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  • 1.
    Ahl, Rebecka
    et al.
    Örebro University, School of Medical Sciences. Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Lindgren, Rickard
    Örebro University Hospital. Division of Trauma and Emergency Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Cao, Yang
    Örebro University, School of Medical Sciences. Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Riddez, Louis
    Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, Solna, Sweden.
    Mohseni, Shahin
    Örebro University, School of Medical Sciences. Örebro University Hospital. Division of Trauma and Emergency Surgery, Department of Surgery, Orebro University Hospital, Örebro, Sweden; Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Risk factors for depression following traumatic injury: An epidemiological study from a scandinavian trauma center2017In: Injury, ISSN 0020-1383, E-ISSN 1879-0267, Vol. 48, no 5, p. 1082-1087Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: A significant proportion of patients suffer depression following traumatic injuries. Once manifested, major depression is challenging to overcome and its presence risks impairing the potential for physical rehabilitation and functional recovery. Risk stratification for early detection and intervention in these instances is important. This study aims to investigate patient and injury characteristics associated with an increased risk for depression.

    METHODS: All patients with traumatic injuries were recruited from the trauma registry of an urban university hospital between 2007 and 2012. Patient and injury characteristics as well as outcomes were collected for analysis. Patients under the age of eighteen, prescribed antidepressants within one year of admission, in-hospital deaths and deaths within 30days of trauma were excluded. Pre- and post-admission antidepressant data was requested from the national drugs registry. Post-traumatic depression was defined as the prescription of antidepressants within one year of trauma. To isolate independent risk factors for depression a multivariable forward stepwise logistic regression model was deployed.

    RESULTS: A total of 5981 patients met the inclusion criteria of whom 9.2% (n=551) developed post-traumatic depression. The mean age of the cohort was 42 [standard deviation (SD) 18] years and 27.1% (n=1620) were females. The mean injury severity score was 9 (SD 9) with 18.4% (n=1100) of the patients assigned a score of at least 16. Six variables were identified as independent predictors for post-traumatic depression. Factors relating to the patient were female gender and age. Injury-specific variables were penetrating trauma and GCS score of≤8 on admission. Furthermore, intensive care admission and increasing hospital length of stay were predictors of depression.

    CONCLUSION: Several risk factors associated with the development of post-traumatic depression were identified. A better targeted in-hospital screening and patient-centered follow up can be offered taking these risk factors into consideration.

  • 2.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Ibsens princip bör styra vårdsektorn2014In: Sjukhusläkaren, ISSN 1651-2715, no 5, p. 26-26Article in journal (Other (popular science, discussion, etc.))
  • 3.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Tid för klinisk analys2015In: Sjukhusläkaren, ISSN 1651-2715, no 1, p. 34-34Article in journal (Other (popular science, discussion, etc.))
  • 4.
    Algotson, S.
    et al.
    Allebarnsratten, Stockholm, Sweden; Sch Hosp Culinary Arts & Meal Sci, Univ Örebro, Örebro, Sweden.
    Öström, Åsa
    Örebro University, School of Humanities, Education and Social Sciences.
    Sapere-taste lessons in Swedish pre-schools2010In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 20, no Suppl. 1, p. 106-106Article in journal (Other academic)
  • 5.
    Ali, DK
    et al.
    Division of Social Medicine, Department of Public Health Science, Karolinska Institutet, Stockholm, Sweden.
    Dalal, Koustuv
    Division of Social Medicine, Department of Public Health Science, Karolinska Institutet, Stockholm, Sweden.
    Yousefzade-Chabok, S
    Trauma Research Center, Guilan University of Medical Science, Rasht, Iran.
    Jansson, B
    Division of Social Medicine, Department of Public Health Science, Karolinska Institutet, Stockholm, Sweden.
    Mohammadi, R
    Division of Social Medicine, Department of Public Health Science, Karolinska Institutet, Stockholm, Sweden.
    Costs related to drowning and near drowning in northern Iran (Guilan province)2011In: Ocean and Coastal Management, ISSN 0964-5691, E-ISSN 1873-524X, Vol. 54, no 3, p. 250-255Article in journal (Refereed)
    Abstract [en]

    In Iran and many other low- and middle-income countries, few  studies have been carried out in order to assess which cost analysis methods should be  undertaken at the household and community level in relation to incidences of drowning. In this study, we have attempted to develop a model for  estimating the impact of the economic burden that drowning and near drowning events incur for victims’ families in the Guilan province in the north of  Iran by  using an  incidence approach. During the financial year of March 2007 to 2008,  the following cost-related aspects of  drowning episodes were evaluated: (note: main cost elements were income adjusted by family and years) medical costs, productivity loss  costs and death costs. A total of 137 drowning fatalities and 104 near drowning incidents were recorded. Males in the age  span of  10e29  years constitute a  majority of  the epidemiology and economy data. When the number of variables included in cost analysis was expanded, the estimated burden of economic duress increased dramatically; however, drowning cost for  one drowned victim was equivalent to 17  times the country’s  gross domestic product(GDP) per capital. Identification of  injured person-based costs in  this study will  enable development of  more effective prevention programs and provide indicators of  other costs related to drowning episodes such as  property damage and the impact of  these accidents on community services and the public health care system.

  • 6.
    Anderberg, Natasha
    Örebro University, School of Health and Medical Sciences.
    Ungdomars erfarenheter av vattenpipsrökning: En kvalitativ intervjustudie2011Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 7.
    Anderson, Ian
    et al.
    The University of Melbourne, Melbourne, Australia.
    Tano, Sofia
    School of Business and Economy, Umeå University, Umeå, Sweden.
    Yap, Leslie
    Native Hawaiian Center of Excellence, John A Burns School of Medicine, University of Hawaii, Honolulu HI, United States.
    Indigenous and tribal peoples' health (The Lancet-Lowitja Institute Global Collaboration): a population study2016In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 388, no 10040, p. 131-157Article in journal (Refereed)
    Abstract [en]

    Background: International studies of the health of Indigenous and tribal peoples provide important public health insights. Reliable data are required for the development of policy and health services. Previous studies document poorer outcomes for Indigenous peoples compared with benchmark populations, but have been restricted in their coverage of countries or the range of health indicators. Our objective is to describe the health and social status of Indigenous and tribal peoples relative to benchmark populations from a sample of countries.

    Methods: Collaborators with expertise in Indigenous health data systems were identified for each country. Data were obtained for population, life expectancy at birth, infant mortality, low and high birthweight, maternal mortality, nutritional status, educational attainment, and economic status. Data sources consisted of governmental data, data from non-governmental organisations such as UNICEF, and other research. Absolute and relative differences were calculated.

    Findings: Our data (23 countries, 28 populations) provide evidence of poorer health and social outcomes for Indigenous peoples than for non-Indigenous populations. However, this is not uniformly the case, and the size of the rate difference varies. We document poorer outcomes for Indigenous populations for: life expectancy at birth for 16 of 18 populations with a difference greater than 1 year in 15 populations; infant mortality rate for 18 of 19 populations with a rate difference greater than one per 1000 livebirths in 16 populations; maternal mortality in ten populations; low birthweight with the rate difference greater than 2% in three populations; high birthweight with the rate difference greater than 2% in one population; child malnutrition for ten of 16 populations with a difference greater than 10% in five populations; child obesity for eight of 12 populations with a difference greater than 5% in four populations; adult obesity for seven of 13 populations with a difference greater than 10% in four populations; educational attainment for 26 of 27 populations with a difference greater than 1% in 24 populations; and economic status for 15 of 18 populations with a difference greater than 1% in 14 populations.

    Interpretation: We systematically collated data across a broader sample of countries and indicators than done in previous studies. Taking into account the UN Sustainable Development Goals, we recommend that national governments develop targeted policy responses to Indigenous health, improving access to health services, and Indigenous data within national surveillance systems.

  • 8.
    Andersson, Elin
    et al.
    Örebro University, School of Health and Medical Sciences.
    Ström, Josefin
    Örebro University, School of Health and Medical Sciences.
    Psykosocial arbetsmiljö samt självupplevd hälsa hos anställda inom idéella fotbolls- och gymnastikföreningar: En kvantitativ tvärsnittsstudie2010Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 9. Andersson, Eva
    et al.
    Persson, Bodil
    Bryngelsson, Ing-Liss
    Magnuson, Anders
    Torén, Kjell
    Wingren, Gun
    Westberg, Håkan
    Örebro University, School of Health and Medical Sciences.
    Cohort mortality study of Swedish pulp and paper mill workers-nonmalignant diseases2007In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 33, no 6, p. 470-478Article in journal (Refereed)
    Abstract [en]

    Objectives The aim of this study was to determine mortality among pulp and paper mill workers according to the main mill pulping process, department, and gender, particular reference being given to diseases of the circulatory and respiratory systems.

    Methods The cohort of 18 163 men and 2 291 women employed between 1939 and 1999 and with >1 year of employment was followed for mortality from 1952 to 2001 (acute myocardial infarction from 1969). Standardized mortality ratios (SMR) with 95% confidence intervals (95% CI) were estimated by comparing the observed number of deaths with the expected number for the entire Swedish population. Exposure was assessed from personnel files in the mills. Data from an exposure measurement database are also presented.

    Results There were 5898 deaths in the cohort. Total mortality had an SMR of 1.02 (95% CI 0.98–1.06) for the men in the sulfate mills and an SMR of 0.93 (95% CI 0.90–0.97) for the men in the sulfite mills. Mortality from acute myocardial infarction was increased among the men in both the sulfate and sulfite mills [SMR 1.22 (95% CI 1.12–1.32) and SMR 1.11 (95% CI 1.02–1.21), respectively] and by department in sulfate pulping (SMR 1.29, 95% CI 1.07–1.54), paper production (SMR 1.26, 95% CI 1.06–1.49), and maintenance (SMR 1.16, 95% CI 1.02–1.30). Mortality from cerebrovascular disease, diabetes mellitus, and nonmalignant respiratory diseases was not increased.

    Conclusions Death from acute myocardial infarction, but not cerebrovascular diseases, was increased in this cohort and was probably related to a combination of different occupational exposures (eg, dust, sulfur compounds, shift work, and noise).

