SwePub
Sök i SwePub databas

  Utökad sökning

Träfflista för sökning "WFRF:(Klingberg Allvin Marie 1972 ) "

Sökning: WFRF:(Klingberg Allvin Marie 1972 )

  • Resultat 1-38 av 38
Sortera/gruppera träfflistan
   
NumreringReferensOmslagsbildHitta
1.
  • Klingberg-Allvin, Marie, et al. (författare)
  • One foot wet and one foot dry : transition into motherhood among married adolescent women in rural Vietnam
  • 2008
  • Ingår i: Journal of Transcultural Nursing. - : Sage Publications. - 1043-6596 .- 1552-7832. ; 19:4, s. 338-346
  • 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.
  •  
2.
  • Påfs, Jessica, 1984-, et al. (författare)
  • Implementing the liberalized abortion law in Kigali, Rwanda : Ambiguities of rights and responsibilities among health care providers
  • 2020
  • Ingår i: Midwifery. - : Churchill Livingstone. - 0266-6138 .- 1532-3099. ; 80
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: Rwanda amended its abortions law in 2012 to allow for induced abortion under certain circumstances. We explore how Rwandan health care providers (HCP) understand the law and implement it in their clinical practice. Design: Fifty-two HCPs involved in post-abortion care in Kigali were interviewed by qualitative individual in-depth interviews (n =32) and in focus group discussions (n =5) in year 2013, 2014, and 2016. All data were analyzed using thematic analysis. Findings: HCPs express ambiguities on their rights and responsibilities when providing abortion care. A prominent finding was the uncertainties about the legal status of abortion, indicating that HCPs may rely on outdated regulations. A reluctance to be identified as an abortion provider was noticeable due to fear of occupational stigma. The dilemma of liability and litigation was present, and particularly care providers’ legal responsibility on whether to report a woman who discloses an illegal abortion. Conclusion: The lack of professional consensus is creating barriers to the realization of safe abortion care within the legal framework, and challenge patients right for confidentiality. This bring consequences on girl's and women's reproductive health in the setting. Implications for practice: To implement the amended abortion law and to provide equitable maternal care, the clinical and ethical guidelines for HCPs need to be revisited. © 2019
  •  
3.
  • Atuhairwe, Susan, et al. (författare)
  • Evaluating the safety, effectiveness and acceptability of treatment of incomplete second-trimester abortion using misoprostol provided by midwives compared with physicians : study protocol for a randomized controlled equivalence trial
  • 2019
  • Ingår i: Trials. - : Springer Science and Business Media LLC. - 1745-6215. ; 20:1
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: A large proportion of abortion-related mortality and morbidity occurs in the second trimester of pregnancy. The Uganda Ministry of Health policy restricts management of second-trimester incomplete abortion to physicians who are few and unequally distributed, with most practicing in urban regions. Unsafe and outdated methods like sharp curettage are frequently used. Medical management of second-trimester post-abortion care by midwives offers an advantage given the difficulty in providing surgical management in low-income settings and current health worker shortages. The study aims to assess the safety, effectiveness and acceptability of treatment of incomplete second-trimester abortion using misoprostol provided by midwives compared with physicians.METHODS: A randomized controlled equivalence trial implemented at eight hospitals and health centers in Central Uganda will include 1192 eligible women with incomplete abortion of uterine size > 12 weeks up to 18 weeks. Each participant will be randomly assigned to undergo a clinical assessment and treatment by either a midwife (intervention arm) or a physician (control arm). Enrolled participants will receive 400 μg misoprostol administered sublingually every 3 h up to five doses within 24 h at the health facility until a complete abortion is confirmed. Women who do not achieve complete abortion within 24 h will undergo surgical uterine evacuation. Pre discharge, participants will receive contraceptive counseling and information on what to expect in terms of side effects and signs of complications, with follow-up 14 days later to assess secondary outcomes. Analyses will be by intention to treat. Background characteristics and outcomes will be presented using descriptive statistics. Differences between groups will be analyzed using risk difference (95% confidence interval) and equivalence established if this lies between the predefined range of - 5% and + 5%. Chi-square tests will be used for comparison of outcome and t tests used to compare mean values. P ≤ 0.05 will be considered statistically significant.DISCUSSION: Our study will provide evidence to inform national and international policies, standard care guidelines and training program curricula on treatment of second-trimester incomplete abortion for improved access.TRIAL REGISTRATION: ClinicalTrials.gov, NCT03622073 . Registered on 9 August 2018.
  •  
4.
  • Cleeve, Amanda, et al. (författare)
  • Abortion as agentive action: reproductive agency among young women seeking post-abortion care in Uganda
  • 2017
  • Ingår i: Culture, Health and Sexuality. - : Informa UK Limited. - 1369-1058 .- 1464-5351. ; 19:11, s. 1286-1300
  • Tidskriftsartikel (refereegranskat)abstract
    • Unsafe abortion in Africa continues to be a major contributor to the global maternal mortality which affects young women in particular. In Uganda, where abortion is legally restricted and stigmatised, unsafe abortion is a major public health issue. We explored reproductive agency in relation to unsafe abortion among young women seeking post-abortion care. Through in-depth interviews we found that reproductive agency was constrained by gender norms and power imbalances and strongly influenced by stigma. Lack of resources and the need for secrecy resulted in harmful abortion practices and delayed care-seeking. Women did not claim ownership of the abortion decision, but the underlying meaning in the narratives positioned abortion as an agentive action aiming to regain control over one's body and future. Women's experiences shaped contraceptive intentions and discourse, creating a window of opportunity that was often missed. This study provides unique insight into how young women negotiate and enact reproductive agency in Uganda. Health systems need to strengthen their efforts to meet young women's sexual and reproductive health needs and protect their rights. Enabling young women's agency through access to safe abortion and contraception is paramount.
  •  
5.
  • Cleeve, Amanda, et al. (författare)
  • Morality versus duty - A qualitative study exploring midwives' perspectives on post-abortion care in Uganda
  • 2019
  • Ingår i: Midwifery. - : Elsevier BV. - 0266-6138 .- 1532-3099. ; 77, s. 71-77
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: We aimed to explore midwives' perspectives on post-abortion care (PAC) in Uganda. Specifically, we sought to improve understanding of the quality of care.DESIGN: This was a qualitative study using individual in-depth interviews and an inductive thematic analysis.SETTING AND PARTICIPANTS: Interviews were conducted with 22 midwives (the 'informants') providing PAC in a public hospital in Kampala, Uganda. The narratives were based on experiences in current and previous workplaces, in rural and urban settings.FINDINGS: The findings comprise one main theme - morality versus duty to provide quality post-abortion care - and three sub-themes. Our findings confirm that the midwives were committed to saving women's lives but had conflicting personal morality in relation to abortion and sense of professional duty, which seemed to influence their quality of care. Midwives were proud to provide PAC, which was described as a natural part of midwifery. However, structural challenges, such as lack of supplies and equipment and high patient loads, hampered provision of good quality care and left informants feeling frustrated. Although abortion was often implied to be immoral, the experience of PAC provision appeared to shape views on legality, leading to an ambiguous, yet more liberal, stance. Abortion stigma was reported to exist within communities and the health workforce, extending to both providers and care-seeking women. Informants had witnessed mistreatment of women seeking care due to abortion complications, through deliberate care delays and denial of pain medication.KEY CONCLUSION AND IMPLICATIONS FOR PRACTICE: Midwives in PAC were dedicated to saving women's lives; however, conflicting morality and duty and poor working conditions impeded quality of care. Enabling midwives to provide good quality care includes increasing the patient-midwife ratio and ensuring essential resources are available. Additionally, efforts that de-stigmatise abortion and promote accountability are needed. Implementation of policies on respectful post-abortion care could aid in ensuring all women are treated with respect.
  •  
6.
