| 41. |
- Kiruja, Jonah, et al.
(författare)
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Risk factors for stillbirth and beliefs : Findings from a pilot near miss questionnaire study in Somaliland focusing the mother-baby dyad
- 2017
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Ingår i: MOJ Women’s Health. - Edmond, OK, USA : MedCrave Group, LLC. - 2475-5494. ; 5:3
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Tidskriftsartikel (refereegranskat)abstract
- Background: Somalia is one of 13 countries in Africa with stillbirth rates of more than 30 per 1000 total birth. To our knowledge no study in Somaliland has focused on the mother-baby dyad regarding risk factors for stillbirth. The objective of this study was to identify frequency, causes and beliefs for stillbirth in mothers with life threatening conditions as a pilot for a potential nationwide near-miss study with full coverage in the Somaliland health care system.Method: A prospective cross sectional study using the WHO near-miss questionnaire in a tertiary level hospital with 1.385 deliveries during a five months period in 2015.Results: Out of 138 near miss and death events 22% (n=30) had a stillbirth. Seventy-seven percent (77%) of the mothers (n=23) with stillborn babies survived and 23% died (n=7). They were diagnosed with life threatening conditions, possible to prevent, on arrival at the tertiary hospital. None of them developed the maternal complication/s during the hospital stay. Cesarean sections (43%) were performed within three hours after arrival. Beliefs regarding the stillbirth for the near miss women were that holding the baby born death helps them cope with the loss (74%) and that religious believes helps them cope faster with the loss (91%).Conclusion and clinical implications: The near miss women, their families, TBAs and SBAs might need better information of what causes a stillbirth, how they could prevent it and about the near miss women’s beliefs surrounding stillbirth to enable them to communicate this to pregnant women and prevent delay in admission to the tertiary level hospital. Furthermore, this pilot study suggest that the “Near Miss Questionnaire” could be used in low-and middle income settings to detect a full picture of the situation with stillbirth in a country.
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| 42. |
- Klingberg-Allvin, Marie, 1972-, et al.
(författare)
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"Change-makers in midwifery care": Exploring the differences between expectations and outcomes - a qualitative study of a midwifery net-based education programme in the Somali region
- 2019
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Ingår i: Midwifery. - : Elsevier BV. - 0266-6138 .- 1532-3099. ; 69, s. 135-142
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study is to explore midwifery educators’ expected outcomes in the net-based master's programme, the programmes’ realised outcomes and the reported difference regarding the increased choices for the graduates and the effect on their agency.DesignIn this case study, we focused on a net-based master's programme in sexual and reproductive health in Somalia. Somalia suffers from a shortage of skilled birth attendants and there is a need for building up the capacity of midwifery educators.Setting and participantsData was collected in focus group discussions at the start of the programme and eight months after the students graduated. The data were analysed through the lens of the choice framework, which is based on the capability approach.FindingsFindings show that many of the graduates’ expectations were met, while some were more difficult to fulfil. While the midwives’ choices and resource portfolios had improved because of their role as educators, the social structure prevented them from acting on their agency, specifically in regards to making changes at the social level. Several of the positive developments can be attributed to the pedagogy and structure of the programme.ConclusionThe flexibility of net-based education gave the midwifery educators a new educational opportunity that they previously did not have. Students gained increased power and influence on some levels. However, they still lack power in government organisations where, in addition to their role as educators, they could use their skills and knowledge to change policies at the social level.
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| 43. |
- Klingberg-Allvin, Marie, 1972-, et al.
(författare)
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Co-creation to scale up provision of simplified high-quality comprehensive abortion care in East Central and Southern Africa
- 2018
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Ingår i: Global Health Action. - : Informa UK Limited. - 1654-9716 .- 1654-9880. ; 11:1
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Tidskriftsartikel (refereegranskat)abstract
- Universal access to comprehensive abortion care (CAC) is a reproductive right and is essential to reduce preventable maternal mortality and morbidity. In East Africa, abortion rates are consistently high, and the vast majority of all abortions are unsafe, significantly contributing to unnecessary mortality and morbidity. The current debate article reflects and summarises key action points required to continue to speed the implementation of and expand access to CAC in the East, Central, and Southern African (ECSA) health community. To ensure universal access to quality CAC, a regional platform could facilitate the sharing of best practices and successful examples from the region, which would help to visualise opportunities. Such a platform could also identify innovative ways to secure women's access to quality care within legally restrictive environments and would provide information and capacity building through the sharing of recent scientific evidence, guidelines, and training programmes aimed at increasing women's access to CAC at the lowest effective level in the healthcare system. This type of infrastructure for exchanging information and developing co-creation could be crucial to advancing the Sustainable Development Goals 2030 agenda.
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| 44. |
- Klingberg-Allvin, Marie, et al.
