| 1. |
- Anyango, Cartrine, et al.
(författare)
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Women with disabilities’ experiences of intimate partner violence : a qualitative study from Sweden
- 2023
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Ingår i: BMC Women's Health. - : BioMed Central (BMC). - 1472-6874. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Intimate Partner Violence (IPV) is a prevalent form of gender-based violence affecting one in three women globally. It is also a preventable cause of ill-health, disability, and death. Current research suggests that women with disabilities are at a significantly higher risk of experiencing violence throughout their lifetime. They are almost twice as likely to experience violence compared to men with disabilities or men and women without disabilities. Additionally, they experience higher rates of all types of violence. This increased vulnerability may be due to factors related to disability such as dependence on others for support, mistrust, and social and physical isolation. Although there is existing research on IPV against women in general, there is limited knowledge on IPV against women with disabilities. To address this gap in knowledge, this study aimed to explore women with disabilities’ perceptions and experiences of being victims/survivors of IPV in Sweden.Methods: This was a qualitative study conducted through in-depth interviews with eleven women with disabilities. The participants were aged eighteen years upwards. The collected data was analyzed using reflexive thematic analysis with a constructivist epistemological standpoint.Results: We developed four themes. Theme one: “multiple abuse by multiple abusers, over time,” describes the participants’ experiences of various types of violence from different perpetrators for prolonged periods. Theme two: “psychological abuse—harmful, but neglected and difficult to prove,” explains how women with disabilities’ perceive psychological abuse as harmful, but not given the same level of seriousness as physical violence. It also expresses the difficulties they encountered in providing tangible evidence to prove instances of psychological abuse. Theme three: “abuse does not end with separation,” highlights how abuse can continue beyond separation/divorce. Theme four: “surviving abusive relationships” describes the different and evolving ways the participants used to navigate their abusive relationships.Conclusions: Women with disabilities face all forms of abuse. They find it challenging to prove psychological abuse, and the system is inadequate in addressing its harm. The abuse also continues after separation or divorce. The support system should consider the needs of women with disabilities who experience violence, both during and after the abusive relationship. Service providers should be better equipped to detect and handle all types of IPV, especially psychological abuse.
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| 2. |
- Anyatonwu, Obinna Princewill, et al.
(författare)
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The determinants of postpartum contraceptive use in Nigeria
- 2023
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Ingår i: Frontiers in Global Women's Health. - : Frontiers Media S.A.. - 2673-5059. ; 4
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Postpartum contraception is vital for maternal and child health, and reduces the risk of infant mortality. The Health Belief Model (HBM) is a widely accepted framework for exploring health behaviors, such as contraceptive use. Therefore, this study aimed to investigate the factors influencing postpartum contraceptive use in Nigeria and to contextualize the findings within the framework of the HBM.Methods: This study was a secondary analysis of cross-sectional data collected from the Demographic Health Survey conducted in Nigeria (NDHS). In total, 28,041 women were included in this study. Self-reported contraceptive use was the outcome, while the explanatory variables included maternal age, place of residence, region of residence, religion, marital status, educational level, household wealth quintiles, knowledge of the ovulatory cycle, decision-maker for health care, and distance to health care facilities. Descriptive statistics and multivariate logistic regression were used to summarize and identify factors influencing postpartum contraceptive use. The HBM was used to discuss the main findings.Results: The prevalence of postpartum contraceptive use in Nigeria is 27%. Our findings showed that the odds of using contraceptives during the postpartum period were higher among women who knew their ovulation cycles, lived in urban areas in the southern region, had no distance barriers to health care, and were 25–49 years old. Education, wealth, and marital status also increase the odds of contraceptive use. However, women who lived in the northeast and northwest regions or shared decision-making with their partners had lower odds.Conclusion: This study highlights the need for region-specific and age-focused interventions to increase contraceptive use in Nigeria. Additionally, increasing accessibility and affordability of contraceptives for younger and economically disadvantaged women, along with promoting women's autonomy in decision-making, can further enhance contraceptive use across Nigeria.