  • 10.
    Andersson, Eva
    et al.
    Sahlgrens Univ Hosp, Gothenburg, Sweden.
    Westberg, Håkan
    Örebro University Hospital.
    Bryngelsson, Ing-Liss
    Dept Occupat & Environm Med, Örebro Univ Hosp, Örebro, Sweden.
    Magnuson, Anders
    Clin Epidemiol & Biostat Unit, Örebro Univ Hosp, Örebro, Sweden.
    Persson, Bodil
    Dept Occupat & Environm Med, Linköping Univ Hosp, Linköping, Sweden; Dept Occupat & Environm Med, Univ Lund Hosp, Lund, Sweden.
    Cancer incidence among Swedish pulp and paper mill workers: a cohort study of sulphate and sulphite mills2013In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 86, no 5, p. 529-540Article in journal (Refereed)
    Abstract [en]

    Associations between various malignancies and work in the pulp and paper industry have been reported but mostly in analyses of mortality rather than incidence. We aimed to study cancer incidence by main mill pulping process, department and gender in a Swedish cohort of pulp and paper mill workers. The cohort (18,113 males and 2,292 females, enrolled from 1939 to 1999 with > 1 year of employment) was followed up for cancer incidence from 1958 to 2001. Information on the workers' department and employment was obtained from the mills' personnel files, and standardized incidence ratios (SIRs) were calculated using the Swedish population as reference. Overall cancer incidence, in total 2,488 cases, was not increased by work in any department. However, risks of pleural mesothelioma were increased among males employed in sulphate pulping (SIR, 8.38; 95 % CI, 3.37-17) and maintenance (SIR, 6.35; 95 % CI, 3.47-11), with no corresponding increase of lung cancer. Testicular cancer risks were increased among males employed in sulphate pulping (SIR, 4.14; 95 % CI, 1.99-7.61) and sulphite pulping (SIR, 2.59; 95 % CI, 0.95-5.64). Female paper production workers showed increased risk of skin tumours other than malignant melanoma (SIR, 2.92; 95 % CI, 1.18-6.02). Incidence of pleural mesothelioma was increased in the cohort, showing that asbestos exposure still has severe health consequences, and highlighting the exigency of strict asbestos regulations and elimination. Testicular cancer was increased among pulping department workers. Shift work and endocrine disruptors could be of interest in this context.

  • 11.
    Andersson G, Ulrika
    et al.
    Örebro University, School of Health and Medical Sciences.
    Jern, Camilla
    Örebro University, School of Health and Medical Sciences.
    " Det är som att vi bara ska få känna oss delaktiga, men att det bara är på låtsas": En kvalitativ studie om ungdomars syn på sin delaktghet i samhället2010Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 12.
    Andersson, Irene
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Werle, Frida
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    En kvalitativ analys av jämställdhetsplaner i offentlig verksamhet: - Vad säger de egentligen?2013Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background People who are discriminated have an increased risk for poor mental and physical health. The discrimination law regulates discrimination, and in it it's written that gender is one of the discrimination foundations. A gender equal society makes gender differences in life expectancy smaller, and there are more self reported health inconveniences in countries who are not gender equal. Sweden's labour market is characterized by gender segregation, and there's a correlation between gender segregation at work and illness for both genders. In the discrimination law it's written that every workplace with at least 25 employees are obligated to have a plan for gender equality.

    Aim The aim is to describe plans of gender equality of workplaces in the public area with a base in the Swedish discrimination law

    Method The plans for gender equality have been analysed with deductive qualitative content analyzis. Six plans from different employers in the public area have been collected in a medium big municipality in Sweden.

    Result Most of the plans follow the directions in the discrimination law. Employees shall be able to combine family life with working life and no one should be harassed because of gender. No one should be discriminated in the process of job seeking, but some affirmative action can occur if one of the genders are underrepresented. There should be no irrelevant salary differences.

    Discussion There may be other policy documents which regulate the gender equality work at some of the workplaces, and therefore there could be some missing parts in the plans. Social support and group identification are factors of protection against discrimination, and should be given more space in the plans. Affirmative actions can be discrimination of the gender who is not prioritized and this could be solved with an elimination of the society based gender roles. In order for gender equality to have a positive effect on public health, men should adopt traditional female roles.

  • 13. Andersson, Johnny
    et al.
    Eriksson, Charli
    Örebro University, School of Health and Medical Sciences.
    Järliden, Eva
    Från hälsoprojekt till partnerskap för hållbar välfärdsutveckling2010In: Partnerskap för hållbar välfärdsutveckling: utveckling och forskning under sex år i fyra städer / [ed] Charli Eriksson, Eva Järliden, Annika Larsson, Solveig Sandberg, Örebro: Örebro universitet , 2010, p. 3-11Chapter in book (Other academic)
  • 14.
    Andersson, Robin
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Dahlström, Albin
    Hälsofrämjande skolutveckling: En kvalitativ intervjustudie med rektorer i två kommuner2011Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 15.
    Andersson, Ulrika
    et al.
    Örebro University, School of Health and Medical Sciences.
    Karlsson, Jonas
    Örebro University, School of Health and Medical Sciences.
    Hälsofrämjande arbetsplats.....idag eller imorgon?: - En kvantitativ studie där salutogena indikatorer på hälsa samt upplevelse av arbete och arbetsplats kartläggs2010Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 16.
    Andrews, Johanna Y.
    et al.
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Dalal, Koustuv
    Department of Medical and Health Sciences, Centre for Medical Technology Assessment, Division of Social Medicine and Public Health Sciences, Linköping University, Linköping, Sweden.
    Umbilical cord-cutting practices and place of delivery in Bangladesh2011In: International Journal of Gynecology & Obstetrics, ISSN 0020-7292, E-ISSN 1879-3479, Vol. 114, no 1, p. 43-6Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate place of delivery, umbilical cord-cutting instruments used, and substances applied to the cord stump in Bangladesh.

    Methods: A cross-sectional data analysis was performed on a nationally representative sample of 4925 women of reproductive age (15-49 years) with at least 1 child.

    Results: More than 80% of women delivered at home. In 6% of cases, blades from a clean-delivery kit (CDK) were used to cut the cord; in 90% of cases, the blades used were from another source; in 4% of cases, other instruments such as bamboo strips and scissors were used to cut the cord. In 51% of cases, a substance (e.g. antibiotic powder/ointment, alcohol/spirit, mustard oil with garlic, boric powder, turmeric, and chewed rice) was applied to the stump after the cord was cut.

    Conclusion: The present findings underscore the need for further advocacy, availability, and use of cord-cutting instruments from CDKs, especially for deliveries that occur outside healthcare facilities.

  • 17.
    Andrews-Chavez, Johanna
    et al.
    Friedman School of Nutrition Science and Policy, Tufts University, Boston, USA.
    Biswas, Animesh
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Gifford, Mervyn
    Department of Public Health Sciences, University of Skövde, Skövde, Sweden.
    Eriksson, Charli
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Dalal, Koustuv
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Identifying households with low immunisation completion in Bangladesh2012In: Health, ISSN 1949-4998, E-ISSN 1949-5005, Vol. 4, no 11, p. 1088-1097Article in journal (Refereed)
    Abstract [en]

    The objective of this study was to investigate if the mothers’ demographics and household characteristics—including type of use of cooking fuel, energy and toilet facilities—have any implication for complete immunisation rates among their children. A cross-sectional data analysis of a nationally representative sample of 4925 women with at least one child was performed. Chisquared tests and multivariate logistic regression analyses were used. Immunisation coverage was positively associated with the mother’s education and with household characteristics such as toilet facility, electricity and involvement in a microfinance group. These findings indicate the need for further advocacy for increased knowledge on the importance of vaccination and affordable public immunisation programs focusing on higher risk households such as those with pit facilities, lack of electricity and no participation in a microfinance group. Such households warrant further attention and can be targeted for immunisation coverage.

  • 18.
    Androutsos, O
    et al.
    Department of Nutrition and Dietetics, Harokopio University, Athens, Greec.
    Apostolidou, E
    Department of Nutrition and Dietetics, Harokopio University, Athens, Greec.
    Iotova, V
    Department of Pediatrics, Medical University Varna, Varna, Bulgaria.
    Socha, P
    The Children’s Memorial Health Institute, Warsaw, Poland.
    Birnbaum, J
    Dr. von Hauner Children’s Hospital, University of Munich Medical Centre, Munich, Germany.
    Moreno, L
    GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain; School of Health Science (EUCS), University of Zaragoza, Zaragoza, Spain .
    De Bourdeaudhuij, I
    Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium.
    Koletzko, B
    Dr. von Hauner Children’s Hospital, University of Munich Medical Centre, Munich, Germany.
    Manios, Y
    Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
    Nilsen, Bente (Contributor)
    Oslo and Akershus University College of Applied Science, Oslo, Norway.
    Process evaluation design and tools used in a kindergarten-based, family-involved intervention to prevent obesity in early childhood: the ToyBox-study2014In: Obesity Reviews, ISSN 1467-7881, E-ISSN 1467-789X, Vol. 15, no Suppl 3, p. 74-80Article in journal (Refereed)
    Abstract [en]

    Process evaluation (PE) is used for the in-depth evaluation of the implementation process of health promotion programmes. The aim of the current paper was to present the PE design and tools used in the ToyBox-intervention. The PE design was based on a three-step approach, including the identification of ToyBox-specific PE elements (step 1), the development of PE tools and harmonization of procedures (step 2), and the implementation of PE using standardized protocol and tools across the intervention countries (step 3). Specifically, to evaluate the implementation of the intervention, teachers' monthly logbooks were recorded (dose delivered, fidelity, dose received); post-intervention questionnaires were completed by parents/caregivers and teachers (dose received); participation and attrition rates were recorded (recruitment, reach); and audit questionnaires and retrospective information on weather conditions were collected (physical and social environment within which the intervention was implemented). Regarding the teachers' training sessions, the researchers who performed the trainings completed evaluation forms and documented teachers' attendance after each training (dose delivered, fidelity, dose received) and teachers completed evaluation forms after each training (dose received). The PE performed in the ToyBox-intervention may contribute in the evaluation of its effectiveness, guide the revision of the intervention material and provide insights for future health promotion programmes and public health policy.

