| 1. |
- Adam, Sumaiya, et al.
(författare)
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Pregnancy as an opportunity to prevent type 2 diabetes mellitus: FIGO Best Practice Advice.
- 2023
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Ingår i: International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. - 1879-3479. ; 160:Suppl 1, s. 56-67
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Forskningsöversikt (refereegranskat)abstract
- Gestational diabetes (GDM) impacts approximately 17 million pregnancies worldwide. Women with a history of GDM have an 8-10-fold higher risk of developing type 2 diabetes and a 2-fold higher risk of developing cardiovascular disease (CVD) compared with women without prior GDM. Although it is possible to prevent and/or delay progression of GDM to type 2 diabetes, this is not widely undertaken. Considering the increasing global rates of type 2 diabetes and CVD in women, it is essential to utilize pregnancy as an opportunity to identify women at risk and initiate preventive intervention. This article reviews existing clinical guidelines for postpartum identification and management of women with previous GDM and identifies key recommendations for the prevention and/or delayed progression to type 2 diabetes for global clinical practice.
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| 2. |
- Adam, Sumaiya, et al.
(författare)
-
Pregnancy as an opportunity to prevent type 2 diabetes mellitus: FIGO Best Practice Advice.
- 2023
-
Ingår i: International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. - : Wiley. - 1879-3479 .- 0020-7292. ; 160:Suppl 1, s. 56-67
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Forskningsöversikt (refereegranskat)abstract
- Gestational diabetes (GDM) impacts approximately 17million pregnancies worldwide. Women with a history of GDM have an 8-10-fold higher risk of developing type 2 diabetes and a 2-fold higher risk of developing cardiovascular disease (CVD) compared with women without prior GDM. Although it is possible to prevent and/or delay progression of GDM to type 2 diabetes, this is not widely undertaken. Considering the increasing global rates of type 2 diabetes and CVD in women, it is essential to utilize pregnancy as an opportunity to identify women at risk and initiate preventive intervention. This article reviews existing clinical guidelines for postpartum identification and management of women with previous GDM and identifies key recommendations for the prevention and/or delayed progression to type 2 diabetes for global clinical practice.
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| 3. |
- Miranda, Jezid, et al.
(författare)
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Global health systems strengthening: FIGO's strategic view on reducing maternal and newborn mortality worldwide.
- 2024
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Ingår i: International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. - 1879-3479.
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Forskningsöversikt (refereegranskat)abstract
- To demonstrate that successful health systems strengthening (HSS) projects have addressed disparities and inequities in maternal and perinatal care in low-income countries.A comprehensive literature review covered the period between 1980 and 2022, focusing on successful HSS interventions within health systems' seven core components that improved maternal and perinatal care.The findings highlight the importance of integrating quality interventions into robust health systems, as this has been shown to reduce maternal and newborn mortality. However, several challenges, including service delivery gaps, poor data use, and funding deficits, continue to hinder the delivery of quality care. To improve maternal and newborn health outcomes, a comprehensive HSS strategy is essential, which should include infrastructure enhancement, workforce skill development, access to essential medicines, and active community engagement.Effective health systems, leadership, and community engagement are crucial for a comprehensive HSS approach to catalyze progress toward universal health coverage and global improvements in maternal and newborn health.