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| 3. |
- Birabwa, Catherine, et al.
(författare)
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Knowledge and information exposure about family planning among women of reproductive age in informal settlements of Kira municipality, Wakiso district, Uganda
- 2021
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Ingår i: Epidemiologic Methods. - : Frontiers Media S.A.. - 2194-9263 .- 2161-962X. ; 2
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: A high unmet need for family planning (FP) prevails in sub-Saharan Africa. Knowledge, awareness creation, and ensuring accessibility are frequently used to increase FP uptake. However, evidence on knowledge or information dissemination about FP among marginalized populations in urban settings in Africa is limited. This study explored the knowledge of FP methods, media exposure, and contact with FP providers among women from an informal settlement in Uganda.Methods: Using a cross-sectional study design, we interviewed 626 women aged 15–49 years living in informal settlements of Kira municipality, selected through multistage sampling. Using a standard questionnaire, data was collected on socioeconomic characteristics, knowledge of FP methods, and access to media FP messages among others. Binomial log-linear regression was used to assess disparities in exposure to media FP messages or provider information. Data were analyzed using STATA version 14, at a 5% level of statistical significance.Results: Nearly all women in the survey were aware of FP methods (99.7%). On average, each woman was aware of 10 FP methods. The most commonly known methods were male condoms (98.2%), injectables (97.4%), and the oral contraceptive pill (95.2%). Use of any contraceptive was found among 42.7% of respondents. Exposure to media was found in 70.6% of the respondents, mostly through television (58.5%) and radio (58.3%). Discussing FP with a provider was significantly associated with media exposure (aPR 1.4, 95% CI: 1.24–1.56). Less than 50% of women who were not using FP had contact with an FP provider. Women in union (aPR 1.6, 95% CI: 1.01–2.68) and those with access to media messages (aPR 2.5, 95% CI: 1.37–4.54) were more likely to have contact with a provider to discuss FP.Conclusion: There is high general awareness about FP methods and media exposure, but method use was low. Further exploration of women's understanding of FP methods and the fit between existing education programs and FP knowledge needs in this urban setting should be conducted. The potential for mobile health solutions in this urban population should be explored. Future studies should focus on the knowledge and understanding of FP among unmarried and nulliparous women and those with no access to media information.
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| 4. |
- Daca, Chanvo Salvador Lucas, 1976-
(författare)
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Making the connections : understanding inequalities in reproductive and child health in Mozambique
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: In Mozambique, despite significant socio-economic and health system challenges, there has been progress in reproductive and child health in recent years. However, there is still a lack of comprehensive studies that thoroughly unravel the socio-economic determinants of health and health inequalities in the country.The overall aim of this thesis was to understand the socio-economic and geographic inequalities in reproductive and child health with the intention of informing and optimizing the implementation of targeted health programmes in Mozambique.Methods: This thesis is based on three sub-studies that used data obtained from population-based health surveys. In sub-study I, prevalence ratios (PRs) with 95% confidence intervals (95% CI) were calculated by log binomial regression to assess the relationship of socio-economic, demographic, and geographic characteristics with three outcomes of interest: insecticide-treated bed nets (ITNs), child immunization coverage and modern contraceptive use. Sub-study II used the concentration index (Cindex) and decomposition analysis to assess the socio-economic and regional contributions to the wealth inequality in health preventive care. Sub-study III estimated absolute risk differences and the slope index of inequality (SII) as the measures of association between the socio-economic variables and the outcomes (ITN use, fever treatment and Fansidar prophylaxis) for the 2015 and 2018 surveys, as well as for the differences between the two time points.Results: The proportion of mothers with at least one child aged under five years that did not use an ITN was 51.01%, while 46.25% of women had children aged one to four years who were not fully immunized and 74.28% of women did not use modern contraceptives. Non-educated mothers and residents of the southern region were more likely to report not using an ITN (PR = 1.36; 95% CI: 