  • 19.
    Androutsos, O
    et al.
    Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
    Katsarou, C
    Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
    Payr, A
    Dr. von Hauner Children’s Hospital, University of Munich Medical Centre, Munich, Germany.
    Birnbaum, J
    Dr. von Hauner Children’s Hospital, University of Munich Medical Centre, Munich, Germany.
    Geyer, C
    Dr. von Hauner Children’s Hospital, University of Munich Medical Centre, Munich, Germany.
    Wildgruber, A
    State Institute of Early Childhood Research, Munich, Germany.
    Kreichauf, S
    State Institute of Early Childhood Research, Munich, Germany.
    Lateva, M
    Department of Pediatrics, Medical University Varna, Varna, Bulgaria.
    De Decker, E
    Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium.
    De Craemer, M
    Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium.
    Socha, P
    The Children’s Memorial Health Institute, Warsaw, Poland.
    Moreno, L
    GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain; School of Health Science (EUCS), University of Zaragoza, Zaragoza, Spain.
    Iotova, V
    Department of Pediatrics, Medical University Varna, Varna, Bulgaria.
    Koletzko, B V
    Dr. von Hauner Children’s Hospital, University of Munich Medical Centre, Munich, Germany.
    Manios, Y
    Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
    Nilsen, Bente (Contributor)
    Oslo and Akershus University College of Applied Science, Oslo, Norway.
    Designing and implementing teachers' training sessions in a kindergarten-based, family-involved intervention to prevent obesity in early childhood: the ToyBox-study2014In: Obesity Reviews, ISSN 1467-7881, E-ISSN 1467-789X, Vol. 15, no Suppl 3, p. 48-52Article in journal (Refereed)
    Abstract [en]

    Since school-based interventions are mainly delivered by the school staff, they need to be well-trained and familiarized with the programme's aims, procedures and tools. Therefore, the institute, research group, governmental or non-governmental body in charge of the coordination and implementation of the programme needs to devote time and resources to train the school staff before programme's implementation. This is particularly crucial in multi-centre studies where more than one research teams are involved. Both research teams and school staff need to be trained, using standard protocols and procedures, to ensure that the intervention will be delivered in a standardized manner throughout the intervention centres. The ToyBox-intervention, a multi-component, kindergarten-based, family-involved intervention, focusing on water consumption, snacking, physical activity and sedentary behaviours in preschool children, was implemented over the academic year 2012-2013 in six European countries. As part of this intervention, three teachers' training sessions were delivered to motivate and train teachers in implementing the intervention. The local researchers were trained centrally before delivering the training sessions for the teachers and followed a common protocol using standardized presentations and procedures. The aim of the current paper is to describe the protocol and methodological issues related to the teachers' training sessions conducted within the ToyBox-intervention.

  • 20.
    Aremu, Olatunde
    et al.
    Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Stockholm, Sweden; College of Medicine, University of Ibadan Oyo State, Ibadan, Nigeria.
    Lawoko, Stephen
    Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Stockholm, Sweden.
    Dalal, Koustuv
    Department of Medical and Health Sciences, Center for Medical Technology Assessment, Linköpings University, Linköping, Sweden.
    Childhood vitamin A capsule supplementation coverage in Nigeria: a multilevel analysis of geographic and socioeconomic inequities.2010In: The Scientific World Journal, ISSN 1537-744X, Vol. 10, p. 1901-14Article in journal (Refereed)
    Abstract [en]

    Vitamin A deficiency (VAD) is a huge public health burden among preschool-aged children in sub-Saharan Africa, and is associated with a high level of susceptibility to infectious diseases and pediatric blindness. We examined the Nigerian national vitamin A capsule (VAC) supplementation program, a short-term cost-effective intervention for prevention of VAD-associated morbidity for equity in terms of socioeconomic and geographic coverage. Using the most current, nationally representative data from the 2008 Nigerian Demographic and Health Survey, we applied multilevel regression analysis on 19,555 children nested within 888 communities across the six regions of Nigeria. The results indicate that there was variability in uptake of VAC supplement among the children, which could be attributed to several characteristics at individual, household, and community levels. Individual-level characteristics, such as maternal occupation, were shown to be associated with receipt of VAC supplement. The results also reveal that household wealth status is the only household-level characteristic that is significantly associated with receipt of VAC, while neighborhood socioeconomic disadvantage and geographic location were the community-level characteristics that determined receipt of VAC. The findings from this study have shown that both individual and contextual socioeconomic status, together with geographic location, is important for uptake of VAC. These findings underscore the need to accord the VAC supplementation program the much needed priority with focus on characteristics of neighborhoods (communities), in addition to individual-level characteristics.

  • 21.
    Aremu, Olatunde
    et al.
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; College of Medicine, University of Ibadan, Ibadan, Nigeria.
    Lawoko, Stephen
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Dalal, Koustuv
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Medicine and Health Sciences, Centre for Health Technology Assessment, Linköping University, Linköping, Sweden.
    Neighborhood socioeconomic disadvantage, individual wealth status and patterns of delivery care utilization in Nigeria: a multilevel discrete choice analysis.2011In: International Journal of Women's Health, ISSN 1179-1411, E-ISSN 1179-1411, Vol. 3, p. 167-74Article in journal (Refereed)
    Abstract [en]

    Background: High maternal mortality continues to be a major public health problem in most part of the developing world, including Nigeria. Understanding the utilization pattern of maternal healthcare services has been accepted as an important factor for reducing maternal deaths. This study investigates the effect of neighborhood and individual socioeconomic position on the utilization of different forms of place of delivery among women of reproductive age in Nigeria.

    Methods: A population-based multilevel discrete choice analysis was performed using the most recent population-based 2008 Nigerian Demographic and Health Surveys data of women aged between 15 and 49 years. The analysis was restricted to 15,162 ever-married women from 888 communities across the 36 states of the federation including the Federal Capital Territory of Abuja.

    Results: The choice of place to deliver varies across the socioeconomic strata. The results of the multilevel discrete choice models indicate that with every other factor controlled for, the household wealth status, women's occupation, women's and partner's high level of education attainment, and possession of health insurance were associated with use of private and government health facilities for child birth relative to home delivery. The results also show that higher birth order and young maternal age were associated with use of home delivery. Living in a highly socioeconomic disadvantaged neighborhood is associated with home birth compared with the patronage of government health facilities. More specifically, the result revealed that choice of facility-based delivery is clustered around the neighborhoods.

    Conclusion: Home delivery, which cuts across all socioeconomic strata, is a common practice among women in Nigeria. Initiatives that would encourage the appropriate use of healthcare facilities at little or no cost to the most disadvantaged should be accorded the utmost priority.

  • 22. Aremu, Olatunde
    et al.
    Lawoko, Stephen
    Dalal, Koustuv
    The influence of individual and contextual socioeconomic status on obstetric care utilization in the democratic republic of Congo: a population-based study2012In: International Journal of Preventive Medicine, ISSN 2008-7802, E-ISSN 2008-8213, Vol. 3, no 4, p. 278-285Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Maternal health care utilization continues to focus on the agenda of health care planners around the world, with high attention being paid to the developing countries. The devastating effect of maternal death at birth on the affected families is untold. This study examines the utilization of obstetric care in the Democratic Republic of Congo.

    METHODS: We have used the nationally representative data from the 2007. Democratic Republic of Congo Demographic and Health Survey. Multilevel regression analysis has been applied to a nationally representative sample of 6,695 women, clustered around 299 communities in the country.

    RESULTS: The results show that there are variations in the use of antenatal care and delivery care. Individual-level characteristics, such as women's occupation and household wealth status are shown to be associated with the use of antenatal care. Uptake of facility-based delivery has been seen to be dependent on the household wealth status, women's education, and partner's education. The effect of the neighborhoods' socioeconomic disadvantage on the use of antenatal care and facility-based delivery are the same. Women from highly socioeconomically disadvantaged communities, compared to their counterparts from less socioeconomically disadvantaged neighborhoods, are less likely to utilize both the antenatal services and healthcare facility for child delivery. The result of this study has shown that both individual and contextual socioeconomic status play an important role in obstetric care uptake.

    CONCLUSION: Thus, intervention aimed at improving the utilization of obstetrics care should target both the individual economic abilities of the women and that of their environment when considering the demand side.

  • 23.
    Aremu, Olatunde
    et al.
    Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden; Southampton Health Technology Assessment Centre, School of Medicine University of Southampton, Southampton, UK; College of Medicine, University of Ibadan, Ibadan, Nigeria .
    Lawoko, Stephen
    Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden.
    Moradi, Tahereh
    Division of Epidemiology, The institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.
    Dalal, Koustuv
    Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden; Departments of Medicine and Health Science, Centre for Health Technology Assessment Linköping University, Linköping, Sweden.
    Socio-economic determinants in selecting childhood diarrhoea treatment options in Sub-Saharan Africa: a multilevel model.2011In: The Italian Journal of Pediatrics, ISSN 1720-8424, E-ISSN 1824-7288, Vol. 37, no 13Article in journal (Refereed)
    Abstract [en]

    Background: Diarrhoea disease which has been attributed to poverty constitutes a major cause of morbidity and mortality in children aged five and below in most low-and-middle income countries. This study sought to examine the contribution of individual and neighbourhood socio-economic characteristics to caregiver's treatment choices for managing childhood diarrhoea at household level in sub-Saharan Africa.

    Methods: Multilevel multinomial logistic regression analysis was applied to Demographic and Health Survey data conducted in 11 countries in sub-Saharan Africa. The unit of analysis were the 12,988 caregivers of children who were reported to have had diarrhoea two weeks prior to the survey period.

    Results: There were variability in selecting treatment options based on several socioeconomic characteristics. Multilevel-multinomial regression analysis indicated that higher level of education of both the caregiver and that of the partner, as well as caregivers occupation were associated with selection of medical centre, pharmacies and home care as compared to no treatment. In contrast, caregiver's partners' occupation was negatively associated with selection medical centre and home care for managing diarrhoea. In addition, a low-level of neighbourhood socio-economic disadvantage was significantly associated with selection of both medical centre and pharmacy stores and medicine vendors.

    Conclusion: In the light of the findings from this study, intervention aimed at improving on care seeking for managing diarrhoea episode and other childhood infectious disease should jointly consider the influence of both individual SEP and the level of economic development of the communities in which caregivers of these children resides.