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| 4. |
- Okong, Pius
(författare)
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Maternal morbidity in Uganda : studies on life-threatening pregnancy complications in low-income settings
- 2004
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Life-threatening complications in pregnancy rarely achieves public health prominence in the same way as maternal mortality partly because they represent a wide spectrum of conditions. The improved level of care in many high-income countries has significantly reduced morbidity and risk of death from these conditions. However in low-income countries, such as Uganda, weak and poorly resourced health systems, socio -cultural factors and the threat by HIV/AIDS combine to increase the risk of morbidity and death. The rationale for the studies was the need to identify ways to promote health actions that can reduce maternal morbidity from life-threatening pregnancy complications. Aim: This thesis explores the role of HIV/AIDS in post abortion endometritis-myometritis (PAEM) and postpartum endometritis-myometritis (PPEM). It also examines audit of a subset of women with lifethreatening pregnancy complications called "near miss cases"; monitoring of treatment of lifethreatening pregnancy complications and socio cultural barriers to access care in Uganda. Methods: A case-control design was used over a 12-month period to study the risk of HIV infection in women with and without PAEM and PPEM in one hospital in Kampala, Uganda (papers 1&2). Then a subset of women (229) with life-threatening pregnancy complications called "near miss cases" were audited with respect to seeking care, access to services and quality of care in 4 referral hospitals, over a 21 months period (Paper 3). A cross sectional survey of all basic EmOC and comprehensive EmOC (district hospital) facilities in Kiboga district was carried out over a two year period to document treatment of women with lifethreatening pregnancy complications. Met need for treatment of these cases was derived, in relation to the population of the district (Paper 4). Seventeen FGD were conducted with adult men and women and with adolescent boys and girls in three study districts, on adolescence, their roles and responsibilities, pre-marital sexual relations, HIV/AIDS, pregnancy and abortion. Content analysis was used to describe the findings (Paper 5). Results: HIV infection was not found to correlate with the risk for PAEM, HIV-1 seroprevalence 17 (32.7%) among women with PAEM and 38 (36.5%) among women without post-abortion infection; but this was double the seroprevalence among antenatal clients in the same hospital, 14.6% in 1997. HIV-1 seroprevalence was significantly higher among women with postpartum endometritismyometritis (PPEM) than controls, 26 (42.3%) and 26 (21.3%) respectively (p=0.002) OR 2.74 (95%Cl 1.34- 5.65). Over a two-year period, there was a ten-fold increase in "met need" for treatment of women with life-threatening pregnancy complications from 4% to 47%. Births in health facilities increased from 17% to 24%. Met need for cesarean sections increased from 1.3% to 2.3% and case fatality rite for women with life-threatening complications decreased from 9.4% to 1.85%. A major finding was the gender inequality in income generation, leading to different social and sexual strategies between adolescent boys and girls. Customary requirements for boys to offer gifts or pay bridal wealth in marriage and the local government taxation act, which selectively taxes boys but not girls of the same age, serve to entrench the subordinate roles of girls predisposing them to high-risk sexual behavior. Lack of empathy and support from parents and the community for an unmarried pregnant girl often leaves her without other options than to resort to unsafe abortion. Conclusions: The prevalence of HIV-1 among women with and without PAEM was higher than in antenatal mothers, but HIV was not a risk factor for PAEM. HIV-1 was found to be a risk factor for PPEM, these findings further complicating management of these life-threatening complications of pregnancy. Women who were treated for life-threatening pregnancy complications survived in spite of substandard care identified in more than half the cases. However audit of near miss cases might offer a non-threatening stimulus for improving quality of obstetric care. More than a ten-fold increase in treatment of life-threatening pregnancy complications was achieved over a two year period, and this might offer an important way of monitoring programmes for reduction of maternal mortality. Engendering local government taxation act and customary marriage requirements might reduce entrenching gender stereotypes among adolescents. There is need to involve parents, teachers and adolescents in dialogue on an enabling environment for safe transition from childhood to adulthood.
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| 5. |
- Poon, Liona C, et al.
(författare)
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Hypertensive disorders of pregnancy and long-term cardiovascular health: FIGO Best Practice Advice.
