenatal care, although they called for increased training and resources to prevent inappropriate management. A prevailing overuse driven by women's request and increased commercialisation was described. Other clinical examinations were seen as being disregarded by women in favour of ultrasound, resulting in missed opportunities for identifying potential pregnancy complications. The use of ultrasound for sex selection purposes raised concern among participants. Visualisation of human features or heartbeat during ultrasound was commonly described as the point where the fetus became regarded as a 'person'. Women were said to prioritise fetal health interests over their own health, particularly if a woman had difficulties becoming pregnant or had undergone assisted fertilisation. The woman's husband and his family were described as having an important role in decision-making in situations of maternal and fetal health conflicts. Conclusions: This study provides insight into issues surrounding ultrasound use in contemporary Vietnam, some of which may be specific to this low-income context. It is clear that ultrasound has become a central tool in prenatal care in Vietnam and that it has also been embraced by women. However, there seems to be a need to balance women's demands for obstetric ultrasound with better recognition of the valuable contribution to be made by the full range of clinical examinations in pregnancy, along with a more strategic allocation of resources, that is, use of obstetric ultrasound based on clinical indications. Better regulation of private obstetric practice also appears to be needed. While the root causes of sex selection need to be addressed at societal level, efforts are also required more immediately to find ways to combat the inappropriate use of ultrasound for the purpose of sex selection.

  • 79.
    Edvinsson, Sören
    et al.
    Umeå University, Faculty of Social Sciences, Centre for Population Studies (CPS).
    Häggström Lundevaller, Erling
    Umeå University, Faculty of Social Sciences, Department of Statistics.
    Malmberg, Gunnar
    Umeå University, Faculty of Social Sciences, Department of Geography and Economic History, Economic and social geography.
    Do unequal societies cause death among the elderly?: a study of the health effects of inequality in Swedish municipalities, 20062013In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 6, no 1, article id 19116Article in journal (Refereed)
    Abstract [en]

    Background: A lively public and academic debate has highlighted the potential health risk of living in regions and nations characterized by inequality. However, previous research provides an ambiguous picture, with positive association mainly having been found on higher geographical levels. One explanation for this could be that the effect of living in more heterogeneous social settings differs between levels of aggregation. 

    Methods: We examine the association between income inequality (using the Gini coefficient) and all-cause mortality in Swedish municipalities in the age group 65-74. A multi-level analysis is applied and we control for e.g. individual income and average income level in the unicipality. The analyses are based on individual register data on all residents born between 1932 and 1941, and outcomes are measured for the year 2006.

    Results: Lower individual income as well as lower average income level in the municipality of residence increased mortality significantly. We found an association between income inequality and mortality with excessive deaths in unequal municipalities even after controlling for mean income level and personal income. The results from the analysis of individual data differed substantially from analyses using aggregate data.

    Conclusions: Income inequality has a significant association with mortality in the age groups 65 to 75 at municipality level. The association is small compared to many other variables, but it is not negligible. Even in a comparatively equal society like Sweden, we need to consider possible effects of income inequality on mortality at the local level. 

  • 80.
    Egondi, Thaddaeus
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Kyobutungi, Catherine
    Kovats, Sari
    Muindi, Kanyiva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Ettarh, Remare
    Rocklöv, Joacim
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Time-series analysis of weather and mortality patterns in Nairobi's informal settlements2012In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 5, p. 23-32Article in journal (Refereed)
    Abstract [en]

    Background: Many studies have established a link between weather (primarily temperature) and daily mortality in developed countries. However, little is known about this relationship in urban populations in sub-Saharan Africa. Objectives: The objective of this study was to describe the relationship between daily weather and mortality in Nairobi, Kenya, and to evaluate this relationship with regard to cause of death, age, and sex. Methods: We utilized mortality data from the Nairobi Urban Health and Demographic Surveillance System and applied time-series models to study the relationship between daily weather and mortality for a population of approximately 60,000 during the period 2003-2008. We used a distributed lag approach to model the delayed effect of weather on mortality, stratified by cause of death, age, and sex. Results: Increasing temperatures (above 75th percentile) were significantly associated with mortality in children and non-communicable disease (NCD) deaths. We found all-cause mortality of shorter lag of same day and previous day to increase by 3.0% for a 1 degree decrease from the 25th percentile of 18 degrees C (not statistically significant). Mortality among people aged 50+ and children aged below 5 years appeared most susceptible to cold compared to other age groups. Rainfall, in the lag period of 0-29 days, increased all-cause mortality in general, but was found strongest related to mortality among females. Low temperatures were associated with deaths due to acute infections, whereas rainfall was associated with all-cause pneumonia and NCD deaths. Conclusions: Increases in mortality were associated with both hot and cold weather as well as rainfall in Nairobi, but the relationship differed with regard to age, sex, and cause of death. Our findings indicate that weather-related mortality is a public health concern for the population in the informal settlements of Nairobi, Kenya, especially if current trends in climate change continue.