  • 24.
    Asghar, Naveed
    et al.
    School of Natural Sciences, Technology and Environmental Studies, Södertörn University, Huddinge; Inflammatory Response and Infection Susceptibility Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Petersson, Mona
    School of Natural Sciences, Technology and Environmental Studies, Södertörn University, Huddinge.
    Johansson, Magnus
    Örebro University, School of Medical Sciences. School of Natural Sciences, Technology and Environmental Studies, Södertörn University, Huddinge; 3Inflammatory Response and Infection Susceptibility Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Dinnetz, Patrik
    School of Natural Sciences, Technology and Environmental Studies, Södertörn University, Huddinge.
    Local landscape effects on population dynamics of Ixodes ricinus2016In: Geospatial health, ISSN 1827-1987, Vol. 11, no 3, p. 283-289, article id 487Article in journal (Refereed)
    Abstract [en]

    Ixodes ricinus, a common tick in Europe, transmits severe tickborne pathogens (TBPs). In Sweden, both prevalence and incidence of tick-borne infections have increased during the last few decades, and a majority of the cases is reported from the area around Stockholm. Among ticks, transmission of TBPs involves co-feeding of susceptible larvae or nymphs with infected ticks on the same host. Seasonal synchrony of immature stages and total tick abundance are important factors for the probability of horizontal transmission of TBPs. We have studied the association between local landscape characteristics and population dynamics and the probability of co-occurrence of different life cycle stages of I. ricinus at different locations south of Stockholm, Sweden. We found significant spatiotemporal variation in tick activity patterns. Mean tick abundance varied with a tenfold difference among study sites. The probability of co-occurrence of larvae, nymphs and female adults was highest in June and decreased significantly with vegetation height. In addition, the amount of forest habitat and open water in the surrounding landscape of the study sites expressed significant negative effects on tick abundance and co-occurrence, indicating that environmental heterogeneity may increase the likelihood of good rodent habitats, which in turn, are suitable hosts for immature ticks.

  • 25.
    Atiya Ali, M.
    et al.
    Department of Biosciences and Nutrition, Karolinska Institute, Stockholm, Sweden.
    Strandvik, B.
    Department of Biosciences and Nutrition, Karolinska Institute, Stockholm, Sweden.
    Sabel, K-G.
    Borås Children Hospital (SÄS), Borås, Sweden.
    Palme Kilander, C.
    Division of Neonatology, Department of Paediatrics, Karolinska Institute, Stockholm, Sweden.
    Strömberg, R.
    Department of Biosciences and Nutrition, Karolinska Institute, Stockholm, Sweden.
    Yngve, Agneta
    Örebro University, School of Hospitality, Culinary Arts & Meal Science. Department of Biosciences and Nutrition, Karolinska Institute, Stockholm, Sweden.
    Polyamine levels in breast milk are associated with mothers' dietary intake and are higher in preterm than full-term human milk and formulas2014In: Journal of human nutrition and dietetics (Print), ISSN 0952-3871, E-ISSN 1365-277X, Vol. 27, no 5, p. 459-467Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Polyamine intake from milk is considered essential for post-natal maturation of the immune system and small intestine. The present study aimed to determine polyamine content in human milk after preterm delivery and the association with mothers' dietary intake. In comparison, the polyamine levels were compared with those in term breast milk and some corresponding formulas.

    METHODS: Transitional breast milk was collected from 40 mothers delivering after 24-36 weeks of gestation, and from 12 mothers delivering after full term. Food intake was assessed in mothers delivering preterm babies using a 3-day diary. Polyamines were analysed by high-performance liquid chromatography.

    RESULTS: The dietary intake of polyamines was significantly associated with breast milk content but weaker for spermine than for spermidine and putrescine. Total polyamine level was higher in preterm than term milk and lower in the corresponding formulas. Putrescine, spermidine and spermine contents [mean (SEM)] in preterm milk were 165.6 (25), 615.5 (80) and 167.7 (16) nmol dL(-1) , respectively, with the levels of putrescine and spermidine being 50% and 25% higher than in term milk. The content of spermine did not differ.

    CONCLUSIONS: Dietary intake of polyamines has an impact on the content in breast milk. The difference between human milk after preterm and term delivery might be considered when using donor human milk for preterm infants. The corresponding formulas had lower contents. Further studies are important for determining the relationship between tissue growth and maturation and optimal intake.

  • 26.
    Augustsson, Kristin
    et al.
    Örebro University, School of Health and Medical Sciences.
    Rydqvist, Amanda
    Sömn och tvättstugescheman: En studie kring vårdanställda skiftarbetares sömn och risk för trötthet, misstag samt olyckor2011Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 27.
    Axelsson, Per
    et al.
    Umeå universitet, Centrum för samisk forskning (CeSam).
    Sköld, Peter
    Umeå universitet, Centrum för samisk forskning (CeSam).
    Tano, Sofia
    Arctic Research Centre at Umeå University (Arcum), Umeå, Sweden.
    Sweden: The Sami2016In: A Global Snapshot of Indigenous and Tribal Peoples' Health: The Lancet–Lowitja Institute Collaboration / [ed] Kate Silburn, Hannah Reich & Ian Anderson, Carlton South, Victoria, Australia: The Lowitja Institute , 2016, , p. 2p. 46-47Chapter in book (Refereed)
  • 28. Axelsson, Roland
    et al.
    Jansson, Charlotte
    Järliden, Eva
    Westblad, Johan
    Jendteg, Stefan
    Sedelius, Thomas
    Sandberg, Andreas
    Eriksson, Charli
    Örebro University, School of Health and Medical Sciences.
    Indikatorer för hållbar välfärdsutveckling på stadsdelsnivå2010In: Partnerskap för hållbar välfärdsutveckling: utveckling och forskning under sex år i fyra städer / [ed] Charli Eriksson, Eva Järliden, Annika Larsson, Solveig Sandberg, Örebro: Örebro universitet , 2010, p. 219-240Chapter in book (Other academic)
  • 29.
    Beales, Darren
    et al.
    Curtin Univ, School of Physiotherapy and Exercise Science, Perth WA, Australia.
    Kyaw-Myint, SuMon
    Safe Work Australia, Canberra Australian Capital Territory, Australia.
    Smith, Anne
    Curtin Univ, School of Physiotherapy and Exercise Science, Perth WA, Australia.
    O'Sullivan, Peter
    Curtin Univ, School of Physiotherapy and Exercise Science, Perth WA, Australia.
    Pransky, Glenn
    Liberty Mutual Research Institute for Safety, Boston MA, USA.
    Linton, Steven
    Örebro University, School of Law, Psychology and Social Work.
    Job, Jenny
    Safe Work Australia, Canberra Australian Capital Territory, Australia.
    Straker, Leon
    Curtin Univ, School of Physiotherapy and Exercise Science, Perth WA, Australia.
    Work Productivity Loss in Young Workers Is Substantial and Is Associated With Spinal Pain and Mental Ill-health Conditions2017In: Journal of Occupational and Environmental Medicine, ISSN 1076-2752, E-ISSN 1536-5948, Vol. 59, no 3, p. 237-245Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to estimate the effect of spinal pain and mental ill-health conditions on work productivity in 22-year-old workers.

    Methods: A cross-sectional design using data from the Raine Study cohort (n = 867) including self-reported work productivity and self-report of health practitioner diagnosed medical conditions.

    Result: Mean (median, 25th-percentile, 75th-percentile) annualized cost of health-related absenteeism was $AUD1899 ($0, $0, $1738) per worker. Annualized cost of presenteeism was $AUD10,674 ($6573, $4003, $13,087) per worker. Spinal pain and mental ill-health conditions were associated with increased health-related absenteeism, but not presenteeism.

    Conclusion: Work productivity loss in young workers is a substantial problem needing priority attention. Addressing spinal pain and mental ill-health may improve productivity of this important sector of the workforce.

  • 30.
    Beckman, Linda
    et al.
    Department of Public Health, Örebro University, Örebro, Sweden; Department of Public Health, Karlstad University, Karlstad, Sweden.
    Svensson, Mikael
    Örebro University, Örebro University School of Business. Health Metrics, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Frisen, Ann
    Department of Psychology, University of Gothenburg, Gothenburg, Sweden.
    Preference-based health-related quality of life among victims of bullying2016In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 25, no 2, p. 303-309Article in journal (Refereed)
    Abstract [en]

    Purpose: No previous study has estimated the association between bullying and preference-based health-related quality of life (HRQoL) ("utility''), knowledge of which may be used for cost-effectiveness studies of interventions designed to prevent bullying. Therefore, the aim of the study was to estimate preference-based HRQoL among victims of bullying compared to non-victims.

    Methods: A cross-sectional survey data collection among Swedish adolescents aged 15-17 years in the first year of upper secondary school was conducted in the city of Gothenburg in Sweden (N = 758). Preference-based HRQoL was estimated with the SF-6D. Regression analyses were conducted to adjust for some individual-level background variable.

    Results: Mean preference-based health-related quality of life scores were 0.77 and 0.71 for non-victims and victims of bullying, respectively. The difference of 0.06 points was statistically significant (p < 0.05) and robust to inclusion of gender, age, and parental immigrant status.

    Conclusions: The preference-based HRQoL estimates in this study may be used as an upper bound in economic evaluations of bullying prevention interventions, facilitating a comparison between costs and quality-adjusted lifeyears.

  • 31.
    Beckman, Linda
    et al.
    Faculty of Medicine and Health, School of Health Sciences, Örebro, Sweden; Department of Public Health, Karlstad University, Karlstad, Sweden; .
    Svensson, Mikael
    Health Metrics, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Geidne, Susanna
    Örebro University, School of Health Sciences.
    Eriksson, Charli
    Örebro University, School of Health Sciences.
    Effects on alcohol use of a Swedish school-based prevention program for early adolescents: a longitudinal study2017In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 17, article id 2Article in journal (Refereed)
    Abstract [en]

    Background: The aim of the study was to address the lack of evaluations of school-based substance use prevention programs and to conduct a quasi-experimental evaluation of the alcohol use part of the Triad intervention.

    Methods: Eleven Swedish intervention schools (285 pupils) and three control schools (159 pupils) participated in the evaluation. Baseline measurements were conducted in 2011 before the alcohol part in the prevention program was implemented in the intervention schools (school year 6, ages 12–13). We estimated an Intention-To-Treat (ITT) Difference-in-Difference (DD) model to analyze the effectiveness of the intervention on subsequent alcohol use measured in grades 7, 8 and 9.