(författare)
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Comparison of treatment of incomplete abortion with misoprostol by physicians and midwives at district level in Uganda : a randomised controlled equivalence trial
- 2015
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Ingår i: The Lancet. - 0140-6736 .- 1474-547X. ; 385:9985, s. 2392-2398
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Misoprostol is established for the treatment of incomplete abortion but has not been systematically assessed when provided by midwives at district level in a low-resource setting. We investigated the effectiveness and safety of midwives diagnosing and treating incomplete abortion with misoprostol, compared with physicians.METHODS: We did a multicentre randomised controlled equivalence trial at district level at six facilities in Uganda. Eligibility criteria were women with signs of incomplete abortion. We randomly allocated women with first-trimester incomplete abortion to clinical assessment and treatment with misoprostol either by a physician or a midwife. The randomisation (1:1) was done in blocks of 12 and was stratified for study site. Primary outcome was complete abortion not needing surgical intervention within 14-28 days after initial treatment. The study was not masked. Analysis of the primary outcome was done on the per-protocol population with a generalised linear-mixed effects model. The predefined equivalence range was -4% to 4%. The trial was registered at ClinicalTrials.gov, number NCT01844024.FINDINGS: From April 30, 2013, to July 21, 2014, 1108 women were assessed for eligibility. 1010 women were randomly assigned to each group (506 to midwife group and 504 to physician group). 955 women (472 in the midwife group and 483 in the physician group) were included in the per-protocol analysis. 452 (95·8%) of women in the midwife group had complete abortion and 467 (96·7%) in the physician group. The model-based risk difference for midwife versus physician group was -0·8% (95% CI -2·9 to 1·4), falling within the predefined equivalence range (-4% to 4%). The overall proportion of women with incomplete abortion was 3·8% (36/955), similarly distributed between the two groups (4·2% [20/472] in the midwife group, 3·3% [16/483] in the physician group). No serious adverse events were recorded.INTERPRETATION: Diagnosis and treatment of incomplete abortion with misoprostol by midwives is equally safe and effective as when provided by physicians, in a low-resource setting. Scaling up midwives' involvement in treatment of incomplete abortion with misoprostol at district level would increase access to safe post-abortion care.FUNDING: The Swedish Research Council, Karolinska Institutet, and Dalarna University.
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| 45. |
- Klingberg-Allvin, Marie, et al.
(författare)
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Ethics of justice and ethics of care. Values and attitudes among midwifery students on adolescent sexuality and abortion in Vietnam and their implications for midwifery education : a survey by questionnaire and interview
- 2007
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Ingår i: International Journal of Nursing Studies. - : Elsevier. - 0020-7489 .- 1873-491X. ; 44:1, s. 37-46
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Tidskriftsartikel (refereegranskat)abstract
- Adolescent’s sexuality and related reproductive health and rights problems are sensitive issues in Vietnam. Globalisation has had an impact on the lifestyles of young people, and rising numbers of abortion and STI/HIV risks among youth are posing major health concerns in the country. These problems need to be addressed. Midwives belong to a key category of health personnel in Vietnam, whose task it is to promote adolescents’ sexual and reproductive health and prevent reproductive ill health. It is important to understand future midwives’ perceptions and attitudes in order to improve their education and training programmes. Aim: The aim of this study was to investigate Vietnamese midwifery students’ values and attitudes towards adolescent sexuality, abortion and contraception and their views on professional preparation. Methods: A quantitative survey including 235 midwifery students from four different secondary medical colleges in northern Vietnam was carried out in 2003. A qualitative study addressing similar questions was performed and 18 midwifery students were individually interviewed. Findings: Findings revealed a general disapproval of adolescent pre-marital sexual relations and abortion – ‘an ethics of justice’ - but also an empathic attitude and willingness to support young women, who bear the consequences of unwanted pregnancies and social condemnation – ‘an ethics of care’. Gender-based imbalance in sexual relationships, limited knowledge about reproductive health issues among youth, and negative societal attitudes were concerns expressed by the students. The students saw their future tasks mainly related to childbearing and less to other reproductive health issues, such as abortion and prevention of STI/HIV. Conclusion: Midwifery education in Vietnam should encourage value-reflective thinking around gender inequality and ethical dilemmas, in order to prepare midwives to address adolescents’ reproductive health needs.
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| 46. |
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| 47. |
- Klingberg-Allvin, Marie, et al.
(författare)
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Married men's first time experiences of early childbearing and their role in sexual and reproductive decision making : a qualitative study from rural Vietnam
- 2012
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Ingår i: Culture, Health and Sexuality. - : Informa UK Limited. - 1369-1058 .- 1464-5351. ; 14:4, s. 449-461
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Tidskriftsartikel (refereegranskat)abstract
- Male partners' involvement in women's sexual and reproductive health has been increasingly emphasised in international health. A qualitative approach with open-ended qualitative interviews was used to explore young, married men's first time experiences of early childbearing, their sexual and reproductive decision making and the meanings they make of their role as husbands and fathers. The results offer a nuanced picture of the men's vulnerability in becoming young fathers and having to assume their role as family decision-makers, while still being inexperienced in matters related to the health of their wives and newborn child. Constraints to gender equality and traditional norms and values continue to pose barriers to both young men and women making independent decisions in relation to marriage and childbearing. Men's involvement is necessary in healthcare programmes designed to improve women's sexual and reproductive health and the health of the newborn. Young, first-time fathers, in particular, need support and empowerment.