  • 81. Ekirapa-Kiracho, Elizabeth
    et al.
    Kananura, Rornald Muhumuza
    Tetui, Moses
    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 School of Public Health, Kampala, Uganda.
    Namazzi, Gertrude
    Mutebi, Aloysius
    George, Asha
    Paina, Ligia
    Waiswa, Peter
    Bumba, Ahmed
    Mulekwa, Godfrey
    Nakiganda-Busiku, Dinah
    Lyagoba, Moses
    Naiga, Harriet
    Putan, Mary
    Kulwenza, Agatha
    Ajeani, Judith
    Kakaire-Kirunda, Ayub
    Makumbi, Fred
    Atuyambe, Lynn
    Okui, Olico
    Kiwanuka, Suzanne Namusoke
    Effect of a participatory multisectoral maternal and newborn intervention on maternal health service utilization and newborn care practices: a quasi-experimental study in three rural Ugandan districts2017In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, article id 1363506Article in journal (Refereed)
    Abstract [en]

    Background: The MANIFEST study in eastern Uganda employed a participatory multisectoral approach to reduce barriers to access to maternal and newborn care services.

    Objectives: This study analyses the effect of the intervention on the utilization of maternal and newborn services and care practices.

    Methods: The quasi-experimental pre- and post-comparison design had two main components: community mobilization and empowerment, and health provider capacity building. The primary outcomes were utilization of antenatal care (ANC), delivery and postnatal care, and newborn care practices. Baseline (n = 2237) and endline (n = 1946) data were collected from women of reproductive age. The data was analysed using difference in differences (DiD) analysis and logistic regression.

    Results: The DiD results revealed an 8% difference in early ANC attendance (p < 0.01) and facility delivery (p < 0.01). Facility delivery increased from 66% to 73% in the intervention area, but remained unchanged in the comparison area (64% vs 63%, p < 0.01). The DiD results also demonstrated a 20% difference in clean cord care (p < 0.001) and an 8% difference in delayed bathing (p < 0.001). The intervention elements that predicted facility delivery were attending ANC four times [adjusted odds ratio (aOR) 1.42, 95% confidence interval (CI) 1.171.74] and saving for maternal health (aOR 2.11, 95% CI 1.39-3.21). Facility delivery and village health team (VHT) home visits were key predictors for clean cord care and skin-to-skin care.

    Conclusions: The multisectoral approach had positive effects on early ANC attendance, facility deliveries and newborn care practices. Community resources such as VHTs and savings are crucial to maternal and newborn outcomes and should be supported. VHT-led health education should incorporate practical measures that enable families to save and access transport services to enhance adequate preparation for birth.

  • 82. Ekirapa-Kiracho, Elizabeth
    et al.
    Paina, Ligia
    Kananura, Rornald Muhumuza
    Mutebi, Aloysius
    Jane, Pacuto
    Tumuhairwe, Juliet
    Tetui, Moses
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Makerere University School of Public Health, Department of Health Policy Planning and Management, Kampala, Uganda.
    Kiwanuka, Suzanne N.
    'Nurture the sprouting bud; do not uproot it'. Using saving groups to save for maternal and newborn health: lessons from rural Eastern Uganda2017In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, article id 1347311Article in journal (Refereed)
    Abstract [en]

    Background: Saving groups are increasingly being used to save in many developing countries. However, there is limited literature about how they can be exploited to improve maternal and newborn health.

    Objectives: This paper describes saving practices, factors that encourage and constrain saving with saving groups, and lessons learnt while supporting communities to save through saving groups.