    Results: The main results show no effect on the likelihood of drinking alcohol or drinking to intoxication.

    Conclusions: The lack of positive effects highlights the need for policy-makers and public health officials need to carefully consider and evaluate prevention programs in order to ensure that they are worthwhile from school, health, and societal perspectives.

  • 32.
    Bejerot, Susanne
    et al.
    Karolinska Institutet, Stockholm, Sweden .
    Gardner, Ann
    Järvapsykiatrin, Stockholm, Sweden.
    Humble, Mats B.
    Äldrepsykiatrin, Akademiska sjukhuset, Uppsala, Sweden.
    D-vitaminbrist [Vitamin D deficiency]: vems ansvar? [who's responsibility?]2011In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 108, no 14, p. 812-812Article in journal (Refereed)
  • 33.
    Bendtsen, Preben
    et al.
    Department of Medicine and Health, Linköping University, Linköping, Sweden.
    Karlsson, Nadine
    Department of Medicine and Health, Linköping University, Linköping, Sweden.
    Dalal, Koustuv
    Department of Medicine and Health, Linköping University, Linköping, Sweden.
    Nilsen, Per
    Department of Medicine and Health, Linköping University, Linköping, Sweden.
    Hazardous drinking concepts, limits and methods: low levels of awareness, knowledge and use in the Swedish population2011In: Alcohol and Alcoholism, ISSN 0735-0414, E-ISSN 1464-3502, Vol. 46, no 5, p. 638-45Article in journal (Refereed)
    Abstract [en]

    Aims: To investigate the awareness and knowledge of hazardous drinking limits among the general population in Sweden and the extent to which people estimate their alcohol consumption in standard drinks to assess their level of drinking.

    Methods: A population-based study involving 6000 individuals selected from the total Swedish population was performed. Data were collected by means of a postal questionnaire. The mail survey response rate was 54.3% (n = 3200) of the net sample of 5891 persons.

    Results: With regard to drinking patterns, 10% of the respondents were abstainers, 59% were sensible drinkers and 31% were classified as hazardous drinkers. Most of the abstainers (80%), sensible drinkers (64%) and hazardous drinkers (56%) stated that they had never heard about the standard drink method. Familiarity with the hazardous drinking concept also differed between the three categories although ∼61% of sensible and hazardous drinkers expressed awareness of the concept (46% of the abstainers). Knowledge about the limits for sensible drinking was very poor. Between 94 and 97% in the three categories did not know the limit. There was a statistically significant association between having visited health care within the last 12 months and being aware of the standard drink method and the hazardous drinking concept, but not with knowing the hazardous drinking limits. Similarly, there was a significant association between having had at least one alcohol conversation in health care within the last 12 months and being aware of the standard drink method and the hazardous drinking concept, but not with knowing the hazardous drinking limits.

    Conclusion: The results can be seen as a major challenge for the health-care system and public health authorities because they imply that a large proportion of the Swedish population does not know when alcohol consumption becomes a threat to their health. The current strategy to disseminate knowledge about sensible drinking limits to the population through the health-care system seems to have failed and new means of informing the population are warranted.

  • 34.
    Biswas, Animesh
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Maternal and Neonatal Death Review System to Improve Maternal and Neonatal Health Care Services in Bangladesh2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Bangladesh has made encouraging progress in reducing maternal and neonatal mortality over the past two decades. However, deaths are much higher than in many other countries. The death reporting system to address maternal, neonatal deaths and stillbirths is still poor. Moreover, cause identification for each of the community and facility deaths is not functional. The overall objective of this thesis is to develop, implement and evaluate the Maternal and Neonatal Death Review (MNDR) system in Bangladesh. The study has been conducted in two districts of Bangladesh. A mixed method is used in studies I and II, whereas a qualitative method is used in studies III-V, and cost of MNDR is calculated in study VI. In-depth interviews, focus group discussions, group discussions, participant observations and document reviews are used as data collection techniques. Quantitative data are collected from the MNDR database. In study I, community death notification in the MNDR system was found to be achievable and acceptable at district level in the existing government health system. A simple death notification process is used to capture community-level maternal and neonatal deaths and stillbirths. It was useful for local-level planning by health managers. In study II, death-notification findings explored dense pocket areas in the district. The health system took local initiatives based on the findings. This resulted in visible and tangible changes in care-seeking and client satisfaction. Death numbers in 2012 were reduced in comparison with 2010 in the specific area. In study III, verbal autopsies at community level enabled the identification of medical and social causes of death, including community delays. Deceased family members cordially provided information on deaths to field-level government health workers. The health managers used the findings for a remedial action plan, which was implemented as per causal findings. In study IV, social autopsy highlights social errors in the community, and promotes discussion based on a maternal or neonatal death, or stillbirth. This was aneffective means to  deliver some important messages and to sensitize the community. Importantly, the community itself plans and decides on what should be done in future to avert such deaths. In study V, facility death review of maternal and neonatal deaths was found to be possible and useful in upazila and district facilities. It not only identified medical causes of death, but also explored gaps and challenges in facilities that can be resolved. The findings of facility death reviews were helpful to local health mangers and planners in order to develop appropriate action plans and improve quality of care at facility level. Finally, in study VI, the initial piloting costs required for MNDR implementation were estimated, including large capacity development and other developmental costs. However, in the following year, costs were reduced. Unit cost per activity was 3070 BDT in 2010, but, in the following years, 1887 BDT and 2207 BDT, in 2011 and 2012 respectively.

    List of papers
    1. Community Notification of Maternal, Neonatal Deaths and Still Births in Maternal and Neonatal Death Review (MNDR) System: Experiences in Bangladesh
    Open this publication in new window or tab >>Community Notification of Maternal, Neonatal Deaths and Still Births in Maternal and Neonatal Death Review (MNDR) System: Experiences in Bangladesh
    2014 (English)In: Health, ISSN 1949-5005, Vol. 6, no 16, p. 2218-2226Article in journal (Refereed) Published
    Abstract [en]

    Objectives: The aim of the study was to examine the process of community maternal, neonatal deaths and still births notification within the Bangladesh government health structure using the Maternal and Neonatal Death Review (MNDR) system. The study also explored the feasibility and acceptance of community death notification in the MNDR system.

    Methods: The study was under-taken in the Thakurgaon district of Bangladesh during 2010. During the study a mix of both qualitative and quantitative information was collected. A review of the documentation process of community death notification was undertaken and focus group discussions (FGDs) with community members, health care providers and managers in a sub-district were conducted, with in-depth interviews (IDIs) with district heath and family planning managers. Quantitative data were collected from community death notifications in the district during January to December 2010.

    Results: The death notification process was implemented by the government health care system within the Thakurgaon district. Field level health and family planning staff collected maternal and neonatal death information, recorded the death on the notification form and reported back to the Upazila (sub-district of the district) focal point at the Upazila health complex (primary health care centre). Community people were encouraged to share their death information to field level health staff. The health and family planning managers in the district periodically discussed the maternal and neonatal deaths and prepared remedial action plans in high death notified areas. In 2010, 59 maternal deaths, 739 neonatal deaths and 633 still births were reported in Thakurgaon district. District health and family planning departments performed community death notification as part of their routine daily work and integrated these procedures with other field level activities.

    Place, publisher, year, edition, pages
    China: Scientific Research Publishing, 2014
    Keywords
    Community death notification, maternal and neonatal death, bangladesh
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:oru:diva-41207 (URN)10.4236/health.2014.616257 (DOI)
    Note

    Available from: 2015-01-13 Created: 2015-01-13 Last updated: 2017-10-17Bibliographically approved
    2. Maternal and neonatal death review (MNDR): A useful approach to identifying appropriate and effective maternal and neonatal health initiatives in Bangladesh
    Open this publication in new window or tab >>Maternal and neonatal death review (MNDR): A useful approach to identifying appropriate and effective maternal and neonatal health initiatives in Bangladesh
    Show others...
    2014 (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Objectives: To identify the effects of Maternal and Neonatal Death Review (MNDR) in terms of improving maternal and neonatal health at the community level in Bangladesh.

    Methods: Both quan- titative and qualitative methods were undertaken for collecting data in Kashipur Union, Bangla- desh. Death notifications from households, subsequent data collections from a focus-group discus- sion (FGD), a group discussion (GD) and in-depth interviews (IDIs) were obtained using structured tools and guidelines.

    Results: A total of four maternal deaths, 21 neonatal deaths and 15 still births were reported in the MNDR death notification system at Kashipur Union in 2010. Data were presented to local programme managers, who took various initiatives including awareness pro- grammes, pregnancy registration, antenatal care, birth planning, and also the revitalization of a community clinic. The coverage of antenatal care, delivery in clinics, postnatal care and referral of complications increased through the active participation of the community. Community health- care providers, care recipients and members of the community expressed satisfaction with the quality of maternal and neonatal services. In the preceding two years, maternal and neonatal deaths substantially reduced in Kashipur (in 2011 maternal death = 1, neonatal death = 20, still birth = 8; in 2012 maternal death = 1, neonatal death = 8, still birth = 13).

    Conclusions: The MNDR system successfully delivered notification of all maternal and neonatal deaths in the defined area and collected information for the formulation and implementation of specific interventions, which resulted in visible and tangible changes in care-seeking and client satisfaction.

    Keywords
    Maternal and neonatal health, death review, primary healthcare, Bangladesh
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:oru:diva-41213 (URN)
    Available from: 2015-01-13 Created: 2015-01-13 Last updated: 2017-10-18Bibliographically approved
    3. Experiences of Community Verbal Autopsy in Maternal and Newborn Health of Bangladesh
    Open this publication in new window or tab >>Experiences of Community Verbal Autopsy in Maternal and Newborn Health of Bangladesh
    Show others...
    2015 (English)Manuscript (preprint) (Other academic)
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Research subject
    Public health
    Identifiers
    urn:nbn:se:oru:diva-46529 (URN)
    Available from: 2015-11-18 Created: 2015-11-18 Last updated: 2017-10-18Bibliographically approved
    4. Social Autopsy: A Social Intervention to Generate Community Awareness of Maternal and Neonatal Deaths
    Open this publication in new window or tab >>Social Autopsy: A Social Intervention to Generate Community Awareness of Maternal and Neonatal Deaths
    Show others...
    (English)Manuscript (preprint) (Other academic)
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Research subject
    Public health
    Identifiers
    urn:nbn:se:oru:diva-46531 (URN)
    Available from: 2015-11-18 Created: 2015-11-18 Last updated: 2017-10-17Bibliographically approved
    5. Facility Death Review of Maternal and Neonatal Deaths in Bangladesh
    Open this publication in new window or tab >>Facility Death Review of Maternal and Neonatal Deaths in Bangladesh
    Show others...
    2015 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 11, article id e0141902Article in journal (Refereed) Published
    Abstract [en]

    Objectives: To explore the experiences, acceptance, and effects of conducting facility death review (FDR) of maternal and neonatal deaths and stillbirths at or below the district level in Bangladesh.