  • Dalmar, Abdirisak Ahmed, et al. (författare)
  • Rebuilding research capacity in fragile states : the case of a Somali-Swedish global health initiative
  • 2017
  • Ingår i: Global Health Action. - Abingdon : Informa UK Limited. - 1654-9716 .- 1654-9880. ; 10:1
  • Tidskriftsartikel (refereegranskat)abstract
    • This paper presents an initiative to revive the previous Somali-Swedish Research Cooperation, which started in 1981 and was cut short by the civil war in Somalia. A programme focusing on research capacity building in the health sector is currently underway through the work of an alliance of three partner groups: six new Somali universities, five Swedish universities, and Somali diaspora professionals. Somali ownership is key to the sustainability of the programme, as is close collaboration with Somali health ministries. The programme aims to develop a model for working collaboratively across regions and cultural barriers within fragile states, with the goal of creating hope and energy. It is based on the conviction that health research has a key role in rebuilding national health services and trusted institutions.
  •  
7.
  • Egal, Jama Ali, et al. (författare)
  • A lack of reproductive agency in facility-based births makes home births a first choice regardless of potential risks and medical needs : a qualitative study among multiparous women in Somaliland
  • 2022
  • Ingår i: Global Health Action. - : Informa UK Limited. - 1654-9716 .- 1654-9880. ; 15:1
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Around 20% of births in Somaliland take place at health facilities staffed by trained healthcare professionals; 80% take place at home assisted by Traditional Birth Attendants (TBAs) with no formal training. There has been no research into women's choice of place of birth.OBJECTIVE: In this study, we explore multipara women's needs and preferences when choosing the place of birth.METHOD: An explorative qualitative study using individual in-depth interviews analysed inductively using content analysis. The interviews were conducted in Somaliland with 25 multiparous women who had experience of giving birth both at home and at a health facility within the past three years.RESULTS: The results provide a description of how, for women in Somaliland, a lack of reproductive agency in facility-based births makes home births a first choice regardless of potential risks and medical need. The women in this study desired intentionality in their role as mothers and sought some measure of control over the environment where they planned to give birth, depending on the circumstances of that particular birth. The results describe what quality care means for multipara women in Somaliland and how women choose birthplace based on previous experiences of care. The expectation of respectful care was a vital part for women when choosing a place of birth.CONCLUSION: To meet women's needs and preferences in Somaliland, further investments are needed to strengthen the midwifery profession and to define and test a context specific midwife-led continuity of care model to be scaled up. A dialogue to create new roles and responsibilities for the TBAs who attend most home births is further needed to link them to the formal healthcare system and assure timely healthcare seeking during pregnancy and birth.
  •  
8.
  • Egal, Jama Ali, 1977-, et al. (författare)
  • Facility-based maternal deaths : Their prevalence, causes and underlying circumstances. A mixed method study from the national referral hospital of Somaliland
  • 2023
  • Ingår i: Sexual & Reproductive HealthCare. - 1877-5756 .- 1877-5764. ; 37
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: Somaliland has one of the highest rates of maternal deaths in the world. An estimated 732 women die for every 100,000 live births. This study aims to identify the prevalence of facility-based maternal deaths, the causes and their underlying circumstances by interviewing relatives and health care providers at the main referral hospital.METHOD: A hospital-based mixed method study. The prospective cross-sectional design of the WHO Maternal Near Miss tool was combined with narrative interviews with 28 relatives and 28 health care providers in direct contact with maternal deaths. The quantitative data was analysed with descriptive statistics using SPSS and the qualitative part of the study was analysed with content analysis using NVivo.RESULTS: From the 6658 women included 28 women died. The highest direct cause of maternal death was severe obstetric haemorrhage (46.4%), followed by hypertensive disorders (25%) and severe sepsis (10.7%). An indirect obstetric cause of death was medical complications (17.9%). Twenty-five per cent of these cases were admitted to ICU and 89% had referred themselves to the hospital for treatment. The qualitative data identifies two categories of missed opportunities that could have prevented these maternal mortalities: poor risk awareness in the community and inadequate interprofessional collaboration at the hospital.CONCLUSION: The referral system needs to be strengthened utilizing Traditional Birth Attendants as community resource supporting the community facilities. The communication skills and interprofessional collaboration of the health care providers at the hospital needs to be addressed and a national maternal death surveillance system needs to be commenced.
  •  
9.
  • Egal, Jama Ali, 1977-, et al. (författare)
  • Incidence and causes of severe maternal outcomes in Somaliland using the sub-Saharan Africa maternal near-miss criteria : A prospective cross-sectional study in a national referral hospital.
  • 2022
  • Ingår i: International Journal of Gynecology & Obstetrics. - : Wiley. - 0020-7292 .- 1879-3479. ; 159:3, s. 856-864
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: To describe the incidence and causes of severe maternal outcomes and the unmet need for life-saving obstetric interventions among women admitted for delivery in a referral hospital in Somaliland.METHODS: A prospective cross-sectional study was conducted from April 15, 2019, to March 31, 2020, with women admitted during pregnancy or childbirth or within 42 days after delivery. Data was collected using the World Health Organization (WHO) and sub-Saharan Africa (SSA) maternal near-miss (MNM) tools. Descriptive analysis was performed by computing frequencies, proportions and ratios.RESULTS: The MNM ratio were 56 (SSA criteria) and 13 (WHO criteria) per 1,000 live births. The mortality index was highest among women with medical complications (63%), followed by obstetric haemorrhage (13%), pregnancy-related infection (10%) and hypertensive disorders (7.9%) according to the SSA MNM criteria. Most women giving birth received prophylactic oxytocin for postpartum haemorrhage prevention (97%), and most laparotomies (60%) for ruptured uterus were conducted after three hours.CONCLUSION: There is a need to improve the quality of maternal health services through implementation of evidence-based obstetric interventions and continuous in-service training for health care providers. Using the SSA MNM criteria could facilitate such preventive measures in this setting as well as similar low-resource contexts.
  •  
10.
  • Egal, Jama Ali, 1977- (författare)
  • Women search for normality in birth : Solutions empowering resilience and reproductive agency while reducing adverse outcomes for Somaliland women
  • 2023
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • This thesis aimed to explore the causes of severe pregnancy outcomes and maternal deaths in Somaliland (studies I and II) and how these causes are influenced by the context of the wider health system (studies III and IV). Methodology: Both quantitative and qualitative methodologies were used. A prospective cross-sectional design was used to collect data for studies I and II. Study II focused on maternal deaths using a mixed method design. Studies III and IV used individual interviews to explore the needs of women when choosing a place of birth and the role of traditional birth attendants (TBAs) in maternity services in Somaliland. Analysis: Data were analysed using descriptive statistics and percentages. An inductive content analysis was used for study III, and a qualitative thematic analysis was used for study IV.Results: Study I showed that the maternal near-miss (MNM) ratio was 56 MNMs per 1,000 live births according to the Sub-Saharan Africa (SSA) criteria and 13 MNMs per 1,000 live births according to the WHO criteria. The mortality index was highest among women with medical complications. Study II highlighted that 89% of these women self-referred to the hospital and that only 25% were admitted to the intensive care unit. Poor risk awareness and inadequate interprofessional collaboration contributed to missed opportunities. Study III showed that the lack of reproductive agency involved in facility-based births makes home births a first choice, regardless of potential risks and medical needs. Study IV demonstrated that TBAs need to be better connected with health facilities and skilled birth attendants (SBAs) to reduce maternal and neonatal mortality and morbidities in Somaliland.Conclusion: Women search for normality in birth, and the midwifery profession could provide this normality by facilitating resilience and reproductive agency while reducing adverse outcomes of pregnancy, birth and the postpartum period. There is a need to improve the quality of maternal health services by implementing evidence-based obstetric interventions and continuous in-service training. The referral system needs to be strengthened by utilising TBAs as a community resource to support community maternal and child health centres.
  •  
11.