    Methods: This qualitative study was done in three districts in Eastern Uganda. Saving groups were identified and provided with support to enhance members' access to maternal and newborn health. Fifteen focus group discussions (FGDs) and 18 key informant interviews (KIIs) were conducted to elicit members' views about saving practices. Document review was undertaken to identify key lessons for supporting saving groups. Qualitative data are presented thematically.

    Results: Awareness of the importance of saving, safe custody of money saved, flexible saving arrangements and easy access to loans for personal needs including transport during obstetric emergencies increased willingness to save with saving groups. Saving groups therefore provided a safety net for the poor during emergencies. Poor management of saving groups and detrimental economic practices like gambling constrained saving. Efficient running of saving groups requires that they have a clear management structure, which is legally registered with relevant authorities and that it is governed by a constitution.

    Conclusions: Saving groups were considered a useful form of saving that enabled easy acess to cash for birth preparedness and transportation during emergencies. They are like 'a sprouting bud that needs to be nurtured rather than uprooted', as they appear to have the potential to act as a safety net for poor communities that have no health insurance. Local governments should therefore strengthen the management capacity of saving groups so as to ensure their efficient running through partnerships with non-governmental organizations that can provide support to such groups.

  • 83. Ekirapa-Kiracho, Elizabeth
    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), Department of Health Policy Planning and Management, Makerere University, Kampala, Uganda.
    Bua, John
    Kananura, Rornald Muhumuza
    Waiswa, Peter
    Makumbi, Fred
    Atuyambe, Lynn
    Ajeani, Judith
    George, Asha
    Mutebi, Aloysuis
    Kakaire, Ayub
    Namazzi, Gertrude
    Paina, Ligia
    Kiwanuka, Suzanne Namusoke
    Maternal and neonatal implementation for equitable systems: a study design paper2017In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, article id 1346925Article in journal (Refereed)
    Abstract [en]

    Background: Evidence on effective ways of improving maternal and neonatal health outcomes is widely available. The challenge that most low-income countries grapple with is implementation at scale and sustainability. Objectives: The study aimed at improving access to quality maternal and neonatal health services in a sustainable manner by using a participatory action research approach.

    Methods: The study consisted of a quasi-experimental design, with a participatory action research approach to implementation in three rural districts (Pallisa, Kibuku and Kamuli) in Eastern Uganda. The intervention had two main components; namely, community empowerment for comprehensive birth preparedness, and health provider and management capacity-building. We collected data using both quantitative and qualitative methods using household and facility-level structured surveys, record reviews, key informant interviews and focus group discussions. We purposively selected the participants for the qualitative data collection, while for the surveys we interviewed all eligible participants in the sampled households and health facilities. Descriptive statistics were used to describe the data, while the difference in difference analysis was used to measure the effect of the intervention. Qualitative data were analysed using thematic analysis.

    Conclusions: This study was implemented to generate evidence on how to increase access to quality maternal and newborn health services in a sustainable manner using a multisectoral participatory approach.

  • 84.
    Emmelin, Anders
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Fantahun, Mesganaw
    Berhane, Yemane
    Wall, Stig
    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.
    Vulnerability to episodes of extreme weather: Butajira, Ethiopia, 1998-19992009In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 2, p. 140-148Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: During 1999-2000, great parts of Ethiopia experienced a period of famine which was recognised internationally. The aim of this paper is to characterise the epidemiology of mortality of the period, making use of individual, longitudinal population-based data from the Butajira demographic surveillance site and rainfall data from a local site.

    METHODS: Vital statistics and household data were routinely collected in a cluster sample of 10 sub-communities in the Butajira district in central Ethiopia. These were supplemented by rainfall and agricultural data from the national reporting systems.

    RESULTS: Rainfall was high in 1998 and well below average in 1999 and 2000. In 1998, heavy rains continued from April into October, in 1999 the small rains failed and the big rains lasted into the harvesting period. For the years 1998-1999, the mortality rate was 24.5 per 1,000 person-years, compared with 10.2 in the remainder of the period 1997-2001. Mortality peaks reflect epidemics of malaria and diarrhoeal disease. During these peaks, mortality was significantly higher among the poorer.