    Methods This was a qualitative study with healthcare providers involved in FDRs. Two districts were studied: Thakurgaon district (a pilot district) and Jamalpur district (randomly selected from three follow-on study districts). Data were collected between January and November 2011. Data were collected from focus group discussions, in-depth interviews, and document review. Hospital administrators, obstetrics and gynecology consultants, and pediatric consultants and nurses employed in the same departments of the respective facilities participated in the study. Content and thematic analyses were performed.

    Results: FDR for maternal and neonatal deaths and stillbirths can be performed in upazila health complexes at sub-district and district hospital levels. Senior staff nurses took responsibility for notifying each death and conducting death reviews with the support of doctors. Doctors reviewed the FDRs to assign causes of death. Review meetings with doctors, nurses, and health managers at the upazila and district levels supported the preparation of remedial action plans based on FDR findings, and interventions were planned accordingly. There were excellent examples of improved quality of care at facilities as a result of FDR. FDR also identified gaps and challenges to overcome in the near future to improve maternal and newborn health.

    Discussion: FDR of maternal and neonatal deaths is feasible in district and upazila health facilities. FDR not only identifies the medical causes of a maternal or neonatal death but also explores remediable gaps and challenges in the facility. FDR creates an enabled environment in the facility to explore medical causes of deaths, including the gaps and challenges that influence mortality. FDRs mobilize health managers at upazila and district levels to forward plan and improve healthcare delivery.

    Place, publisher, year, edition, pages
    San Francisco, USA: Public Library of Science, 2015
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Research subject
    Public health
    Identifiers
    urn:nbn:se:oru:diva-46535 (URN)10.1371/journal.pone.0141902 (DOI)000364303800035 ()26540233 (PubMedID)2-s2.0-84951309788 (Scopus ID)
    Note

    Funding Agencies:

    UNICEF, Bangladesh through Canadian CIDA (Department of Foreign Affairs, Trade and Development)

    Department for International Development (DFID) & European Commission (EC)

    Available from: 2015-11-18 Created: 2015-11-18 Last updated: 2018-07-02Bibliographically approved
    6. The economic cost of implementing maternal and neonatal death review in a district of Bangladesh
    Open this publication in new window or tab >>The economic cost of implementing maternal and neonatal death review in a district of Bangladesh
    (English)Manuscript (preprint) (Other academic)
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Research subject
    Public health
    Identifiers
    urn:nbn:se:oru:diva-46533 (URN)
    Available from: 2015-11-18 Created: 2015-11-18 Last updated: 2017-10-17Bibliographically approved
  • 35.
    Biswas, Animesh
    et al.
    Örebro University, School of Health Sciences. Centre for Injury Prevention and Research (CIPRB), Dhaka, Bangladesh.
    Dalal, Koustuv
    Örebro University, School of Health Sciences.
    Abdullah, Abu Sayeed Md
    Centre for Injury Prevention and Research (CIPRB), Dhaka, Bangladesh.
    Gifford, Mervyn
    Örebro University, School of Health Sciences.
    Halim, M.A.
    Centre for Injury Prevention and Research (CIPRB), Dhaka, Bangladesh.
    Maternal complications in a geographically challenging and hard to reach district of Bangladesh: a qualitative study2016In: F1000 Research, ISSN 0106-3324, E-ISSN 2046-1402, Vol. 5, article id 2417Article in journal (Refereed)
    Abstract [en]

    Background: Maternal complications contribute to maternal deaths in developing countries. Bangladesh still has a high prevalence of maternal mortality, which is often preventable. There are some geographically challenging and hard to reach rural districts in Bangladesh and it is difficult to get information about maternal complications in these areas. In this study, we examined the community lay knowledge of possible pregnancy complications. We also examined the common practices associated with complications and we discuss the challenges for the community.

    Methods: The study was conducted in Moulvibazar of north east Bangladesh, a geographically challenged, difficult to reach district. Qualitative methods were used to collect the information. Pregnant women, mothers who had recently delivered, their guardians and traditional birth attendants participated in focus group discussions. Additionally, in-depth interviews were conducted with the family members. Thematic analyses were performed.

    Results: The study revealed that there is a lack of knowledge of maternal complications. In the majority of cases, the mothers did not receive proper treatment for maternal complications. There are significant challenges that these rural societies need to address: problems of ignorance, traditional myths and family restrictions on seeking better treatment. Moreover, traditional birth attendants and village doctors also have an important role in assuring appropriate, effective and timely treatment.

    Conclusions: The rural community lacks adequate knowledge on maternal complications. Reduction of the societal barriers including barriers within the family can improve overall practices. Moreover, dissemination of adequate information to the traditional birth attendant and village doctors may improve the overall situation, which would eventually help to reduce maternal deaths.

  • 36.
    Biswas, Animesh
    et al.
    Centre for Injury Prevention and Research Bangladesh (CIPRB), Dhaka, Bangladesh .
    Dalal, Koustuv
    Örebro University, School of Health Sciences. Centre for Injury Prevention and Safety Promotion.
    Deave, Toity
    University of the West of England, Bristol, United Kingdom.
    Mashreky, Saidur Rahman
    Centre for Injury Prevention and Research Bangladesh (CIPRB), Dhaka, Bangladesh; Bangladesh University of Health Sciences (BUHS), Bangladesh .
    Burn Injury of a Pregnant Mother in Rural Bangladesh: A Case Report2017In: Health Scope, ISSN 2251-8959, Vol. 6, no 4, article id e63168Article in journal (Refereed)
    Abstract [en]

    Introduction: This paper describes a case of pregnant mother who died of burn injury in order to understand the societal factors related to the event. We reviewed the case in the rural community. Initially, the case was reported as a maternal death to maternal and neonatal death review (MNDR) system being conducted in Bangladesh within exiting health system to explore the medical and social causes of maternal and newborn deaths. However, during the verbal autopsy, it was found that the mother died of bun injury. Therefore, we performed detailed case study.

    Case Presentation: A woman aged 18 years was nine months pregnant in a rural community in Moheskhali upazila of Cox's Bazar district. During the wintertime, themotherfeels coldandgoes near to the oven in the yard to bewarm. Suddenly, part of her clothing (Anchal of Sari) catches fire; she does not recognized and starts to walk towards her room. A neighbor notices and starts to shout. The woman scars and tries to run. The neighbors come with a bucket of water. By this time, the fire spreads over whole body and cloths. Immediately after the event, she is transferred to a medical college hospital.

    Conclusions: Doctors tried to do immediate cesarean section; however, they could not save the life of the baby inside. The mother who was severely burnt also died after 10 days. Rural community in Bangladesh still does not have adequate awareness and knowledge about risk of burn. The scarce knowledge of appropriate steps immediately after burn was explored. Moreover, delays in decision-making and transferring the patient to the facility were identified. Specific interventions need to be taken to increase knowledge and awareness in the community, which could save thousands of lives.

  • 37.
    Biswas, Animesh
    et al.
    Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh.
    Dalal, Koustuv
    Örebro University, School of Health Sciences.
    Hossain, Jahangir
    Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh.
    Baset, Kamran Ul
    Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh.
    Rahman, Fazlur
    Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh.
    Mashreky, Saidur Rahman
    Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh.
    Lightning Injury is a disaster in Bangladesh?: Exploring its magnitude and public health needs2016In: F1000 Research, ISSN 0106-3324, E-ISSN 2046-1402, Vol. 5, article id 2931Article in journal (Refereed)
    Abstract [en]

    Background: Lightning injury is a global public health issue. Low and middle-income countries in the tropical and subtropical regions of the world are most affected by lightning. Bangladesh is one of the countries at particular risk, with a high number of devastating lightning injuries in the past years, causing high mortality and morbidity. The exact magnitude of the problem is still unknown and therefore this study investigates the epidemiology of lightning injuries in Bangladesh, using a national representative sample.

    Methods: A mixed method was used. The study is based on results from a nationwide cross-sectional survey performed in 2003 in twelve randomly selected districts. In the survey, a total of 819,429 respondents from 171,336 households were interviewed using face-to-face interviews. In addition, qualitative information was obtained by reviewing national and international newspaper reports of lightning injuries sustained in Bangladesh between 13 and 15 May 2016.

    Results: The annual mortality rate was 3.661 (95% CI 0.9313–9.964) per 1,000,000 people. The overall incidence of lightning injury was 19.89/100,000 people. Among the victims, 60.12% (n=98) were males and 39.87% (n=65) were females. Males were particularly vulnerable, with a 1.46 times increased risk compared with females (RR 1.46, 95% CI 1.06–1.99). Rural populations were more vulnerable, with a 8.73 times higher risk, than urban populations (RR 8.73, 95% CI 5.13–14.86). About 43% of injuries occurred between 12 noon and 6 pm. The newspapers reported 81 deaths during 2 days of electric storms in 2016. Lightning has been declared a natural disaster in Bangladesh.

    Conclusions: The current study indicates that lightning injuries are a public health problem in Bangladesh. The study recommends further investigations to develop interventions to reduce lightning injuries, mortality and related burden in Bangladesh.