1.17–1.59), while those in the lowest wealth quintile had a higher chance of having children who were not fully immunized (PR = 1.34; 95% CI: 1.04–1.71). Similarly, non-educated mothers (PR = 1.17; 95% CI: 1.10–1.25), non-working women (PR = 1.09; 95% CI: 1.04–1.16) and those in the poorest wealth quintile (PR = 1.13; 95% CI: 1.04–1.24) were more likely to not use modern contraception (sub-study I). Sub-study II found a Cindex of -0.081 for non-ITN, -0.189 for a lack of vaccination coverage and -0.284 for non-contraceptive use, showing a worse health outcome among the poorest population. The study revealed that 88.41% of the wealth gap for ITNs was explained by socio-economic factors, with education and wealth playing the largest roles. With regard to the lack of full vaccination, socio-economic factors (47.74%), particularly the wealth quintile (35.79%), emerged as the predominant contributor to the inequality. Similarly, socio-economic factors (39.39%) were also the main explanatory factors for the lack of contraceptive use, but to a lesser degree than for the other two outcomes (sub-study II). Access to health preventive activities increased in all of the three studied outcomes between 2015 and 2018. Significant reductions in ITN inequality were observed for all socio-economic variables, but no decrease of inequalities in fever treatment and Fansidar prophylaxis was found over time (sub-study III).Conclusion: This thesis revealed that bed net use and immunization coverage among children, and modern contraceptive use among women, were notably low. There was inequality, concentrated among the poor, in reproductive and child preventive measures. The greater part of this inequality could be attributed to low wealth and education, as well as to residence in rural areas. Reductions in socio-economic inequalities between 2015 and 2018 were observed for ITN use but not for fever treatment or malaria prophylaxis. Based on these findings, achieving universal health coverage in Mozambique will require an equitable resource distribution among rural regions, increased community education on health preventative measures and health service expansion to socio-economically disadvantaged households.
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| 5. |
- Daca, Chanvo S. L., et al.
(författare)
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Socioeconomic and geographical inequalities in health care coverage in Mozambique : a repeated cross-sectional study of the 2015 and 2018 national surveys
- 2023
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Ingår i: BMC Public Health. - : BioMed Central (BMC). - 1471-2458. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundOver the past years, Mozambique has implemented several initiatives to ensure equitable coverage to health care services. While there have been some achievements in health care coverage at the population level, the effects of these initiatives on social inequalities have not been analysed.ObjectiveThe present study aimed to assess changes in socioeconomic and geographical inequalities (education, wealth, region, place of residence) in health care coverage between 2015 and 2018 in Mozambique.MethodsThe study was based on repeated cross-sectional surveys from nationally representative samples: the Survey of Indicators on Immunisation, Malaria and HIV/AIDS in Mozambique (IMASIDA) 2015 and the 2018 Malaria Indicator survey. Data from women of reproductive age (15 to 49 years) were analysed to evaluate health care coverage of three indicators: insecticide-treated net use, fever treatment of children, and use of Fansidar malaria prophylaxis for pregnant women. Absolute risk differences and the slope index of inequality (SII) were calculated for the 2015 survey period and the 2018 survey period, respectively. An interaction term between the socioeconomic and geographical variables and the period was included to assess inequality changes between 2015 and 2018.ResultsThe non-use of insecticide-treated nets dropped, whereas the proportion of women with children who were not treated for fever and the prevalence of women who did not take the full Fansidar dose during pregnancy decreased between 2015 and 2018. Significant reductions in the inequality related to insecticide-treated net use were observed for all socioeconomic variables. Concerning fever treatment, some reductions in socioeconomic inequalities were observed, though not statistically significant. For malaria prophylaxis, the SII was significant for education, wealth, and residence in both periods, but no significant inequality reductions were observed in any of these variables over time.ConclusionsWe observed significant reductions of socioeconomic inequalities in insecticide-treated net use, but not in fever treatment of children and Fansidar prophylaxis for pregnant women. Decision-makers should target underserved populations, specifically the non-educated, poor, and rural women, to address inequalities in health care coverage.