  • Emtell Iwarsson, K., et al. (författare)
  • Contraceptive use among migrant, second-generation migrant and non-migrant women seeking abortion care : a descriptive cross-sectional study conducted in Sweden
  • 2019
  • Ingår i: BMJ Sexual & Reproductive Health. - : BMJ. - 2515-1991 .- 2515-2009. ; 45:2, s. 118-126
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: The objective of this study was to compare ever-in life contraception use, use of contraception at current conception, and planned use of contraception after an induced abortion, among three groups of women: migrants, second-generation migrants and non-migrant women, and to compare the types of contraception methods used and intended for future use among the three groups of women. Methods: The cross-sectional study administered a questionnaire face-to-face to women aged 18 years and older who were seeking abortion care at one of six abortion clinics in Stockholm County from January to April 2015. Results: The analysis included 637 women. Migrants and second-generation migrants were less likely to have used contraception historically, at the time of the current conception, and to plan to use contraception after their induced abortion compared with non-migrant women. Historically, non-migrants had used pills (89%) and withdrawal (24%) while migrants had used the copper intrauterine device (24%) to a higher extent compared to the other two groups of women. Both the migrants (65%) and second-generation migrants (61%) were more likely than the non-migrants (48%) to be planning to use long-acting reversible contraception. Conclusions: Lower proportions of contraception use were found in migrants and second-generation migrants than in non-migrants. In addition, there were significant differences in the types of contraception methods used historically and intended for future use.
  •  
12.
  • Erlandsson, Kerstin, 1961-, et al. (författare)
  • Evaluating a model for the capacity building of midwifery educators in Bangladesh through a blended, web-based master’s programme
  • 2019
  • Ingår i: Global Health Action. - : Taylor & Francis. - 1654-9716 .- 1654-9880. ; 12:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: While setting international standards for midwifery education has attracted considerable global attention, the education and training of midwifery educators has been relatively neglected, particularly in low-resource settings where capacity building is crucial. Objective: The aim of this study was to describe the expectations of midwifery educators in Bangladesh who took part in a blended web-based master’s programme in SRHR and the extent to which these were realized after 12 months of part-time study.Methods: Both quantitative and qualitative methods have been used to collect data. A structured baseline questionnaire was distributed to all participants at the start of the first course (n = 30) and a second endpoint questionnaire was distributed after they (n = 29) had completed the core courses one year later. At the start of the first course, five focus group discussions (FGD) were held with the midwifery educators. Descriptive statistics and content analysis were used for the analyses.Results: Midwifery educators who took part in the study identified expectations that can be grouped into three distinct areas. They hoped to become more familiar with technology, anticipated they would learn pedagogical and other skills that would enable them to better support their students’ learning and thought they might acquire skills to empower their students as human beings. Participants reported they realized these ambitions, attributing the master’s programme with helping them take responsibility for their own teaching and learning, showing them how to enhance their students’ learning and how to foster reflective and critical thinking among them.Conclusions: Midwifery educators have taken part in a creative learning environment which has developed their engagement in teaching and learning. They have done this using a blended learning model which combines online learning with face-to-face contact. This model can be scaled up in low resource and remote settings.
  •  
13.
  • Erlandsson, Kerstin, 1961-, et al. (författare)
  • Evaluation of an online master’s programme in Somaliland : A phenomenographic study on the experience of professional and personal development among midwifery faculty
  • 2017
  • Ingår i: Nurse Education in Practice. - : Elsevier. - 1471-5953 .- 1873-5223. ; 25, s. 96-103
  • Tidskriftsartikel (refereegranskat)abstract
    • To record the variation of perceptions of midwifery faculty in terms of the possibilities and challenges related to the completion of their first online master's level programme in Sexual and Reproductive Health and Rights in Somaliland. The informants included in this phenomenongraphical focus group study were those well-educated professional women and men who completed the master's program. The informant perceived that this first online master's level programme provided tools for independent use of the Internet and independent searching for evidence-based information, enhanced professional development, was challenge-driven and evoked curiosity, challenged professional development, enhanced personal development and challenged context-bound career paths. Online education makes it possible for well-educated professional women to continue higher education. It furthermore increased the informants' confidence in their use of Internet, software and databases and in the use of evidence in both their teaching and their clinical practice. Programmes such as the one described in this paper could counter the difficulties ensuring best practice by having a critical mass of midwives who will be able to continually gather contemporary midwifery evidence and use it to ensure best practice. An increase of online education is suggested in South-central Somalia and in similar settings globally.
  •  
14.
  • Erlandsson, Kerstin, 1961-, et al. (författare)
  • Implementing an internet-based capacity building program for interdisciplinary midwifery-lead teams in Ethiopia, Kenya Malawi and Somalia
  • 2021
  • Ingår i: Sexual & Reproductive HealthCare. - : Elsevier B.V.. - 1877-5756 .- 1877-5764. ; 30
  • Tidskriftsartikel (refereegranskat)abstract
    • The Swedish care model MIDWIZE defined as midwife-led interdisciplinary care and zero separation between mother and newborn, was implemented in 2020–21 in Ethiopia, Kenya, Malawi, and Somalia in a capacity building programme funded by the Swedish Institute. Objective: To determine the feasibility of using an internet-based capacity building programme contributing to effective midwifery practices in the labour rooms through implementation of dynamic birthing positions, delayed umbilical cord clamping and skin-to-skin care of newborns in the immediate postnatal period. Methods: The design is inspired by process evaluation. Focus group discussions with policy leaders, academicians, and clinicians who participated in the capacity building programme were carried out. Before and after the intervention, the numbers for dynamic birthing positions, delayed umbilical cord clamping and skin-to-skin care of the newborn in the immediate postnatal period were detected. Results: Participants believed the internet-based programme was appropriate for their countries’ contexts based on their need for improved leadership and collaboration, the need for strengthened human resources, and the vast need for improved outcomes of maternal and newborn health. Conclusion: The findings provide insight into the feasibility to expand similar online capacity building programmes in collaboration with onsite policy leaders, academicians, and clinicians in sub-Saharan African countries with an agenda for improvements in maternal and child health. © 2021
  •  
15.
  • Graner, Sophie, 1971-, et al. (författare)
  • 'Normal foetal movements make me happy' : a qualitative study on pregnant women's perception on signs and symtoms during pregnancy and maternal helath care in rural Vietnam
  • Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
    • Background: Women's understanding of pregnancy and antenatal care is influneced by their cultural context. In low income settings women may have limited influence over their reproductive health including when to seek health care. Awareness of signs of pregnancy complications is essential to seek timely care. The use of antenatal care services in Vietnam has been studied with quantatative methods but there are few qualitative studies on the perception of pregnancy and maternal health care among Vietnamse women. Method: The study was conducted in a rural district in northern Vietnam. Four focus group discussions with pregnant women were performed. The data was analysed using manifest and latent content analysis. Result: The latent theme 'Securing pregnancy during normal course and at deviation' consisting of the main categories 'Ensuring a healthy pregnancy' and 'Seperating the normal from the abnormal' emerged. Conclusion: This qualitative study of pregnant women in rural Vietnam indicates how women create a stategy to promote a healthy pregnancy through lifestyle adjustments, gathering of information, and seeking timely medical care. Insight in pregnancy-related conditions were sought from various sources and influenced both by Vietnamese traditions and modern medical knowledge. Public knowledge about deviating symtoms during pregnancy and high confidence in maternal health care are most likely contributing factors to the relative good maternal health status in Vietnam.
  •  
16.
  • Kiruja, Jonah, et al. (författare)
  • Association between delayed cesarean section and severe maternal and adverse newborn outcomes in the Somaliland context : a cohort study in a national referral hospital
  • 2023
  • Ingår i: Global Health Action. - : Taylor & Francis. - 1654-9716 .- 1654-9880. ; 16:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Background In a critical obstetric situation, the time interval between the decision of performing a caesarean section (CS) and delivery can influence maternal and newborn outcomes. In Somaliland, consent for surgical procedures, such as CS needs to be sought from family members. Objective To determine the association between a delay in performing a CS and severe maternal and newborn outcomes in a national referral hospital in Somaliland. The type of barriers leading to delayed performance of CS after a doctor's decision were also explored. Methods Women were followed from the time of decision to perform CS until discharge from the hospital between 15 April 2019 and 30 March 2020. No delay was defined as < 1 hour and delayed CS was defined as 1-3 hours and >3 hours from decision of CS to delivery. Information was collected on barriers leading to delayed CS and maternal and newborn outcomes. Data was analysed using binary and multivariate logistic regression. Results Overall, 1255 women were recruited from a larger cohort of 6658 women. A delay in CS >3 hours was associated with higher odds of severe maternal outcomes (aOR 1.58, 95% CI [1.13-2.21]). On the contrary, delay in performing a CS >3 hours was associated with lower odds of stillbirth (aOR 0.48, 95% CI [0.32-0.71]) compared to women without delay. Further, family decision-making for consent was the most important barrier leading to delays of >3 hours as compared to financial factors and barriers related to healthcare providers (48% vs 26% and 15%, respectively, p < 0.001). Conclusions In this setting, delay in performing CS >3 hours was associated with higher risk of severe maternal outcomes. A standardised system of performing a CS by primarily addressing the barriers associated with family decision-making, financial aspects and healthcare providers is needed.