  • 38.
    Biswas, Animesh
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Injury Prevention and Research Bangladesh (CIPRB), Dhaka, Bangladesh; Deptartment of Public Health Sciences, Region Örebro County, Örebro, Sweden.
    Dalal, Koustuv
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Rahman, Fazlur
    Centre for Injury Prevention and Research Bangladesh (CIPRB), Dhaka, Bangladesh.
    Deave, Toity
    Centre for Child & Adolescent Health, Health & Applied Sciences, University of the West of England, Bristol, UK.
    Intimate Partner Violence during pregnancy and victim’s perception on miscarriage2015In: International Journal of Public Health Research, ISSN 2381-4837, Vol. 3, no 2, p. 58-63Article in journal (Refereed)
    Abstract [en]

    Introduction: Women who suffer intimate partner violence (IPV) encounter reproductive health problems including miscarriages. IPV in Bangladeshi women is known to be acute socio- medical problem. The aim of the current study was to determine the prevalence of intimate partner violence from the husband during pregnancy and to explore the victims’ perceptions of IPV and miscarriage.

    Methods: Women who were admitted to a sub-district level hospital in Bangladesh due to miscarriage between July and December 2007 were invited to participate. A cross-sectional study was performed using mixed methods. Descriptive statistics were applied to the quantitative data and the qualitative data were analysed using thematic analysis.

    Results: Majority of women aged between 18 – 30 years (68.4%), more than 38% had no education and most of them had low socio-economic conditions. 43 (56.6%) women reported that they had experienced sexual violence in the last four months. 20 (26.3%) women suffered this once a week and 30% (n=23) faced sexual violence twice or more in a week. 29 (38.2%) women believed that current miscarriage was due to their husband’s sexual violence. The women reported that their husband forced sexual intercourse on them and that they were highly controlling over their day-to-day lives.

    Conclusion: Sexual violence during pregnancy is a hidden health problem for women in rural Bangladesh. Education and information need to be made more widely available to improve maternal health and child survival.

  • 39.
    Biswas, Animesh
    et al.
    Örebro University, School of Health Sciences. Centre for Injury Prevention and Research (CIPRB), Dhaka, Bangladesh.
    Halim, Abdul
    Centre for Injury Prevention and Research (CIPRB) , Dhaka, Bangladesh.
    Rahman, Fazlur
    Centre for Injury Prevention and Research (CIPRB) , Dhaka, Bangladesh.
    Eriksson, Charli
    Örebro University, School of Health Sciences.
    Dalal, Koustuv
    Örebro University, School of Health Sciences.
    The Economic Cost of Implementing Maternal and Neonatal Death Review in a District of Bangladesh2016In: Journal of Public Health Research, ISSN 2279-9028, E-ISSN 2279-9036, Vol. 5, no 3, p. 99-103, article id 729Article, review/survey (Refereed)
    Abstract [en]

    Introduction: Maternal and neonatal death review (MNDR) introduced in Bangladesh and initially piloted in a district during 2010. MNDR is able to capture each of the maternal, neonatal deaths and stillbirths from the community and government facilities (hospitals). This study aimed to estimate the cost required to implement MNDR in a district of Bangladesh during 2010-2012.

    Materials and Methods: MNDR was implemented in Thakurgaon district in 2010 and later gradually extended until 2015. MNDR implementation framework, guidelines, tools and manual were developed at the national level with national level stakeholders including government health and family planning staff at different cadre for piloting at Thakurgaon. Programme implementation costs were calculated by year of costing and costing as per component of MNDR in 2013. The purchasing power parity conversion rate was 1 $INT = 24.46 BDT, as of 31st Dec 2012.

    Results: Overall programme implementation costs required to run MNDR were 109,02,754 BDT (445,738 $INT $INT) in the first year (2010). In the following years cost reduced to 8,208,995 BDT (335,609 $INT, during 2011) and 6,622,166 BDT (270,735 $INT, during 2012). The average cost per activity required was 3070 BDT in 2010, 1887 BDT and 2207 BDT required in 2011 and 2012 respectively. Each death notification cost 4.09 $INT, verbal autopsy cost 8.18 $INT, and social autopsy cost 16.35 $INT. Facility death notification cost 2.04 $INT and facility death review meetings cost 20.44 $INT. One death saved by MNDR costs 53,654 BDT (2193 $INT).

    Conclusions: Programmatic implementation cost of conducting MPDR give an idea on how much cost will be required to run a death review system for a low income country settings using government health system.

  • 40.
    Biswas, Animesh
    et al.
    Örebro University, School of Health Sciences. Reproductive and Child Health Unit, Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh.
    Halim, M. A.
    Reproductive and Child Health Unit, Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh.
    Dalal, Koustuv
    Örebro University, School of Health Sciences.
    Rahman, Fazlur
    Reproductive and Child Health Unit, Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh.
    Exploration of social factors associated to maternal deaths due to haemorrhage and convulsions: Analysis of 28 social autopsies in rural Bangladesh2016In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 16, no 1, article id 659Article in journal (Refereed)
    Abstract [en]

    Background: Social autopsy is an innovative approach to explore social barriers and factors associated to a death in the community. The process also sensitize the community people to avert future deaths. Social autopsy has been introduced in maternal deaths in Bangladesh first time in 2010. This study is to identify the social factors in the rural community associated to maternal deaths. It also looks at how the community responses in social autopsy intervention to prevent future maternal deaths.

    Methods: The study was conducted in the Thakurgaon district of Bangladesh in 2010. We have purposively selected 28 social autopsy cases of which maternal deaths occurred due to either haemorrhage or due to convulsions. The autopsy was conducted by the Government health and family planning first line field supervisors in rural community. Family members and neighbours of the deceased participated in each autopsy and provided their comments and responses.

    Results: A number of social factors including delivery conducted by the untrained birth attendant or family members, delays in understanding about maternal complications, delays in decision making to transfer the mother, lack of proper knowledge, education and traditional myth influences the maternal deaths. The community identified their own problems, shared within them and decide upon rectify themselves for future death prevention.

    Conclusions: Social autopsy is a useful tools to identify social community within the community by discussing the factors that took place during a maternal death. The process supports villagers to think and change their behavioural patterns and commit towards preventing such deaths in the future.

  • 41.
    Biswas, Animesh
    et al.
    Centre for Injury Prevention Research, Dhaka, Bangladesh.
    Rahman, Aminur
    Centre for Injury Prevention Research, Dhaka, Bangladesh.
    Mashreky, Saidur
    Centre for Injury Prevention Research, Dhaka, Bangladesh.
    Rahman, Fazlur
    Centre for Injury Prevention Research, Dhaka, Bangladesh.
    Dalal, Koustuv
    Department of Medical and Health Sciences, Center for Medical Technology Assessment and Division of Social Medicine and Public Health Sciences, Linköping Universtity, Linköping, Sweden.
    Unintentional injuries and parental violence against children during flood: a study in rural Bangladesh.2010In: Rural and remote health, ISSN 1445-6354, Vol. 10, no 1, p. 1199-Article in journal (Refereed)
    Abstract [en]

    Introduction: Violence and injuries are under-reported in developing countries, especially during natural disasters such as floods. Compounding this, affected areas are isolated from the rest of the country. During 2007 Bangladesh experienced two consecutive floods which affected almost one-third of the country. The objective of this study was to examine unintentional injuries to children in rural Bangladesh and parental violence against them during floods, and also to explore the association of socioeconomic characteristics.

    Methods: A cross-sectional rural household survey was conducted in the worst flood-affected areas. A group of 638 randomly selected married women of reproductive age with at least one child at home were interviewed face-to-face using pre-tested structured questionnaires. The chi2 test and logistic regression were used for data analysis.

    Results: The majority of families (90%) were affected by the flood and were struggling to find food and shelter, resulting in the parents becoming violent towards their children and other family members in the home. Cuts (38%), falls (22%) and near drowning (21%) comprised the majority of unintentional injuries affecting children during the floods. A large number of children were abused by their parents during the floods (70% by mothers and 40% by fathers). The incidence of child injuries and parental violence against children was higher among families living in poor socio-economic conditions, whose parents were of low occupational status and had micro-credit loans during the floods.

    Conclusions: Floods can have significant effects on childhood injury and parental violence against children. The improvement of socio-economic conditions would assist in preventing child injuries and parental violence.

  • 42.
    Biswas, Animesh
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh; Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh; WHO Collaborating Centre On Community Safety Promotion, Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden.
    Rahman, Aminur
    Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh.
    Rahman Mashkreky, Saidur
    Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh.
    Humaira, Tasnuva
    Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh.
    Dalal, Koustuv
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Rescue and emergency management of a man-made disaster: Lesson learnt from a collapse factory building, Bangladesh2015In: Scientific World Journal, ISSN 1537-744X, E-ISSN 1537-744X, article id 136434Article in journal (Refereed)
    Abstract [en]

    A tragic disaster occurred on April 24, 2013, in Bangladesh, when a nine storied building in a suburban area collapsed and killed 1115 people and injured many more.The study describes the process of rescue operation and emergency management services provided in the event. Data were collected using qualitative methods including in-depth interviews and a focus group discussion with the involved medical students, doctors, volunteers, and local people. Immediately after the disaster, rescue teams came to the place from Bangladesh Armed Forces, Bangladesh Navy, Bangladesh Air Force, and Dhaka Metropolitan and local Police and doctors, medical students, and nurses fromnearbymedical college hospitals and private hospitals and students fromcolleges and universities including local civil people. Doctors and medical students provided 24-hour services at the disaster place and in hospitals. Minor injured patients were treated at health camps and major injured patients were immediately carried to nearby hospital. Despite the limitations of a low resource setting, Bangladesh faced a tremendous challenge to manage the man-made disaster and experienced enormous support from different sectors of society to manage the disaster carefully and saved thousands of lives. This effort could help to develop a standard emergency management system applicable to Bangladesh and other counties with similar settings.

  • 43.
    Biswas, Animesh
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Injury Prevention and Research (CIPRB), Dhaka, Bangladesh.
    Rahman, F.
    Centre for Injury Prevention and Research (CIPRB), Dhaka, Bangladesh.
    Eriksson, Charli
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Dalal, Koustuv
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Maternal and neonatal death review (MNDR): A useful approach in identifying appropriate and effective maternal and neonatal health initiative in Bangladesh2014In: Health, ISSN 1949-5005, Vol. 6, p. 1669-1679Article in journal (Refereed)
    Abstract [en]

    Objectives: To identify the effects of Maternal and Neonatal Death Review (MNDR) in terms of improving maternal and neonatal health at the community level in Bangladesh.