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| 6. |
- Mulubwa, Chama, et al.
(författare)
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Framing contraceptive use motivations among adolescents and young adults living in informal settlements in Kira municipality, Wakiso district, Uganda
- 2021
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Ingår i: Epidemiologic Methods. - : Frontiers Media S.A.. - 2194-9263 .- 2161-962X. ; 2
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The use of contraceptives among adolescents and young adults is one of the most cost-effective strategies to address many sexual and reproductive health (SRH) challenges, including unintended pregnancies, early marriages, and sexually transmitted infections. Despite a high burden of SRH challenges, uptake and unmet needs of modern contraceptives remain low in Uganda, especially among adolescents and young adults in informal settlement settings. This study aimed to explore the motivations of adolescents and young people to use modern contraceptives (or not).Methods: We analysed qualitative data from eight focus group discussions with 88 adolescents and young people aged 18-24 years residing in informal settlements of urban communities in Kira Municipality of Wakiso district, Uganda.Results: Motivations for use (or not) of modern contraceptives were framed by two interrelated constructs, sources of information on contraception and the unacceptable use of contraceptives among adolescents widespread in the community. These two, in turn, formed the scope of knowledge upon which adolescents and young people based their decision on whether or not to access and use modern contraceptives.Conclusion: To be more effective, sexual and reproductive health programs and interventions that aim to motivate the use of modern contraceptives among adolescents and young people in informal settings should be more comprehensive and focused on alleviating individual, health systems, social, religious factors that reinforce negative health-seeking behaviours towards contraceptive use. In addition, there is a need to support adolescents and young people with socio-economic empowering strategies that equip them with sufficient resources to choose contraceptives of their choice.
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| 7. |
- Namatovu, Fredinah, PhD, 1980-, et al.
(författare)
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Access and utilization of intimate partner violence-related services : The multiple-level barriers encountered by women with disabilities
- 2023
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Background: Current data suggests a high prevalence of intimate partner violence (IPV) among women withdisabilities (WWDs), yet there is still scanty research on the experiences of this population regarding access andutilization of IPV services.Methods: Using qualitative in-depth data obtained from WWDs, our current study sought to identify factors thathinder WWDs from accessing and utilizing IPV services.Results: This study showed that WWDs exposed to IPV encountered multilevel barriers nested at differentsocietal levels as they attempted to access violence-rated services. At the individual level, the identity category ofdisability, not knowing about certain forms of violence, and being better off silent were the main explanations fornot using IPV services. The role of personal connections was the main factor that influenced the utilization ofIPV services, at the interpersonal level while at the organizational level, a lack of effective communication, powerimbalances, inadequate resources, and failures to follow response standards were identified as the major barriers tousing IPV services. Societal incompetence, as exemplified by treating violence as a taboo and the lack ofregulations criminalizing psychological violence, was the main barrier at the societal level.Conclusions: Our findings suggest that regarding WWDs, improving their access and utilization of IPV servicesrequires interventions that address barriers at societal multiple levels including the individual, interpersonal,organizational, and societal levels. This should include early interventions and programs that not only targetWWDs but also include other key players such as service providers on violence recognition and improve thequality of services. There is a need to also review laws and regulations regarding psychological violence and thenature of interventions in place for this type of violence.
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| 8. |
- Namatovu, Fredinah, 1980-, et al.