    CONCLUSIONS: The analyses reveal a serious humanitarian crisis with the Butajira population during 1998-1999, which met the CDC guideline crisis definition of more than one death per 10,000 per day. No substantial humanitarian relief efforts were triggered, though from the results it seems likely that the poorest in the farming communities are as vulnerable as the pastoralists in the North and East of Ethiopia. Food insecurity and reliance on subsistence agriculture continue to be major issues in this and similar rural communities. Epidemics of traditional infectious diseases can still be devastating, given opportunities in nutritionally challenged populations with little access to health care.

  • 85.
    Eriksson, Malin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Social capital and health: implications for health promotion2011In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 4, p. 5611-Article in journal (Refereed)
    Abstract [en]

    This article is a review of the PhD Thesis of Malin Eriksson, entitled 'Social capital, health and community action - implications for health promotion.' The article presents a theoretical overview of social capital and its relation to health, reviews empirical findings of the links between social capital and (self-rated) health, and discusses the usefulness of social capital in health promotion interventions at individual and community levels. Social capital, conceptualized as an individual characteristic, can contribute to the field of health promotion by adding new knowledge on how social network interventions may best be designed to meet the needs of the target group. The distinction of different forms of social capital, i.e. bonding, bridging, and linking, can be useful in mapping the kinds of networks that are available and health-enhancing (or damaging) and for whom. Further, social capital can advance social network interventions by acknowledging the risk for unequal distribution of investments and returns from social network involvement. Social capital, conceptualized as characterizing whole communities, provides a useful framework for what constitutes health-supporting environments and guidance on how to achieve them. Mapping and mobilization of social capital in local communities may be one way of achieving community action for health promotion. Social capital is context-bound by necessity. Thus, from a global perspective, it cannot be used as a 'cookbook' on how to achieve supportive environments and community action smoothly. However, social capital can provide new ideas on the processes that influence human interactions, cooperation, and community action for health promotion in various contexts.

  • 86.
    Erlandsson, Kerstin
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Byrskog, Ulrika
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Osman, Fatumo
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Pedersen, Christina
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Hatakka, Mathias
    Dalarna University, School of Technology and Business Studies, Information Systems.
    Klingberg-Allvin, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Evaluating a model for the capacity building of midwifery eduators in Bangladesh through a blended, web-based master's programme2019In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 12, no 1, article id 1652022Article in journal (Refereed)
    Abstract [en]

    Background: While setting international standards for midwifery education has attracted considerable global attention, the education and training of midwifery educators has been relatively neglected, particularly in low-resource settings where capacity building is crucial. Objective: The aim of this study was to describe the expectations of midwifery educators in Bangladesh who took part in a blended web-based master's programme in SRHR and the extent to which these were realized after 12 months of part-time study. Methods: Both quantitative and qualitative methods have been used to collect data. A structured baseline questionnaire was distributed to all participants at the start of the first course (n = 30) and a second endpoint questionnaire was distributed after they (n = 29) had completed the core courses one year later. At the start of the first course, five focus group discussions (FGD) were held with the midwifery educators. Descriptive statistics and content analysis were used for the analyses. Results: Midwifery educators who took part in the study identified expectations that can be grouped into three distinct areas. They hoped to become more familiar with technology, anticipated they would learn pedagogical and other skills that would enable them to better support their students' learning and thought they might acquire skills to empower their students as human beings. Participants reported they realized these ambitions, attributing the master's programme with helping them take responsibility for their own teaching and learning, showing them how to enhance their students' learning and how to foster reflective and critical thinking among them. Conclusions: Midwifery educators have taken part in a creative learning environment which has developed their engagement in teaching and learning. They have done this using a blended learning model which combines online learning with face-to-face contact. This model can be scaled up in low resource and remote settings.

  • 87.
    Erlandsson, Kerstin
    et al.
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    Byrskog, Ulrika
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    Osman, Fatumo
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    Pedersen, Christina
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    Hatakka, Mathias
    Örebro University, Örebro University School of Business.
    Klingberg-Allvin, Marie
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    Evaluating a model for the capacity building of midwifery educators in Bangladesh through a blended, web-based master’s programme2019In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 12, no 1, article id 1652022Article in journal (Refereed)
    Abstract [en]

    Background: While setting international standards for midwifery education has attracted considerable global attention, the education and training of midwifery educators has been relatively neglected, particularly in low-resource settings where capacity building is crucial. Objective: The aim of this study was to describe the expectations of midwifery educators in Bangladesh who took part in a blended web-based master’s programme in SRHR and the extent to which these were realized after 12 months of part-time study.