  •  
17.
  • Kiruja, Jonah, et al. (författare)
  • Healthcare providers' experiences of comprehensive emergency obstetric care in Somaliland : An explorative study with focus on cesarean deliveries
  • 2022
  • Ingår i: Sexual & Reproductive HealthCare. - : Elsevier. - 1877-5756 .- 1877-5764. ; 34
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: This study aimed to explore the experiences of healthcare providers (HCPs) regarding the provision of emergency obstetric care (EmOC) with a focus on cesarean deliveries in a referral hospital and maternal and child health centers in SomalilandMethods: An exploratory qualitative approach using focus group discussions was employed at the main referral and teaching hospital and four maternal and child health centers in Hargeisa, Somaliland. Twenty-eight HCPs were divided into groups of 6-8 for discussions lasting 1 to 2 h. All HCPs included in the study had experiences with the provision of EmOC. Data were analyzed using thematic analysis.Results: Collective family decision making was identified by HCPs as a barrier to the provision of EmOC. This tradition of decision making at a group level was perceived as time-consuming and delayed HCPs from obtaining informed consent for EmOC. Low socioeconomic status and poor knowledge about maternal healthcare among users affected care seeking among women. Suboptimal EmOC at the hospital was reported to be due to miscommunication, inadequate interprofessional collaboration and lack of infrastructure.Conclusions: HCPs encountered difficulties with the provision of EmOC. A broad array of strategies targeting the community and healthcare system is needed, including training of HCPs on intracultural communication competence, interprofessional collaboration and use of alternative birth methods other than CS. Antenatal care can be used to prepare families for potential obstetric emergencies and as an opportunity to obtain written informed consent.
  •  
18.
  • Kiruja, Jonah (författare)
  • Quality of maternal healthcare : Exploring severe maternal outcomes and the influence of delays and decision-making on caesarean sections in a low-resource setting
  • 2023
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Somaliland has one of the highest maternal mortality rates worldwide, yet there is limited evidence for severe maternal outcomes and challenges with the provision and utilisation of emergency obstetric care (EmOC). This thesis studied quality of maternal healthcare by exploring severe maternal outcomes and the influences of delays and decision-making on caesarean sections in Somaliland.In Paper I, incidences of severe maternal outcomes and unmet need for emergency obstetric care interventions were investigated at the national hospital using a cross sectional study. The maternal mortality ratio was 462 per 100,000 live births and the maternal near miss ratio 56.5 per 1000 live births, according to sub-Saharan Africa criteria. Most laparotomies (60%) were performed after more than 3 hours. Medical complications (63%) had the highest mortality index.In Paper II, an explorative qualitative study using focus group discussions was conducted with healthcare providers. A collective decision-making process at the family rather than individual level by the woman; poverty and lack of awareness; and healthcare system factors such as miscommunication, infrastructure and inadequate collaboration were experienced as factors contributing to delays with the utilisation of EmOC.In Paper III, a cohort study examined whether there was an association between delayed caesarean section (CS) and adverse maternal and newborn outcomes and the type of barrier leading to delayed CS. A delay in CS of more than 3 hours was associated with higher odds of severe maternal outcomes (aOR 1.58, (95% CI [1.13–2.21]). Moreover, family decision-making for consent was the most important barrier leading to delays of more than 3 hours (48%). In Paper IV, a mixed methods study was conducted to investigate barriers to and facilitators of timely family consent for CS. Women with hypertensive disorders (aOR 8.491, 95% [1.076–66.991]) and obstetric hemorrhage (aOR 3.209, 95% CI [1.159–8.887]) were likely to have late family consent for CS. Poor communication and understanding, differences in understanding between family members on the need for CS and absence of the person giving consent were barriers to timely family consent for CS to be performed. Husband’s autonomous decision-making for CS, adequate disclosure of all relevant information about CS and previous CS aided timely family consent for CS performance.There is need to improve the overall quality of maternal healthcare to reduce severe maternal outcomes. A proactive-orientated model is suggested with strategies targeting the community and healthcare system including training of healthcare providers on intracultural communication competence, obtaining consent and using associated protocols and guidelines, interprofessional collaboration and the use of alternative birth methods other than CS. Antenatal care should be used to prepare families for potential obstetric emergencies and obtain written informed consent. Moreover, women should be allowed to give consent in maternal health emergencies.
  •  
19.
  • Kiruja, Jonah, et al. (författare)
  • Risk factors for stillbirth and beliefs : Findings from a pilot near miss questionnaire study in Somaliland focusing the mother-baby dyad
  • 2017
  • Ingår i: MOJ Women’s Health. - Edmond, OK, USA : MedCrave Group, LLC. - 2475-5494. ; 5:3
  • 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.
  •  
20.
  • Klingberg-Allvin, Marie, 1972-, et al. (författare)
  • "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
  • Ingår i: Midwifery. - : Elsevier BV. - 0266-6138 .- 1532-3099. ; 69, s. 135-142
  • 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.
  •  
21.
  • Klingberg-Allvin, Marie, 1972-, et al. (författare)
  • Co-creation to scale up provision of simplified high-quality comprehensive abortion care in East Central and Southern Africa
  • 2018
  • Ingår i: Global Health Action. - : Informa UK Limited. - 1654-9716 .- 1654-9880. ; 11:1
  • 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.
  •  
22.
  •  
23.
  • Makenzius, Marlene, et al. (författare)
  • Contraceptive uptake in post abortion care-Secondary outcomes from a randomised controlled trial, Kisumu, Kenya.
  • 2018
  • Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 13:8
  • Tidskriftsartikel (refereegranskat)abstract
    • AIM: The aim was to explore contraceptive uptake, associated factors and satisfaction among post abortion-care (PAC) seeking women in Kenya. Due to unsafe abortions, almost 120 000 Kenyan women received PAC in 2012, and of these women, 70% did not use contraception before pregnancy.METHODS: This study was nested in a larger randomised controlled trial, where 859 women sought PAC at two public hospitals in Kisumu, in June 2013-May 2016. The women were randomly assigned to a midwife or a physician for PAC, including contraceptive counselling, and followed up at 7-10 days and three months. Associated factors for contraceptive uptake were analysed with binary logistic regression, and contraceptive method choice, adherence and satisfaction level were examined by descriptive statistics, using IBM SPSS Statistics for Windows, Version 22.0.RESULTS: Out of the 810 PAC-seeking women, 76% (n = 609) accepted the use of contraception. Age groups of 21-25 (OR: 2.35; p < 0.029) and 26-30 (OR: 2.22; p < 0.038), and previous experience of 1-2 gravidities (OR 1.939; p = 0.018) were independent factors associated with the up-take. Methods used: injections 39% (n = 236); pills 27% (n = 166); condoms 25% (n = 151); implant 7% (n = 45) and intrauterine device (IUD) 1% (n = 8). At 3-month follow-up of the women (470/609; 77%), 354 (75%) women still used contraception, and most (n = 332; 94%) were satisfied with the method. Reasons for discontinuation were side-effects (n = 44; 39%), partner refusal (n = 27; 24%), planned pregnancy (n = 27; 24%) and lack of resupplies (n = 15; 13%).CONCLUSIONS: PAC-seeking women seem highly motivated to use contraceptives, yet a quarter decline the use, and at 3-month follow-up a further quarter among the users had discontinued. Implant, IUD and permanent method are rarely used. Strategies to improve contraceptive counselling, particularly to adolescent girls, and to increase access to a wide range of methods, as well as provider training and supervision may help to improve contraceptive acceptance and compliance among PAC-seeking women in Kisumu, Kenya.