- 2023
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Ingår i: International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. - 1879-3479. ; 160:Suppl 1, s. 22-34
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Tidskriftsartikel (refereegranskat)abstract
- Hypertensive disorders of pregnancy (HDP) are the most common causes of maternal and perinatal morbidity and mortality. They are responsible for 16% of maternal deaths in high-income countries and approximately 25% in low- and middle-income countries. The impact of HDP can be lifelong as they are a recognized risk factor for future cardiovascular disease. During pregnancy, the cardiovascular system undergoes significant adaptive changes that ensure adequate uteroplacental blood flow and exchange of oxygen and nutrients to nurture and accommodate the developing fetus. Failure to achieve normal cardiovascular adaptation is associated with the development of HDP. Hemodynamic alterations in women with a history of HDP can persist for years and predispose to long-term cardiovascular morbidity and mortality. Therefore, pregnancy and the postpartum period are an opportunity to identify women with underlying, often unrecognized, cardiovascular risk factors. It is important to develop strategies with lifestyle and therapeutic interventions to reduce the risk of future cardiovascular disease in those who have a history of HDP.
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| 6. |
- Poon, Liona C, et al.
(författare)
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Hypertensive disorders of pregnancy and long-term cardiovascular health: FIGO Best Practice Advice.
- 2023
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Ingår i: International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. - : Wiley. - 1879-3479 .- 0020-7292. ; 160:Suppl 1, s. 22-34
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Tidskriftsartikel (refereegranskat)abstract
- Hypertensive disorders of pregnancy (HDP) are the most common causes of maternal and perinatal morbidity and mortality. They are responsible for 16% of maternal deaths in high-income countries and approximately 25% in low- and middle-income countries. The impact of HDP can be lifelong as they are a recognized risk factor for future cardiovascular disease. During pregnancy, the cardiovascular system undergoes significant adaptive changes that ensure adequate uteroplacental blood flow and exchange of oxygen and nutrients to nurture and accommodate the developing fetus. Failure to achieve normal cardiovascular adaptation is associated with the development of HDP. Hemodynamic alterations in women with a history of HDP can persist for years and predispose to long-term cardiovascular morbidity and mortality. Therefore, pregnancy and the postpartum period are an opportunity to identify women with underlying, often unrecognized, cardiovascular risk factors. It is important to develop strategies with lifestyle and therapeutic interventions to reduce the risk of future cardiovascular disease in those who have a history of HDP.
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| 7. |
- Tumwine, Gilbert, et al.
(författare)
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Enablers of sexual and reproductive health and rights interventions in low- and middle-income countries. Insights from capacity development projects implemented in 13 countries in Africa and Asia
- 2022
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Ingår i: Global Health Action. - : Informa UK Limited. - 1654-9716 .- 1654-9880. ; 15:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: The global community has committed to achieving universal access to sexual and reproductive health and rights (SRHR) services, but how to do it remains a challenge in many low-income countries. Capacity development is listed as a means of implementation for Agenda 2030. Although it has been a major element in international development cooperation, including SRHR, its effectiveness and circumstances under which it succeeds or fails have limited evidence. Objective: The study sought to examine whether improvement in team capacity of SRHR practitioners resulted in improved organisational effectiveness and/or improved SRHR outcomes in low-income countries. Methods: The study involved 99 SRHR interventions implemented in 13 countries from Africa and Asia. Self-reported evaluation data from healthcare practitioners who participated in a capacity development international training programme in SRHR was used. The training was conducted by Lund University in Sweden between 2015 and 2019. Logistic regression models were used to examine the association between improved team capacity, improved organizational effectiveness and improved SRHR outcomes, for all the 99 interventions. Adoption of new SRHR approaches (guidelines and policies), media engagement, support from partner organisations and involvement of stakeholders were assessed as possible confounders. Results: Improved team capacity, support from partner organisations and media engagement were positively associated with improved organisational effectiveness. Improved team capacity was the strongest predictor of organisational effectiveness even after controlling for other covariates at multivariate analysis. However, adopting new SRHR approaches significantly reduced organisational effectiveness. Furthermore, support from partner organisations was positively associated with increased awareness of and demand for SRHR services. Conclusions: Successful implementation of capacity development interventions requires an enabling environment. In this study, an SRHR training programme aiming at improving team capacity resulted in an improvement in organisational effectiveness. Support from partner organisations and media engagement were key enablers of organisational effectiveness.