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| 48. |
- Klingberg-Allvin, Marie, et al.
(författare)
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One foot wet and one foot dry : Transition into motherhood among married adolescent women in rural Vietnam
- 2008
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Ingår i: Journal of Transcultural Nursing. - : Sage Publications. - 1043-6596 .- 1552-7832. ; 19:4, s. 338-346
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Tidskriftsartikel (refereegranskat)abstract
- This study explores married Vietnamese adolescents' perceptions and experiences related to transition into motherhood and their encounter with health care service. In-depth interviews were conducted with 22 women younger than 20 who were either pregnant or had newly delivered. It emerged from the narratives that young women experienced ambivalence in the transition to motherhood in that they felt too young but also happy to be able to please their husband and the extended family. Patterns were shown indicating that the participants experienced lacking power with regard to decisions in relation to pregnancy, delivery, and contraceptive usage. Feelings of being patronized and ignored in the encounter with health care providers were seen in the narratives. Findings might be used for reproductive health care providers, social workers, and educators in their contact with young mothers to empower them to make their own decisions with regard to marriage, childbearing, and contraception.
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| 49. |
- Klingberg-Allvin, Marie, et al.
(författare)
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Perspectives of midwives and doctors on adolescent sexuality and abortion care in Vietnam.
- 2006
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Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 34:4, s. 414-421
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Tidskriftsartikel (refereegranskat)abstract
- Background: Vietnam has one of the highest abortion rates in the world and adolescent abortions are thought to constitute at least one third of all cases. Lack of balanced reproductive health information and services to adolescents and negative social attitudes towards adolescent sexuality are contributing factors to the high abortion rates. Health providers are important in guiding and counselling adolescents on how to protect their reproductive health. There is a lack of studies on health providers’ perspectives on their work in adolescent reproductive health care. Aim: To explore the perspectives of midwives and doctors on adolescent sexuality and abortion, and what they considered to be quality abortion care for adolescents and the barriers to it, as well as to their own training needs. Methods: Observations of care in abortion clinics and focus group discussions (FGD) were used to collect data. Doctors and midwives from three health care facilities in Quang Ninh province in Northern Vietnam participated in a total of eight FGDs. Data were analysed using latent content analysis.Findings: Major barriers identified for quality abortion care were of technical and managerial nature. Participants considered that counselling unmarried clients in connection with abortion should focus on warning against the risks and dangers of abortion and pre-marital sexual relations, which they strongly disapproved of. However, they also expressed a pragmatic and caring attitude towards the unmarried girls and couples coming for abortion. Adolescent sexuality and abortion are morally sensitive issues in the Vietnamese culture. The contradictions between cultural norms and the reality facing health providers while counselling the unmarried adolescents need to be addressed in education and training programmes.
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| 50. |
- Klingberg-Allvin, Marie, et al.
(författare)
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Pregnancies and births among adolescents : a population based prospective study in rural Vietnam
- 2010
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Ingår i: Sexual & Reproductive HealthCare. - : Elsevier. - 1877-5756 .- 1877-5764. ; 1:1, s. 15-19
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To describe birth rates and pregnancy outcomes, specifically stillbirth, preterm delivery and low birth weight (LBW) in relation to socio-demographic characteristics, among adolescent women in a rural district in northern Vietnam.Material and method. Within an epidemiological field laboratory, quarterly surveillance of 7767 adolescent women in the ages 15–19 during the period January 1999 to December 2005 was conducted. Birth rates were calculated and pregnancy outcomes were described in relation to background factors.Result. A total of 1021 pregnancies were reported by 926 adolescent women during the period of whom 17% were below 18years. The estimated adolescent birth rate during 1999–2005 was 27/1000 women-years. The incidence of stillbirth among all births was 19/1000 births. These were more likely to be delivered preterm. The incidence of preterm deliveries and LBW infants was 193 and 75 per 1000 live births, respectively. There were no differences in socio-demographic background for stillbirth, preterm delivery or LBW.Conclusion. Adolescent birth rates were similar to those found in the recent Vietnamese DHS and considerably lower than the average for South-East Asia. Higher rates of stillbirth and preterm delivery were found than those previously reported for Vietnam, indicating the need for careful monitoring of adolescent pregnancies and their infants. Further research is needed to explore if and how much socio-demographic variables influence pregnancy outcome, comparing more differentiated groups, as a basis for interventions to assure access to adequate reproductive health care services for all women.
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