  •  
24.
  • Makenzius, Marlene, et al. (författare)
  • Post-abortion care with misoprostol - equally effective, safe and accepted when administered by midwives compared to physicians : a randomised controlled equivalence trial in a low-resource setting in Kenya
  • 2017
  • Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 7:10
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: To assess the effectiveness of midwives administering misoprostol to women with incomplete abortion seeking post-abortion care (PAC), compared with physicians.DESIGN: A multicentre randomised controlled equivalence trial. The study was not masked.SETTINGS: Gynaecological departments in two hospitals in a low-resource setting, Kenya.POPULATION: Women (n=1094) with incomplete abortion in the first trimester, seeking PAC between 1 June 2013 to 31 May 2016. Participants were randomly assigned to receive treatment from midwives or physicians. 409 and 401 women in the midwife and physician groups, respectively, were included in the per-protocol analysis.INTERVENTIONS: 600 µg misoprostol orally, and contraceptive counselling by a physician or midwife.MAIN OUTCOME MEASURES: Complete abortion not needing surgical intervention within 7-10 days. The main outcome was analysed on the per-protocol population with a generalised estimating equation model. The predefined equivalence range was -4% to 4%. Secondary outcomes were analysed descriptively.RESULTS: The proportion of complete abortion was 94.8% (768/810): 390 (95.4%) in the midwife group and 378 (94.3%) in the physician group. The proportion of incomplete abortion was 5.2% (42/810), similarly distributed between midwives and physicians. The model-based risk difference for midwives versus physicians was 1.0% (-4.1 to 2.2). Most women felt safe (97%; 779/799), and 93% (748/801) perceived the treatment as expected/easier than expected. After contraceptive counselling the uptake of a contraceptive method after 7-10 days occurred in 76% (613/810). No serious adverse events were recorded.CONCLUSIONS: Treatment of incomplete abortion with misoprostol provided by midwives is equally effective, safe and accepted by women as when administered by physicians in a low-resource setting. Systematically provided contraceptive counselling in PAC is effective to mitigate unmet need for contraception.TRIAL REGISTRATION NUMBER: NCT01865136; Results.
  •  
25.
  • Maregn, Rahel Tesfa, et al. (författare)
  • Qualitative study of the roles of midwives in the provision of sexual and reproductive healthcare services in the Somaliland health system
  • 2023
  • Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 13:3
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVES: To explore midwives' perspectives in providing sexual reproductive healthcare services in the Somaliland health system.METHODS: An exploratory qualitative design using focus group discussions (n=6) was used. The study was conducted in the capital of Somaliland, Hargeisa, at six maternal and child healthcare centres that provide sexual and reproductive healthcare (SRH) services. Qualified midwives (n=44) who had been working in the maternal and child health centres for a minimum of 1 year were recruited to participate, and only one did not participate due to illness.RESULTS: The results showed that Somaliland midwives face multiple challenges from a lack of formal arrangements, primarily written guidelines and policies, that explicitly define their role as healthcare professionals, which impact the quality of care they provide. They also reported feeling unsafe when practising according to their professional scope of practice due to challenging cultural norms, customary traditions and Somaliland's legal system. Finally, the midwives called for support, including training, institutional protection and psychological support, to enhance their ability and fulfil their role in SRH services in Somaliland.CONCLUSION: Midwives are essential to the provision of equitable SRH services to women and girls, yet are not fully supported by policies, laws or institutions, often living in fear of the consequences of their behaviours. Our research highlights the importance of understanding the context of Somaliland midwifery in order to better support the development of the midwifery workforce, stronger governance structures and midwifery leadership. Appropriately addressing these challenges faced by midwives can better sustain the profession and help to improve the quality of care provided to women and girls and ultimately enhance their reproductive health outcomes.
  •  
26.
  • Osman, Fatumo, 1973-, et al. (författare)
  • Effects of a culturally tailored parenting support programme in Somali-born parents' mental health and sense of competence in parenting : a randomised controlled trial
  • 2017
  • Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 7:12
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVES: To evaluate the effectiveness of a culturally tailored parenting support programme on Somali-born parents' mental health and sense of competence in parenting.DESIGN: Randomised controlled trial.SETTING: A city in the middle of Sweden.PARTICIPANTS: Somali-born parents (n=120) with children aged 11-16 years and self-perceived stress in their parenting were randomised to an intervention group (n=60) or a waiting-list control group (n=60).INTERVENTION: Parents in the intervention group received culturally tailored societal information combined with the Connect parenting programme during 12 weeks for 1-2 hours per week. The intervention consisted of a standardised training programme delivered by nine group leaders of Somali background.OUTCOME: The General Health Questionnaire 12 was used to measure parents' mental health and the Parenting Sense of Competence scale to measure parent satisfaction and efficacy in the parent role. Analysis was conducted using intention-to-treat principles.RESULTS: The results indicated that parents in the intervention group showed significant improvement in mental health compared with the parents in the control group at a 2-month follow-up: B=3.62, 95% CI 2.01 to 5.18, p<0.001. Further, significant improvement was found for efficacy (B=-6.72, 95% CI -8.15 to -5.28, p<0.001) and satisfaction (B=-4.48, 95% CI -6.27 to -2.69, p<0.001) for parents in the intervention group. Parents' satisfaction mediated the intervention effect on parental mental health (β=-0.88, 95% CI -1.84 to -0.16, p=0.047).CONCLUSION: The culturally tailored parenting support programme led to improved mental health of Somali-born parents and their sense of competence in parenting 2 months after the intervention. The study underlines the importance of acknowledging immigrant parents' need for societal information in parent support programmes and the importance of delivering these programmes in a culturally sensitive manner.CLINICAL TRIAL REGISTRATION: NCT02114593.
  •  
27.
  • Osman, Fatumo, 1973-, et al. (författare)
  • Impact of a culturally tailored parenting programme on the mental health of Somali parents and children living in Sweden : a longitudinal cohort study
  • 2021
  • Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 11:8
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives This study aimed to evaluate the long-term impact (3-year follow-up) of a culturally tailored parenting support programme (Ladnaan) on the mental health of Somali-born parents and their children living in Sweden.Methods In this longitudinal cohort study, Somali-born parents with children aged 11-16 were followed up 3 years after they had participated in the Ladnaan intervention. The Ladnaan intervention comprises two main components: societal information and the Connect parenting programme delivered using a culturally sensitive approach. It consists of 12 weekly group-based sessions each lasting 1-2 hours. The primary outcome was improved mental health in children, as measured by the Child Behaviour Checklist (CBCL). The secondary outcome was improved mental health in parents, as measured by the General Health Questionnaire-12. Data were collected from the parent's perspective.Results Of the 60 parents who were originally offered the intervention, 51 were included in this long-term follow-up. The one-way repeated measures (baseline to the 3-year follow-up) analysis of variance for the CBCL confirmed maintenance of all the treatment gains for children: total problem scores (95% CI 11.49 to 18.00, d=1.57), and externalising problems (95% CI 2.48 to 5.83, d=0.86). Similar results were observed for the parents' mental health (95% CI 0.40 to 3.11, d=0.46).Conclusion Positive changes in the mental health of Somali-born parents and their children were maintained 3 years after they had participated in a parenting support programme that was culturally tailored and specifically designed to address their needs. Our findings highlight the long-term potential benefits of these programmes in tackling mental health issues in immigrant families.
  •  
28.