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| 8. |
- Tumwine, Gilbert, et al.
(författare)
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'One-size doesn't fit all' : Understanding healthcare practitioners' perceptions, attitudes and behaviours towards sexual and reproductive health and rights in low resource settings: An exploratory qualitative study
- 2020
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 15:6, s. 0234658-0234658
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Tidskriftsartikel (refereegranskat)abstract
- Although progress has been made to improve access to sexual and reproductive health services globally in the past two decades, in many low-income countries, improvements have been slow. Discrimination against vulnerable groups and failure to address health inequities openly and comprehensively play a role in this stagnation. Healthcare practitioners are important actors who, often alone, decide who accesses services and how. This study explores how health care practitioners perceive sexual and reproductive health and rights (SRHR) and how background factors influence them during service delivery. Participants were a purposefully selected sample of health practitioners from five low income countries attending a training in at Lund University, Sweden. Semi-structured interviews and qualitative content analysis were used. Three themes emerged. The first theme, "one-size doesn't fit all' in SRHR" reflects health practitioners' perception of SRHR. Although they perceived rights as fundamental to sexual and reproductive health, exercising of these rights was perceived to be context-specific. The second theme, "aligning a pathway to service delivery", illustrates a reflective balancing act between their personal values and societal norms in service delivery, while the third theme, "health practitioners acting as gatekeepers", describes how this balancing act oscillates between enabling and blocking behaviours. The findings suggest that, even though health care practitioners perceive SRHR as fundamental rights, their preparedness to ensure that these rights were upheld in service delivery is influenced by personal values and society norms. This could lead to actions that enable or block service delivery.
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| 9. |
- Tumwine, Gilbert, et al.
(författare)
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Predictors of health care practitioners’ normative attitudes and practices towards sexual and reproductive health and rights : a cross-sectional study of participants from low-income countries enrolled in a capacity-building program
- 2020
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Ingår i: Global Health Action. - : Informa UK Limited. - 1654-9716 .- 1654-9880. ; 13:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Sexual and Reproductive Health and Rights (SRHR) is a concept of human rights applied to sexuality and reproduction. Suboptimal access to SRHR services in many low-income countries results in poor health outcomes. Sustainable development goals (3.7 and 5.6) give a new impetus to the aspiration of universal access to high-quality SRHR services. Indispensable stakeholders in this process are healthcare practitioners who, through their actions or inactions, determine a population’s health choices. Often times, healthcare practitioners’ SRHR decisions are rooted in religious and cultural influences. We seek to understand whether religious and cultural influences differ significantly according to individuals’ characteristics and work environment. Objective: The purpose of this study was to examine the role of healthcare practitioners’ individual characteristics and their work environment in predicting normative SRHR attitudes and behaviours (practices). We hypothesized that religion and culture could be significant predictors of SRHR attitudes and practices. Methods: A quantitative cross-sectional study of 115 participants from ten low-income countries attending a capacity-building programme at Lund University Sweden was conducted. Linear regression models were used to assess for the predictive values of different individual characteristics and workplace environment factors for normative SRHR attitudes and SRHR practices. Results: Self-rated SRHR knowledge was the strongest predictor for both normative SRHR attitudes and normative SRHR practices. However, when adjusted for other individual characteristics, self-rated knowledge lost its significant association with SRHR practices, instead normative SRHR attitudes and active knowledge-seeking behaviour independently predicted normative SRHR practices. Contrary to our hypothesis, importance of religion or culture in an individual’s life was not correlated with the measured SRHR attitudes and practices. Conclusion: Healthcare practitioners’ cultural and religious beliefs, which are often depicted as barriers for implementing full coverage of SRHR services, seem to be modified by active knowledge-seeking behaviour and accumulated working experience with SRHR over time.
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