    Methods: Both quantitative and qualitative methods have been used to collect data. A structured baseline questionnaire was distributed to all participants at the start of the first course (n = 30) and a second endpoint questionnaire was distributed after they (n = 29) had completed the core courses one year later. At the start of the first course, five focus group discussions (FGD) were held with the midwifery educators. Descriptive statistics and content analysis were used for the analyses.

    Results: Midwifery educators who took part in the study identified expectations that can be grouped into three distinct areas. They hoped to become more familiar with technology, anticipated they would learn pedagogical and other skills that would enable them to better support their students’ learning and thought they might acquire skills to empower their students as human beings. Participants reported they realized these ambitions, attributing the master’s programme with helping them take responsibility for their own teaching and learning, showing them how to enhance their students’ learning and how to foster reflective and critical thinking among them.

    Conclusions: Midwifery educators have taken part in a creative learning environment which has developed their engagement in teaching and learning. They have done this using a blended learning model which combines online learning with face-to-face contact. This model can be scaled up in low resource and remote settings.

  • 88.
    Evander, Magnus
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Virology.
    Ahlm, Clas
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Milder winters in northern Scandinavia may contribute to larger outbreaks of haemorrhagic fever virus2009In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 2Article in journal (Refereed)
    Abstract [en]

    The spread of zoonotic infectious diseases may increase due to climate factors such as temperature, humidity and precipitation. This is also true for hantaviruses, which are globally spread haemorrhagic fever viruses carried by rodents. Hantaviruses are frequently transmitted to humans all over the world and regarded as emerging viral diseases. Climate variations affect the rodent reservoir populations and rodent population peaks coincide with increased number of human cases of hantavirus infections. In northern Sweden, a form of haemorrhagic fever called nephropathia epidemica (NE), caused by the Puumala hantavirus (PUUV) is endemic and during 2006-2007 an unexpected, sudden and large outbreak of NE occurred in this region. The incidence was 313 cases/100,000 inhabitants in the most endemic areas, and from January through March 2007 the outbreak had a dramatic and sudden start with 474 cases in the endemic region alone. The PUUV rodent reservoir is bank voles and immediately before and during the peak of disease outbreak the affected regions experienced extreme climate conditions with a record-breaking warm winter, registering temperatures 6-9 degrees C above normal. No protective snow cover was present before the outbreak and more bank voles than normal came in contact with humans inside or in close to human dwellings. These extreme climate conditions most probably affected the rodent reservoir and are important factors for the severity of the outbreak.

  • 89.
    Evengard, Birgitta
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    McMichael, Anthony
    Australian Natl Univ, Canberra, ACT, Australia.
    Vulnerable populations in the Arctic2011In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 4, p. 11210-Article in journal (Refereed)
  • 90.
    Evengård, Birgitta
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Berner, Jim
    Brubaker, Michael
    Mulvad, Gert
    Revich, Boris
    Climate change and water security with a focus on the Arctic2011In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 4, p. 8449-Article in journal (Refereed)
    Abstract [en]

    Water is of fundamental importance for human life; access to water of good quality is of vital concern for mankind. Currently however, the situation is under severe pressure due to several stressors that have a clear impact on access to water. In the Arctic, climate change is having an impact on water availability by melting glaciers, decreasing seasonal rates of precipitation, increasing evapotranspiration, and drying lakes and rivers existing in permafrost grounds. Water quality is also being impacted as manmade pollutants stored in the environment are released, lowland areas are flooded with salty ocean water during storms, turbidity from permafrost-driven thaw and erosion is increased, and the growth or emergence of natural pollutants are increased. By 2030 it is estimated that the world will need to produce 50% more food and energy which means a continuous increase in demand for water. Decisionmakers will have to very clearly include life quality aspects of future generations in the work as impact of ongoing changes will be noticeable, in many cases, in the future. This article will focus on effects of climate-change on water security with an Arctic perspective giving some examples from different countries how arising problems are being addressed.