(författare)
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Adverse perinatal conditions and receiving a disability pension early in life
- 2020
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Ingår i: PLOS ONE. - : PLOS. - 1932-6203. ; 15:2
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The number of young adults on disability pension (DP) is increasing in European countries, creating a need to understand the related risk factors. This study aimed to determine whether adverse perinatal conditions are associated with receiving a DP early in life.Methods: This longitudinal cohort study consisted of all persons (N = 453,223) born in Sweden during 1973–1977, observed from 1991 through 2010 when they were aged between 16 and 37 years. Statistics Sweden provided linked national data on the children and their parents. We used logistic regression to assess the association between perinatal health conditions (birth defect, Apgar score, and small for gestational age) and receiving a DP, adjusting for maternal education and the sex of the child.Results: New recipients of DP were significantly more likely to have had a birth defect (adjusted odds ratio [AOR] 2.74, 95% CI: 2.49–3.00), to have had low Apgar score (AOR 2.12, 95% CI: 1.77–2.52), to have been small for gestational age (AOR 1.73, 95% CI: 1.54–1.94) and to be females (AOR 1.55, 95% CI: 1.46–1.64). Higher maternal education was associated with lower odds of receiving a DP (AOR 0.74, 95% CI: 0.69–0.79) for those with high school education and (AOR 0.67, 95% CI: 0.59–0.75) for those with university education. Age-stratified analysis confirmed increased odds of receiving a DP among those with birth defects and small for gestational age, but this effect reduced with increasing age. Apgar score was significantly associated with starting to receive a DP at ages 16–18 and 19–29, but not at ages 30–33. Women had lower odds of receiving a DP at ages 16–18 (AOR 0.73, 95% CI: 0.64–0.85); however, this reversed from age 19 and upwards (AOR 1.53, 95% CI: 1.41–1.67) and (AOR 2.16, 95% CI: 1.95–2.40) for the age groups of 19–29 and 30–33, respectively. Persons with high maternal education were less likely to receive a DP regardless of age at receiving a DP.Conclusion: Having a birth defect was the strongest indicator of receiving a DP during early adulthood, followed by small for gestational age and low Apgar score. Overall, the effects of the studied perinatal health conditions were pronounced in those who received a DP at 16–18 years, but this effect weakened with increasing age at receiving a DP. Our findings suggest that policies and programs geared at promoting optimal health at birth might contribute to a reduction in receiving a DP.
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| 9. |
- Namatovu, Fredinah, PhD, 1980-, et al.
(författare)
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Exploring the perspectives of professionals on providing intimate partner violence services to women with disabilities
- 2024
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Ingår i: Violence against Women. - : Sage Publications. - 1077-8012 .- 1552-8448. ; 30:2, s. 622-640
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Tidskriftsartikel (refereegranskat)abstract
- This study explored the experiences and perceptions of professional service providers offering services to women with disabilities exposed to intimate partner violence (IPV). Eighteen in-depth interviews were conducted with service providers working in health care, social work, the police, women’s shelters, and the Centre for Violence Against Women. Our findings suggest that providing adequate IPV services to women with disabilities requires coordination and collaboration. IPV services were organized around five overarching themes: finding services; assessing the risk; identification; protection and care; and becoming independent. This approach was helpful for women who faced disability-related challenges in accessing IPV services.
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| 10. |
- Namatovu, Fredinah, PhD, 1980-, et al.
(författare)
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Is teenage parenthood associated with early use of disability pension? Evidence from a longitudinal study
- 2023
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 18:6
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Tidskriftsartikel (refereegranskat)abstract
- Background: Over the past decades the number of young people using disability pensions (DP) has gradually increased in Europe but the reasons for this change are poorly understood. We hypothesize that teenage parenthood could be associated with an increased risk of receiving early DP. The aim of this study was to examine the association between having a first child at age 13-19 and receiving DP at age 20-42 (here called early DP).Methods: A longitudinal cohort study was undertaken based on national register data obtained from 410,172 individuals born in Sweden in 1968, 1969, and 1970. Teenage mothers and fathers were followed until age 42 and compared to non-teenage parent counterparts to examine their early receipt of DP. Descriptive analysis, Kaplan-Meier curves, and Cox regression analyses were performed.Results: The proportion of teenage parents was more than twice higher in the group that received early DP (16%) compared to the group that did not receive early DP (6%) during the study duration. A higher proportion of teenage mothers and fathers started to receive DP at 20-42 years old compared to non-teenage parents, and the difference between the two groups increased during the observation period. A strong association was observed between being a teenage parent and receiving early DP, significant both independently and after adjusting for the year of birth and the father's level of education. From the age of 30 to 42 years, teenage mothers used early DP more often than teenage fathers or non-teenage parents, and this difference also increased during the follow-up period.Conclusion: A strong association was found between teenage parenthood and the use of DP between 20 and 42 years of age. Teenage mothers used DP more than teenage fathers and non-teenage parents.