  • Osman, Fatumo, 1973- (författare)
  • Ladnaan : evaluation of a culturally tailored parenting support program to Somali-born parents
  • 2017
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Background: Research shows that immigrant families encounter different complexities and challenges in a new host country, such as acculturation, isolation and lack of social support. These challenges have been shown to have negative impacts on immigrant families’ mental and emotional health, family function, parenting practices and parents’ sense of competence. Parental support programmes have been shown to positively affect parental skills, strengthen the parent-child relationship, and promote the mental health of parents and children. However, universal parenting support programmes face challenges in reaching and retaining immigrant parents. In addition, there is limited knowledge on the effectiveness of parenting support programmes among immigrant Somali-born parents and their children. Aim: The overall aim of this thesis was to develop and evaluate the effectiveness of a culturally tailored parenting support programme (Ladnaan intervention) on the mental health of Somali-born parents and their children. A further aim was to explore the parents’ experience of such a support programme on their parenting practises. Methods: The thesis involved two explorative qualitative studies and one randomised controlled trial (RCT). Study I employed qualitative focus group discussions (FGDs) to explore Somali-born parents’ need for parenting support. Study II involved an RCT study in which 120 parents with children aged 11–16 years, and parents with self-perceived stress relating to their parenting were randomised to an intervention group or a wait-list control group. The Ladnaan intervention consisted of three components: societal information (two sessions), the Connect parenting programme (10 sessions), and a cultural sensitivity component. The Ladnaan intervention was delivered in the participants’ native language by group leaders of similar background and experience, and modifying the examples and role plays in the Connect programme. The primary outcome was a reduction in children’s emotional and behavioural problems as measured by the Child Behaviour Checklist 8-16. The secondary outcomes were improved mental health among parents, as assessed by the General Health Questionnaire (GHQ12); and greater sense ofparenting competence, as measured by the Parent Sense of Competence (PSOC) scale. Study III comprises a qualitative study using individual semi-structured interviews (conducted two months after the Ladnaan intervention) to explore parents’ experiences of participating in a culturally tailored parenting support programme. Results: The results in study I, shows that Somali-born parents encountered challenges in the host country, which impacted their confidence in parenting and the parent-child relationship. These challenges included insufficient knowledge of the parenting system and social obligations as a parent in the new host country. Other parental challenges in the host country included a stressful society, isolation, role changes, and parent-child power conflict. The Somali parents experienced opportunities to rethink and modify their parenting and strengthen their relationship with their children in the new country, but needed support from the local authority and others in these endeavours. In study II, the Ladnaan intervention showed that, according to the parents’ self-reports, children in the intervention group showed significantly decreased aggressive behaviour, social problems, attention problems, externalising ofbehavioural problems, and in total problems at the two-month follow-up. Moreover, parents in the intervention group showed significantly and clinically improved mental health and sense of competence in parenting at the two-month follow-up. The improved mental health of the parents could, in part, be explained by their satisfaction in parenting. In study III, parents who participated in the culturally tailored intervention programme reported that it enhanced their confidence in parenting and contributed to their ability to become emotionally aware and available for their children. The parents attributed this to the combination of societal information, the Connect programme, and the cultural sensitivity ofthe Ladnaan intervention, which were most supportive for their parenting. The culturally sensitive approach ofthe parenting programme (i.e., conducted in their native language by bicultural and bilingual group leaders) was viewed by the parents as valuable for their participation in the programme, as well as for modifying their parenting practices. Conclusion: The culturally tailored parenting support programme helped parents overcome transition challenges related to social obligation as parents in the host country, and to modify their parenting orientation and styles in the new country. Furthermore, it improved the parents’ mental health and sense of competence in parenting, as well as reduced their children’s behavioural problems. When tailoring and delivering a parenting support programme to immigrant parents it is crucial to consider their specific needs and preferences and to ensure that the programme is culturally sensitive. Such an approach is more likely to contribute to participants’ engagement, retention, and acceptance of the parenting programme; and also improve their parenting practices and strengthen parent-child relationship, leading to improvements in children’s behaviour and parents’ mental health.
  •  
29.
  • Osman, Fatumo, 1973-, et al. (författare)
  • Qualitative study showed that a culturally tailored parenting programme improved the confidence and skills of Somali immigrants
  • 2019
  • Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 108:8, s. 1482-1490
  • Tidskriftsartikel (refereegranskat)abstract
    • AIM: Parenting programmes tailored to immigrant parents have been reported to improve the mental health of the children and parents, as well as parents' sense of competence in parenting. However, research on parents' experiences of programmes tailored to their needs is scarce. This qualitative study aimed to describe Somali parents' experiences of how a culturally sensitive programme affected their parenting.METHODS: The study was conducted in a middle-sized city in Sweden in 2015. Data were collected through semi-structured interviews with 50 participants two months after they took part in a parenting support programme. Inductive and deductive qualitative content analyses were used.RESULTS: A light has been shed was a metaphor that emerged from the analysis and that captured the knowledge the parents gained from the parenting system in Sweden. Parents gained confidence in their parenting role and became emotionally aware of their child's social and emotional needs and how to respond to them. Holding the sessions in the participant's native language was important for the parents' participation and acceptance of the programme.CONCLUSION: Parenting programmes should be tailored to the specific needs of the participants and cultural sensitivity should be factored into programmes to attract immigrant parents. This article is protected by copyright. All rights reserved.
  •  
30.
  • Osman, Fatumo, 1973-, et al. (författare)
  • The implementation of a culturally tailored parenting support programme for Somali immigrant parents living in Sweden : A process evaluation
  • 2022
  • Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 17:9
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Parental support programmes aim to strengthen family functioning and the parent-child relationship and to promote the mental health of children and parents. However, there is a lack of knowledge on how parenting support programmes can be implemented for newly arrived immigrant parents. This process evaluation describes the implementation of a successful parenting programme for immigrant parents from Somalia and identifies key components of the implementation process with a focus on Reach, Adaptation, and Fidelity of Ladnaan intervention.METHOD: This process evaluation considered context, implementation and mechanism of impact, in accordance with the Medical Research Council's guidance. Data were collected through focus group discussions, a questionnaire, attendance lists, field and reflection notes and observations of the sessions. The data were then analysed using content analysis and descriptive statistics.RESULTS: Of the 60 parents invited to the parenting programme, 58 participated in the sessions. The study showed that involving key individuals in the early stage of the parenting programme's implementation facilitated reaching Somali-born parents. To retain the programme participants, parents were offered free transportation. The programme was implemented and delivered as intended. A majority of the parents were satisfied with the programme and reported increased knowledge about children's rights and the support they could seek from social services.CONCLUSIONS: This study illustrates how a parenting support programme can be implemented for Somali-born parents and provides guidance on how to attract immigrant parents to and engage them in participating in parenting support programmes.
  •  
31.
  • Paul, Mandira, 1985-, et al. (författare)
  • Barriers and facilitators in the provision of post-abortion care at district level in central Uganda – a qualitative study focusing on task sharing between physicians and midwives
  • 2014
  • Ingår i: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 14:28
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundAbortion is restricted in Uganda, and poor access to contraceptive methods result in unwanted pregnancies. This leaves women no other choice than unsafe abortion, thus placing a great burden on the Ugandan health system and making unsafe abortion one of the major contributors to maternal mortality and morbidity in Uganda. The existing sexual and reproductive health policy in Uganda supports the sharing of tasks in post-abortion care. This task sharing is taking place as a pragmatic response to the increased workload. This study aims to explore physicians’ and midwives’ perception of post-abortion care with regard to professional competences, methods, contraceptive counselling and task shifting/sharing in post-abortion care.MethodsIn-depth interviews (n = 27) with health care providers of post-abortion care were conducted in seven health facilities in the Central Region of Uganda. The data were organized using thematic analysis with an inductive approach.ResultsPost-abortion care was perceived as necessary, albeit controversial and sometimes difficult to provide. Together with poor conditions post-abortion care provoked frustration especially among midwives. Task sharing was generally taking place and midwives were identified as the main providers, although they would rarely have the proper training in post-abortion care. Additionally, midwives were sometimes forced to provide services outside their defined task area, due to the absence of doctors. Different uterine evacuation skills were recognized although few providers knew of misoprostol as a method for post-abortion care. An overall need for further training in post-abortion care was identified.ConclusionsTask sharing is taking place, but providers lack the relevant skills for the provision of quality care. For post-abortion care to improve, task sharing needs to be scaled up and in-service training for both doctors and midwives needs to be provided. Post-abortion care should further be included in the educational curricula of nurses and midwives. Scaled-up task sharing in post-abortion care, along with misoprostol use for uterine evacuation would provide a systematic approach to improving the quality of care and accessibility of services, with the aim of reducing abortion-related mortality and morbidity in Uganda.