  • 91.
    Evengård, Birgitta
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Sauerborn, Rainer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Climate change influences infectious diseases both in the Arctic and the tropics: joining the dots2009In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 2Article in journal (Refereed)
    Abstract [en]

    Climate change is incontestably a phenomenon of global causes and impacts. However, as much as the contribution of different regions and countries to climate change differs, as much differ the impacts. This paper examines the current and potential impact of climate change on infectious diseases in regions that could not be more different: the Arctic and the tropics (The Arctic is the area north of the Arctic Circle (66.6°N), while the tropics lie between the Tropic of Cancer (23.4°N) and the Tropic of Capricorn (23.4°S)). Despite obvious differences in environmental and socio-economic contexts, there are commonalities between these areas, both in the mechanisms through which climate change influences disease transmission and in the adaptation responses health systems can and should mount. We hope that the lessons in this comparison can be distilled both by policy makers and researchers in both regions. The purpose of this article is ‘to join the dots’ and thus stimulate discussion. Inevitably, the different dots (issues) themselves cannot be elaborated on in detail here. For this, we refer the interested reader to a wide-ranging list of references.

  • 92.
    Fernbrant, Cecilia
    et al.
    Department of Clinical Sciences Malmö, Social Medicine and Global Health, Lund University, Sweden.
    Emmelin, Maria
    Department of Clinical Sciences Malmö, Social Medicine and Global Health, Lund University, Sweden.
    Essén, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Ostergren, Per-Olof
    Department of Clinical Sciences Malmö, Social Medicine and Global Health, Lund University, Sweden.
    Cantor-Graae, Elizabeth
    Department of Clinical Sciences Malmö, Social Medicine and Global Health, Lund University, Sweden.
    Intimate partner violence and poor mental health among Thai women residing in Sweden2014In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, p. 24991-Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES:

    The current aim is to examine the prevalence of intimate partner violence (IPV) among Thai women residing in Sweden and its association with mental health. We also investigate the potential influence of social isolation and social capital regarding the association between IPV and mental health outcome.

    DESIGN:

    A public health questionnaire in Thai was distributed by post to the entire population of Thai women, aged 18-64, residing in two regions in Sweden since 2006. Items included aspects related to IPV (physical/sexual/emotional), sociodemographic background, physical health, mental health (GHQ-12), social isolation, and social capital (i.e. social trust/participation).

    RESULTS:

    The response rate was 62.3% (n=804). Prevalence of lifetime reported IPV was 22.1%, with 20.5% by a previous partner and 6.7% by a current partner. Previous IPV exposure was significantly related to current IPV exposure, and all IPV exposure measures were significantly related to poor mental health. However, Thai women experiencing IPV by a current partner were more at risk for poor mental health than Thai women with previous or without any experience of IPV. Also, among all women exposed to IPV, those with trust in others and without exposure to social isolation seemed to have partial protection against the adverse mental health consequences associated with IPV.

    CONCLUSIONS:

    Most Thai women had never been exposed to IPV, and after migrating to Sweden, women had lower IPV exposure than in Thailand. However, the increased risk for poor mental health among those Thai women exposed to IPV suggests the need for supportive measures and targeted interventions to prevent further injuries and adverse health consequences. Although poor mental health in Thai women represents an obstacle for integration, the potential resilience indicated in the group with high social trust and without exposure to social isolation suggests that such aspects be included in the program designed to facilitate integration.

  • 93.
    Forouzan, Ameneh S
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Social Determinants of Health Research Centre, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
    Rafiey, Hassan
    Padyab, Mojgan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Umeå University, Faculty of Social Sciences, Department of Social Work.
    Ghazinour, Seyedmehdi
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Dejman, Masoumeh
    San Sebastian Chasco, Miguel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Reliability and validity of a Mental Health System Responsiveness Questionnaire in Iran2014In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, p. 1-10Article in journal (Refereed)
    Abstract [en]

    Background:

    The Health System Responsiveness Questionnaire is an instrument designed by the World Health Organization (WHO) in 2000 to assess the experience of patients when interacting with the health care system. This investigation aimed to adapt a Mental Health System Responsiveness Questionnaire (MHSRQ) based on the WHO concept and evaluate its validity and reliability to the mental health care system in Iran.