    Methods: Both quantitative and qualitative methods were undertaken for collecting data in Kashipur Union, Bangladesh. Death notifications from households, subsequent data collections from a focus-group discussion (FGD), a group discussion (GD) and in-depth interviews (IDIs) were obtained using structured tools and guidelines.

    Results: A total of four maternal deaths, 21 neonatal deaths and 15 still birthswere reported in the MNDR death notification system at Kashipur Union in 2010. Data were presented to local programme managers, who took various initiatives including awareness programmes, pregnancy registration, antenatal care, birth planning, and also the revitalization of a community clinic. The coverage of antenatal care, delivery in clinics, postnatal care and referral of complications increased through the active participation of the community. Community healthcare providers, care recipients and members of the community expressed satisfaction with the quality of maternal and neonatal services. In the preceding two years, maternal and neonatal deaths substantially reduced in Kashipur (in 2011 maternal death = 1, neonatal death = 20, stillbirth = 8; in 2012 maternal death = 1, neonatal death = 8, still birth = 13).

    Conclusions: The MNDR system successfully delivered notification of all maternal and neonatal deaths in the defined area and collected information for the formulation and implementation of specific interventions, which resulted in visible and tangible changes in care-seeking and client satisfaction.

  • 44.
    Biswas, Animesh
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh.
    Rahman, Fazlur
    Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh.
    Eriksson, Charli
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Dalal, Koustuv
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Community Notification of Maternal, Neonatal Deaths and Still Births in Maternal and Neonatal Death Review (MNDR) System: Experiences in Bangladesh2014In: Health, ISSN 1949-5005, Vol. 6, no 16, p. 2218-2226Article in journal (Refereed)
    Abstract [en]

    Objectives: The aim of the study was to examine the process of community maternal, neonatal deaths and still births notification within the Bangladesh government health structure using the Maternal and Neonatal Death Review (MNDR) system. The study also explored the feasibility and acceptance of community death notification in the MNDR system.

    Methods: The study was under-taken in the Thakurgaon district of Bangladesh during 2010. During the study a mix of both qualitative and quantitative information was collected. A review of the documentation process of community death notification was undertaken and focus group discussions (FGDs) with community members, health care providers and managers in a sub-district were conducted, with in-depth interviews (IDIs) with district heath and family planning managers. Quantitative data were collected from community death notifications in the district during January to December 2010.

    Results: The death notification process was implemented by the government health care system within the Thakurgaon district. Field level health and family planning staff collected maternal and neonatal death information, recorded the death on the notification form and reported back to the Upazila (sub-district of the district) focal point at the Upazila health complex (primary health care centre). Community people were encouraged to share their death information to field level health staff. The health and family planning managers in the district periodically discussed the maternal and neonatal deaths and prepared remedial action plans in high death notified areas. In 2010, 59 maternal deaths, 739 neonatal deaths and 633 still births were reported in Thakurgaon district. District health and family planning departments performed community death notification as part of their routine daily work and integrated these procedures with other field level activities.

  • 45.
    Biswas, Animesh
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka.
    Rahman, Fazlur
    Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka.
    Eriksson, Charli
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Dalal, Koustuv
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    The economic cost of implementing maternal and neonatal death review in a district of BangladeshManuscript (preprint) (Other academic)
  • 46.
    Biswas, Animesh
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Injury Prevention and Research (CIPRB), Dhaka, Bangladesh.
    Rahman, Fazlur
    Centre for Injury Prevention and Research (CIPRB), Dhaka, Bangladesh.
    Eriksson, Charli
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Halim, Abdul
    Centre for Injury Prevention and Research (CIPRB), Dhaka, Bangladesh.
    Dalal, Koustuv
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Facility Death Review of Maternal and Neonatal Deaths in Bangladesh2015In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 11, article id e0141902Article in journal (Refereed)
    Abstract [en]

    Objectives: To explore the experiences, acceptance, and effects of conducting facility death review (FDR) of maternal and neonatal deaths and stillbirths at or below the district level in Bangladesh.

    Methods This was a qualitative study with healthcare providers involved in FDRs. Two districts were studied: Thakurgaon district (a pilot district) and Jamalpur district (randomly selected from three follow-on study districts). Data were collected between January and November 2011. Data were collected from focus group discussions, in-depth interviews, and document review. Hospital administrators, obstetrics and gynecology consultants, and pediatric consultants and nurses employed in the same departments of the respective facilities participated in the study. Content and thematic analyses were performed.

    Results: FDR for maternal and neonatal deaths and stillbirths can be performed in upazila health complexes at sub-district and district hospital levels. Senior staff nurses took responsibility for notifying each death and conducting death reviews with the support of doctors. Doctors reviewed the FDRs to assign causes of death. Review meetings with doctors, nurses, and health managers at the upazila and district levels supported the preparation of remedial action plans based on FDR findings, and interventions were planned accordingly. There were excellent examples of improved quality of care at facilities as a result of FDR. FDR also identified gaps and challenges to overcome in the near future to improve maternal and newborn health.

    Discussion: FDR of maternal and neonatal deaths is feasible in district and upazila health facilities. FDR not only identifies the medical causes of a maternal or neonatal death but also explores remediable gaps and challenges in the facility. FDR creates an enabled environment in the facility to explore medical causes of deaths, including the gaps and challenges that influence mortality. FDRs mobilize health managers at upazila and district levels to forward plan and improve healthcare delivery.

  • 47.
    Biswas, Animesh
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka.
    Rahman, Fazlur
    Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka.
    Eriksson, Charli
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Halim, Abdul
    Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka.
    Dalal, Koustuv
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Social Autopsy: A Social Intervention to Generate Community Awareness of Maternal and Neonatal DeathsManuscript (preprint) (Other academic)
  • 48.
    Biswas, Animesh
    et al.
    Örebro University, School of Health Sciences. Centre for Injury Prevention and Research, Dhaka, Bangladesh.
    Rahman, Fazlur
    Centre for Injury Prevention and Research, Dhaka, Bangladesh.
    Eriksson, Charli
    Örebro University, School of Health Sciences.
    Halim, Abdul
    Centre for Injury Prevention and Research, Dhaka, Bangladesh.
    Dalal, Koustuv
    Örebro University, School of Health Sciences.
    Social Autopsy of maternal, neonatal deaths and stillbirths in rural Bangladesh: qualitative exploration of its effect and community acceptance2016In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, no 8, article id e010490Article in journal (Refereed)
    Abstract [en]

    Objectives: Social Autopsy (SA) is an innovative strategy where a trained facilitator leads community groups through a structured, standardised analysis of the physical, environmental, cultural and social factors contributing to a serious, non-fatal health event or death. The discussion stimulated by the formal process of SA determines the causes and suggests preventative measures that are appropriate and achievable in the community. Here we explored individual experiences of SA, including acceptance and participant learning, and its effect on rural communities in Bangladesh. The present study had explored the experiences gained while undertaking SA of maternal and neonatal deaths and stillbirths in rural Bangladesh.

    Design: Qualitative assessment of documents, observations, focus group discussions, group discussions and in-depth interviews by content and thematic analyses.

    Results: Each community's maternal and neonatal death was a unique, sad story. SA undertaken by government field-level health workers were well accepted by rural communities. SA had the capability to explore the social reasons behind the medical cause of the death without apportioning blame to any individual or group. SA was a useful instrument to raise awareness and encourage community responses to errors within the society that contributed to the death. People participating in SA showed commitment to future preventative measures and devised their own solutions for the future prevention of maternal and neonatal deaths.

    Conclusions: SA highlights societal errors and promotes discussion around maternal or newborn death. SA is an effective means to deliver important preventative messages and to sensitise the community to death issues. Importantly, the community itself is enabled to devise future strategies to avert future maternal and neonatal deaths in Bangladesh.

  • 49.
    Biswas, Animesh
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Injury Prevention and Research Bangladesh (CIPRB), Dhaka, Bangladesh.
    Rahman, Fazlur
    Centre for Injury Prevention and Research Bangladesh (CIPRB), Dhaka, Bangladesh.
    Halim, Abdul
    Centre for Injury Prevention and Research Bangladesh (CIPRB), Dhaka, Bangladesh.
    Eriksson, Charli
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Dalal, Koustuv
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Experiences of community verbal autopsy in maternal and newborn health in Bangladesh2015In: HealthMed, ISSN 1840-2291, E-ISSN 1986-8103, Vol. 9, no 8, p. 329-338Article in journal (Refereed)
    Abstract [en]

    Introduction: Verbal autopsy in maternal and neonatal deaths is commonly used in developing countries to understand the medical and social causes of death in the community. Bangladesh first undertook a community verbal autopsy program in 2010. This was implemented under the maternal and neonatal death review (MNDR) system.

    Objectives: To know the process of implementation of community verbal autopsy, its acceptability and effect in maternal and neonatal health, Bangladesh.

    Methods: A qualitative study was performed In two districts of Bangladesh in 2011. A review of documents, observations, focus group discussions (FGDs) and in-depth interviews (IDIs) were conducted with health care providers from different systems. Data were analysed using a thematic approach

    Results: Community verbal autopsy was developed in Bangladesh using existing available tools and guidelines. First line field supervisors from health and family planning departments conducted verbal autopsies at the deceased’s home. It has been adopted within the government health system and is able to identify medical and social causes, including delays within the community that are the major contributing factors of maternal and neonatal deaths. Verbal autopsy findings are shared at the Upazila level (sub-district) and these influence the development and implementation of local action plans. Recall bias and hard to reach areas are still challenges to be overcome in the conduction of verbal autopsies.

    Conclusions: The use of community verbal autopsy to identify medical and social causes of maternal and neonatal deaths is possible in an encouraging country context. The Government health system can comfortably conduct autopsies within the community. The findings of autopsy can be an effective tool and can be used by the local health and family planning managers to take the initiative at local level to improve health status of the mother and newborn.

  • 50.
    Biswas, Animesh
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Injury Prevention and Research, Dhaka, Bangladesh.
    Rahman, Fazlur
    Centre for Injury Prevention and Research, Dhaka, Bangladesh.
    Halim, Abdul
    Centre for Injury Prevention and Research, Dhaka, Bangladesh.
    Eriksson, Charli
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Dalal, Koustuv
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Experiences of Community Verbal Autopsy in Maternal and Newborn Health of Bangladesh2015Manuscript (preprint) (Other academic)
1234567 1 - 50 of 519
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