  •  
32.
  • Persson, Maria, et al. (författare)
  • A qualitative study on health care providers' experiences of providing comprehensive abortion care in Cox's Bazar, Bangladesh
  • 2021
  • Ingår i: Conflict and Health. - : BioMed Central (BMC). - 1752-1505. ; 15
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Humanitarian settings are characterised by limited access to comprehensive abortion care. At the same time, humanitarian settings can increase the vulnerability of women and girls to unintended pregnancies and unsafe abortions. Humanitarian actors and health care providers can play important roles in ensuring the availability and accessibility of abortion-related care. This study explores health care providers' perceptions and experiences of providing comprehensive abortion care in a humanitarian setting in Cox's Bazar, Bangladesh and identifies barriers and facilitators in service provision.Method: In-depth interviews (n = 24) were conducted with health care providers (n = 19) providing comprehensive abortion care to Rohingya refugee women and with key informants (n = 5), who were employed by an organisation involved in the humanitarian response. Data were analysed using an inductive content analysis approach.Results: The national menstrual regulation policy provided a favourable legal environment and facilitated the provision of comprehensive abortion care, while the Mexico City policy created organisational barriers since it made organisations unable or unwilling to provide the full comprehensive abortion care package. Supplies were available, but a lack of space created a barrier to service provision. Although training from organisations had made the health care providers confident and competent and had facilitated the provision of services, their knowledge of the national abortion law and menstrual regulation policy was limited and created a barrier to comprehensive abortion services. Even though the health care providers were willing to provide comprehensive abortion care and had acquired skills and applied strategies to communicate with and provide care to Rohingya women, their personal beliefs and their perceptions of Rohingya women influenced their provision of care.Conclusion: The availability and accessibility of comprehensive abortion care was limited by unfavourable abortion policies, a lack of privacy, a lack of knowledge of abortion laws and policies, health care providers' personal beliefs and a lack of cultural safety. To ensure the accessibility and availability of quality services, a comprehensive approach to sexual and reproductive health and rights is needed. Organisations must ensure that health care providers have knowledge of abortion policies and the ability to provide quality care that is woman-centred and non-judgmental.
  •  
33.
  • Påfs, Jessica, 1984-, et al. (författare)
  • Beyond the numbers of maternal near-miss in Rwanda - a qualitative study on women's perspectives on access and experiences of care in early and late stage of pregnancy.
  • 2016
  • Ingår i: BMC Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393 .- 1471-2393. ; 16
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Rwanda has made remarkable progress in decreasing the number of maternal deaths, yet women still face morbidities and mortalities during pregnancy. We explored care-seeking and experiences of maternity care among women who suffered a near-miss event during either the early or late stage of pregnancy, and identified potential health system limitations or barriers to maternal survival in this setting.METHODS: A framework of Naturalistic Inquiry guided the study design and analysis, and the 'three delays' model facilitated data sorting. Participants included 47 women, who were interviewed at three hospitals in Kigali, and 14 of these were revisited in their homes, from March 2013 to April 2014.RESULTS: The women confronted various care-seeking barriers depending on whether the pregnancy was wanted, the gestational age, insurance coverage, and marital status. Poor communication between the women and healthcare providers seemed to result in inadequate or inappropriate treatment, leading some to seek either traditional medicine or care repeatedly at biomedical facilities.CONCLUSION: Improved service provision routines, information, and amendments to the insurance system are suggested to enhance prompt care-seeking. Additionally, we strongly recommend a health system that considers the needs of all pregnant women, especially those facing unintended pregnancies or complications in the early stages of pregnancy.
  •  
34.
  • Påfs, Jessica, 1984-, et al. (författare)
  • 'They would never receive you without a husband' : Paradoxical barriers to antenatal care scale-up in Rwanda
  • 2015
  • Ingår i: Midwifery. - : Elsevier. - 0266-6138 .- 1532-3099. ; 31:12, s. 1149-1156
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: to explore perspectives and experiences of antenatal care and partner involvement among women who nearly died during pregnancy ('near-miss').DESIGN: a study guided by naturalistic inquiry was conducted, and included extended in-community participant observation, semi-structured interviews, and focus group discussions. Qualitative data were collected between March 2013 and April 2014 in Kigali, Rwanda.FINDINGS: all informants were aware of the recommendations of male involvement for HIV-testing at the first antenatal care visit. However, this recommendation was seen as a clear link in the chain of delays and led to severe consequences, especially for women without engaged partners. The overall quality of antenatal services was experienced as suboptimal, potentially missing the opportunity to provide preventive measures and essential health education intended for both parents. This seemed to contribute to women's disincentive to complete all four recommended visits and men's interest in attending to ensure their partners' reception of care. However, the participants experienced a restriction of men's access during subsequent antenatal visits, which made men feel denied to their increased involvement during pregnancy.CONCLUSIONS: 'near-miss' women and their partners face paradoxical barriers to actualise the recommended antenatal care visits. The well-intended initiative of male partner involvement counterproductively causes delays or excludes women whereas supportive men are turned away from further health consultations. Currently, the suboptimal quality of antenatal care misses the opportunity to provide health education for the expectant couple or to identify and address early signs of complications IMPLICATIONS FOR PRACTICE: these findings suggest a need for increased flexibility in the antenatal care recommendations to encourage women to attend care with or without their partner, and to create open health communication about women's and men's real needs within the context of their social situations. Supportive partners should not be denied involvement at any stage of pregnancy, but should be received only upon consent of the expectant mother.
  •  
35.
  • Rehnström Loi, Ulrika, et al. (författare)
  • Abortion and contraceptive use stigma : a cross-sectional study of attitudes and beliefs in secondary school students in western Kenya.
  • 2019
  • Ingår i: Sexual and reproductive health matters. - : Informa UK Limited. - 2641-0397. ; 27:3
  • Tidskriftsartikel (refereegranskat)abstract
    • Social stigma related to women's reproductive decision-making negatively impacts the health of women. However, little is known about stigmatising attitudes and beliefs surrounding abortion and contraceptive use among adolescents. The aim of this study was to measure stigmatising attitudes and beliefs regarding abortion and contraceptive use among secondary school students in western Kenya. A self-reported classroom questionnaire-survey was administered in February 2017 to students at two suburban secondary schools in western Kenya. Two scales were used to measure the stigma surrounding abortion and contraceptive use - the Adolescent Stigmatizing Attitudes, Beliefs and Actions (ASABA) scale and the Contraceptive Use Stigma (CUS) scale. 1,369 students were eligible for the study; 1,207 (females = 618, males = 582) aged 13-21 years were included in the analysis. Descriptive statistics, Pearson's χ2 test, and the t-test were used to analyse the data. Binary logistic regression analysis was used to calculate odds ratios (OR) and 95% confidence intervals (CI). The students reported stigma associated with abortion (53.2%), and contraceptive use (54.4%). A larger proportion of male students reported abortion stigma (57.7%) and contraceptive use stigma (58.5%), compared to female students (49.0%, p = .003 and 50.6%, p = .007, respectively). Higher scores were displayed by younger rather than older age groups. No associations were identified between sexual debut and abortion stigma (p = .899) or contraceptive use stigma (p = .823). Abortion and contraceptive use are stigmatised by students in Kenya. The results can be used to combat abortion stigma and to increase contraceptive use among adolescents in Kenya.
  •  
36.
  • Rehnström Loi, Ulrika, et al. (författare)
  • Contraceptive uptake among post-abortion care-seeking women with unplanned or planned pregnancy in western Kenya.