    Design: In accordance with the WHO health system responsiveness questionnaire and the findings of a qualitative study, a Farsi version of the MHSRQ was tailored to suit the mental health system in Iran. This version was tested in a cross-sectional study at nine public mental health clinics in Tehran. A sample of 500 mental health services patients was recruited and subsequently completed the questionnaire. Item missing rate was used to check the feasibility while the reliability of the scale was determined by assessing the Cronbach's alpha and item total correlations. The factor structure of the questionnaire was investigated by performing confirmatory factor analysis (CFA).

    Results: The results showed a satisfactory feasibility since the item missing value was lower than 5.2%. With the exception of access domain, reliability of different domains of the questionnaire was within a desirable range. The factor loading showed an acceptable unidimentionality of the scale despite the fact that three items related to access did not perform well. The CFA also indicated good fit indices for the model (CFI = 0.99, GFI = 0.97, IFI = 0.99, AGFI = 0.97).

    Conclusions: In general, the findings suggest that the Farsi version of the MHSRQ is a feasible, reliable, and valid measure of the mental health system responsiveness in Iran. Changes to the questions related to the access domain should be considered in order to improve the psychometric properties of the measure.

  • 94.
    Forsum, Elisabet
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Editorial Material: Invited commentary: nutrition during growth and reproduction: studies demonstrating possibilities and difficulties2014In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, no 23484Article in journal (Other academic)
    Abstract [en]

    n/a

  • 95.
    Fottrell, Edward
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Dying to count: mortality surveillance in resource-poor settings2009In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 2Article in journal (Refereed)
    Abstract [en]

    Reliable cause-specific mortality data constitute a crucial resource for health monitoring, service planning and prioritisation. However, in the majority of the world's poorest settings, systematic health and vital event surveillance systems are weak or non-existent. As such, deaths are not counted and causes of death remain unregistered for more than two-thirds of the world's population.For researchers, health workers and policy makers in resource-poor settings, therefore, attempts to measure mortality have to be implemented from first principles. As a result, there is wide variation in mortality surveillance methodologies in different settings, and lack of standardisation and rigorous validation of these methods hinder meaningful comparison of mortality data between settings and over time.With a particular focus on Health and Demographic Surveillance Systems (HDSSs), this paper summarises recent research and conceptual development of certain methodological aspects of mortality surveillance stemming from a series of empirical investigations. The paper describes the advantages and limitations of various methods in particular contexts, and argues that there is no single methodology to satisfy all data needs. Rather, methodological decisions about mortality measurement should be a synthesis of all available knowledge relating to clearly defined concepts of why data are being collected, how they can be used and when they are of good enough quality to inform public health action.

  • 96.
    Frumence, Gasto
    et al.
    Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
    Nyamhanga, Tumaini
    Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
    Mwangu, Mughwira
    Hurtig, Anna-Karin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Challenges to the implementation of health sector decentralization in Tanzania: experiences from Kongwa district council2013In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 6, p. 20983-Article in journal (Refereed)
    Abstract [en]

    Background: During the 1990s, the government of Tanzania introduced the decentralization by devolution (D by D) approach involving the transfer of functions, power and authority from the centre to the local government authorities (LGAs) to improve the delivery of public goods and services, including health services. Objective: This article examines and documents the experiences facing the implementation of decentralization of health services from the perspective of national and district officials. Design: The study adopted a qualitative approach, and data were collected using semi-structured interviews and were analysed for themes and patterns. Results: The results showed several benefits of decentralization, including increased autonomy in local resource mobilization and utilization, an enhanced bottom-up planning approach, increased health workers' accountability and reduction of bureaucratic procedures in decision making. The findings also revealed several challenges which hinder the effective functioning of decentralization. These include inadequate funding, untimely disbursement of funds from the central government, insufficient and unqualified personnel, lack of community participation in planning and political interference. Conclusion: The article concludes that the central government needs to adhere to the principles that established the local authorities and grant more autonomy to them, offer special incentives to staff working in the rural areas and create the capacity for local key actors to participate effectively in the planning process.

  • 97.
    Furberg, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Evengård, Birgitta
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases. 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.
    Facing the limit of resilience: perceptions of climate change among reindeer herding Sami in Sweden2011In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 4, no 8417, p. 11-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The Arctic area is a part of the globe where the increase in global temperature has had the earliest noticeable effect and indigenous peoples, including the Swedish reindeer herding Sami, are amongst the first to be affected by these changes.

    OBJECTIVE: To explore the experiences and perceptions of climate change among Swedish reindeer herding Sami.

    STUDY DESIGN: In-depth interviews with 14 Swedish reindeer herding Sami were performed, with purposive sampling. The interviews focused on the herders experiences of climate change, observed consequences and thoughts about this. The interviews were analysed using content analysis.

    RESULTS: ONE CORE THEME EMERGED FROM THE INTERVIEWS: facing the limit of resilience. Swedish reindeer-herding Sami perceive climate change as yet another stressor in their daily struggle. They have experienced severe and more rapidly shifting, unstable weather with associated changes in vegetation and alterations in the freeze-thaw cycle, all of which affect reindeer herding. The forecasts about climate change from authorities and scientists have contributed to stress and anxiety. Other societal developments have lead to decreased flexibility that obstructs adaptation. Some adaptive strategies are discordant with the traditional life of reindeer herding, and there is a fear among the Sami of being the last generation practising traditional reindeer herding.

    CONCLUSIONS: The study illustrates the vulnerable situation of the reindeer herders and that climate change impact may have serious consequences for the trade and their overall way of life. Decision makers on all levels, both in Sweden and internationally, need improved insights into these complex issues to be able to make adequate decisions about adaptive climate change strategies.

  • 98. Garenne, Michel
    et al.
    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, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana.
    Kabudula, Chodziwadziwa W.
    Gomez-Olive, F. Xavier
    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.
    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.
    Completeness of birth and death registration in a rural area of South Africa: the Agincourt health and demographic surveillance, 1992-20142016In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 9, article id 32795Article in journal (Refereed)
    Abstract [en]

    Background: Completeness of vital registration remains very low in sub-Saharan Africa, especially in rural areas.

    Objectives: To investigate trends and factors in completeness of birth and death registration in Agincourt, a rural area of South Africa covering a population of about 110,000 persons, under demographic surveillance since 1992. The population belongs to the Shangaan ethnic group and hosts a sizeable community of Mozambican refugees.

    Design: Statistical analysis of birth and death registration over time in a 22-year perspective (1992-2014). Over this period, major efforts were made by the government of South Africa to improve vital registration. Factors associated with completeness of registration were investigated using univariate and multivariate analysis.

    Results: Birth registration was very incomplete at onset (7.8% in 1992) and reached high values at end point (90.5% in 2014). Likewise, death registration was low at onset (51.4% in 1992), also reaching high values at end point (97.1% in 2014). For births, the main factors were mother's age (much lower completeness among births to adolescent mothers), refugee status, and household wealth. For deaths, the major factors were age at death (lower completeness among under-five children), refugee status, and household wealth. Completeness increased for all demographic and socioeconomic categories studied and is likely to approach 100% in the future if trends continue at this speed.

    Conclusion: Reaching high values in the completeness of birth and death registration was achieved by excellent organization of the civil registration and vital statistics, a variety of financial incentives, strong involvement of health personnel, and wide-scale information and advocacy campaigns by the South African government.

  • 99.
    George, Asha
    et al.
    Univ Western Cape, Sch Publ Hlth, Bellville, South Africa.
    Tetui, Moses
    Makerere Univ, Makerere Univ Sch Publ Hlth MakSPH, New Mulago Complex, Kampala, Uganda; Umea Univ, Dept Publ Hlth & Clin Med, Epidemiol & Global Hlth Unit, Umea, Sweden.
    Pariyo, George W
    Johns Hopkins Univ, Johns Hopkins Bloomberg Sch Publ Hlth, Dept Int Hlth, Baltimore, MD USA.
    Peterson, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Maternal and newborn health implementation research: programme outcomes, pathways of change and partnerships for equitable health systems in Uganda.2017In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, no sup4, article id 1359924Article in journal (Refereed)
  • 100. George, Asha
    et al.
    Tetui, Moses
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Makerere University School of Public Health (MakSPH), Makerere University, Kampala, Uganda.
    Pariyo, George W.
    Peterson, Stefan S.
    Maternal and newborn health implementation research: programme outcomes, pathways of change and partnerships for equitable health systems in Uganda2017In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, article id 1359924Article in journal (Other academic)
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