  • 2020
  • Ingår i: Sexual & Reproductive HealthCare. - : Elsevier BV. - 1877-5756 .- 1877-5764. ; 23
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVES: To investigate contraceptive uptake among PAC-seeking women reporting either planned pregnancies (PP) or unplanned pregnancies (UP) and to identify factors associated with UP.STUDY DESIGN: This was a sub-study nested in randomised controlled trial (RCT) on women who sought PAC in a low-resource setting in western Kenya. The analysis was based on 807 women who were followed up at 7-10 days and by 472 women at 3 months.MAIN OUTCOME MEASURES: Descriptive statistics and a binary logistic regression model with odds ratios (OR) and 95% confidence intervals (CI) were used.RESULTS: Of the 807 women, 375 (46.3%) reported UP, and 432 (53.3%) PP. Most women, regardless of reported pregnancy intention, agreed to start using contraceptive methods: UP 273 (72.8%) and PP 338 (78.2%), respectively, P = 0.072. Independent factors associated with UP were young age (14-20 years; OR 1.177; 95% CI, 1.045-2.818; P = 0.033), unmarried status (OR 9.149; 95% CI, 5.719-14.638; P < 0.001), nulliparity (OR 1.968; 95% CI, 1.287-3.008; P = 0.002), concealed pregnancy (OR 7.708; 95% CI, 3.299-18.012; P < 0.001) and absence of a partner at the clinic visit (OR 3.174; 95% CI, 2.214-4.552; P < 0.001). At 3-month follow-up, there was no difference in contraceptive use between the UP group (161; 77.4%) and the PP group (193; 73.7%), P = 0.350.CONCLUSION: Contraceptive counselling should be systematically offered to all PAC-seeking women, regardless of their stated pregnancy intention. Adolescents, unmarried women, nulliparous, women with concealed pregnancy and attending the PAC clinic without a partner should be given extra attention by PAC providers offering contraceptive counselling.
  •  
37.
  • Rehnström Loi, Ulrika, et al. (författare)
  • Decision-making preceding induced abortion: a qualitative study of women’s experiences in Kisumu, Kenya
  • 2018
  • Ingår i: Reproductive Health. - : Springer Science and Business Media LLC. - 1742-4755. ; 15
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundUnwanted pregnancies and unsafe abortions are prevalent in regions where women and adolescent girls have unmet contraceptive needs. Globally, about 25 million unsafe abortions take place every year. In countries with restrictive abortion laws, safe abortion care is not always accessible. In Kenya, the high unwanted pregnancy rate resulting in unsafe abortions is a serious public health issue. Gaps exist in knowledge regarding women’s decision-making processes in relation to induced abortions in Kenya. Decision-making is a fundamental factor for consideration when planning and implementing contraceptive services. This study explored decision-making processes preceding induced abortion among women with unwanted pregnancy in Kisumu, Kenya.MethodsIndividual face-to-face in-depth interviews were conducted with nine women aged 19–32 years old. Women who had experienced induced abortion were recruited after receiving post-abortion care at the Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) or Kisumu East District Hospital (KDH) in Kisumu, Kenya. In total, 15 in-depth interviews using open-ended questions were conducted. All interviews were tape-recorded, transcribed and coded manually using inductive content analysis.ResultsRespondents described their own experiences regarding decision-making preceding induced abortion. This study shows that the main reasons for induced abortion were socio-economic stress and a lack of support from the male partner. In addition, deviance from family expectations and gender-based norms highly influenced the decision to have an abortion among the interviewed women. The principal decision maker was often the male partner who pressed for the termination of the pregnancy indirectly by declining his financial or social responsibilities or directly by demanding termination. In some cases, the male partner controlled decision-making by arranging an unsafe abortion without the woman’s consent. Strategic choices regarding whom to confide in were employed as protection against abortion stigma. This contributed to a culture of silence around abortion and unwanted pregnancy, a factor that made women more vulnerable to complications.ConclusionsThe findings suggest that financial, social and gender-based dependencies influence women’s agency and perceived options in decision-making regarding abortion.
  •  
38.
  • Sjöström, Susanne, et al. (författare)
  • Medical students are afraid to include abortion in their future practices : in-depth interviews in Maharastra, India
  • 2016
  • Ingår i: BMC Medical Education. - : Springer Science and Business Media LLC. - 1472-6920. ; 16
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Unsafe abortions are estimated to cause eight per-cent of maternal mortality in India. Lack of providers, especially in rural areas, is one reason unsafe abortions take place despite decades of legal abortion. Education and training in reproductive health services has been shown to influence attitudes and increase chances that medical students will provide abortion care services in their future practice. To further explore previous findings about poor attitudes toward abortion among medical students in Maharastra, India, we conducted in-depth interviews with medical students in their final year of education.METHOD: We used a qualitative design conducting in-depth interviews with twenty-three medical students in Maharastra applying a topic guide. Data was organized using thematic analysis with an inductive approach.RESULTS: The participants described a fear to provide abortion in their future practice. They lacked understanding of the law and confused the legal regulation of abortion with the law governing gender biased sex selection, and concluded that abortion is illegal in Maharastra. The interviewed medical students' attitudes were supported by their experiences and perceptions from the clinical setting as well as traditions and norms in society. Medical abortion using mifepristone and misoprostol was believed to be unsafe and prohibited in Maharastra. The students perceived that nurse-midwives were knowledgeable in Sexual and Reproductive Health and many found that they could be trained to perform abortions in the future.CONCLUSIONS: To increase chances that medical students in Maharastra will perform abortion care services in their future practice, it is important to strengthen their confidence and knowledge through improved medical education including value clarification and clinical training.
  •  
Skapa referenser, mejla, bekava och länka
  • Resultat 1-38 av 38
Typ av publikation
tidskriftsartikel (33)
doktorsavhandling (3)
annan publikation (1)
konferensbidrag (1)
Typ av innehåll
refereegranskat (34)
övrigt vetenskapligt/konstnärligt (4)
Författare/redaktör
Klingberg-Allvin, Ma ... (35)
Osman, Fatumo, 1973- (17)
Erlandsson, Kerstin, ... (11)
Gemzell-Danielsson, ... (8)
Essén, Birgitta, 196 ... (6)
Faxelid, Elisabeth (6)
visa fler...
Kiruja, Jonah (5)
Flacking, Renée, 196 ... (4)
Klingberg-Allvin, Ma ... (3)
Byrskog, Ulrika, 197 ... (3)
Larsson, Elin, C (3)
Hatakka, Mathias, 19 ... (3)
Cleeve, Amanda (3)
Johansson, Annika (2)
Gemzell-Danielsson, ... (2)
Salari, Raziye (2)
Schön, Ulla-Karin, 1 ... (2)
Schön, Ulla-Karin (2)
Litorp, Helena, 1980 ... (2)
Berggren, Vanja, 197 ... (1)
Abdi, Yakoub Aden (1)
Walhad, Said Ahmed (1)
Johansson, A (1)
Kinsman, John (1)
Källestål, Carina, 1 ... (1)
Persson, Lars-Åke, 1 ... (1)
Blomgren, J (1)
Wall, Stig (1)
Emmelin, Maria (1)
Lindgren, H. (1)
Berggren, V (1)
Målqvist, Mats, 1971 ... (1)
Mogren, Ingrid (1)
Amanda, Cleeve (1)
Susan, Atuhairwe (1)
Josaphat, Byamugisha (1)
Elisabeth, Faxelid (1)
Tistad, Malin (1)
Ivarsson, Anneli (1)
Atuhairwe, S (1)
Cleeve, A (1)
Klingberg-Allvin, M (1)
Atuhairwe, Susan (1)
Byamugisha, Josaphat (1)
Hanson, Claudia (1)
Tumwesigye, Nazarius ... (1)
Kakaire, Othman (1)
Danielsson, Kristina ... (1)
Eriksen, Jaran (1)
Vixner, Linda (1)
visa färre...
Lärosäte
Högskolan Dalarna (37)
Karolinska Institutet (31)
Uppsala universitet (17)
Mittuniversitetet (5)
Umeå universitet (3)
Stockholms universitet (3)
visa fler...
Örebro universitet (3)
Högskolan Kristianstad (1)
Lunds universitet (1)
visa färre...
Språk
Engelska (38)
Forskningsämne (UKÄ/SCB)
Medicin och hälsovetenskap (38)
Samhällsvetenskap (6)

År

Kungliga biblioteket hanterar dina personuppgifter i enlighet med EU:s dataskyddsförordning (2018), GDPR. Läs mer om hur det funkar här.
Så här hanterar KB dina uppgifter vid användning av denna tjänst.

 
pil uppåt Stäng

Kopiera och spara länken för att återkomma till aktuell vy