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| 11. |
- Namatovu, Fredinah, 1980-, et al.
(författare)
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The impact of disability on partnership formation in Sweden during 1990-2009
- 2020
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Ingår i: The History of the Family. - : Routledge. - 1081-602X .- 1873-5398. ; 25:2, s. 230-245
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Tidskriftsartikel (refereegranskat)abstract
- Evidence suggests that disability negatively affects people’s propensity to find a partner. Persons with disabilities that eventually find a partner do so later in life compared to the average population. There is a lack of studies on the differences in partnership opportunities for persons with disabilities compared to those without disabilities in Sweden. The aim of this study is to assess the impact of disability on partnership formation and to assess whether partnership formation varies as a function of individual demographic and socio-economic factors. We use nationwide data available in the Swedish Initiative for Research on Microdata in Social and Medical Sciences (Umeå SIMSAM Lab). We follow persons born from 1973 to 1977 when they were from 16 to 37 years of age and analyze their data using logistic regression. Our findings indicate that regardless of whether a person started to receive a disability pension at an early age or later, it was associated with lower odds for partnership formation. For persons who started receiving disability pension from 16 to 20 years of age, chances for partnership formation reduced with increase in age of partnership. Individuals that started to receive disability pension later were more likely to form partnership prior to receiving disability pension. Partnership formation was less likely among persons born outside Sweden, in persons with mothers born outside Sweden, in individuals born by unmarried mothers and in persons, whose mothers had a high level of education. Partnership was high among women and among persons who had many maternal siblings. In conclusion, receiving disability pension was associated with reduced chances for partnership formation. Receiving disability pension might imply financial constraints that negatively influence partnership formation supporting Oppenheimer’s theory on the economic cost of marriage and the uncertainty hypothesis.
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| 12. |
- Namatovu, Fredinah, PhD, 1980-, et al.
(författare)
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The perspectives of professionals on providing services to women withdisabilities that experience intimate-partner violence
- 2021
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Rapport (refereegranskat)abstract
- Aim: The aim of this study was to explore the experiences and perceptions of the service providers on the wayexisting intimate-partner violence (IPV) services are organised to address the needs of people with disabilitiesexposedto IPV.Methods: The researchers conducted in-depth interviews with 17 IPV service providers working in: health care,social work, police, women’s shelters and at the Center against violence. A semi-structured, open-ended interviewwere conducted between March 2020 and December 2020 and transcribed verbatim. A constructivist groundedtheory approach that is based on the principles of symbolic interactionism was used with the purpose ofexplaining how IPV services are organised for people with disabilities in Sweden.Results: In the resulting theoretical framework service providers framed their experience and perceptions ofproviding IPV services to people with disabilities to require coordination and multisectoral collaboration betweendifferent sectors and actors was viewed as ideal for providing adequate services to women with disabilities,however this was not always the actual approach adoptedby all providers. The providers further illustrated thatservice provision for women with disabilities was organised around four overarching themes; pathways; screeningand identification; protection and care; empowerment and independence.Conclusion: This study indicates that providing adequate IPV services to people with disabilities requiremultisectoral collaboration. This approach was considered instrumental for women with disabilities that often facedisability-related challenges that created difficulties in navigating several services on their own.
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| 13. |
- Namatovu, Fredinah, PhD, 1980-, et al.
(författare)
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The relationship between disability and parental status : a register study of the 1968 to 1970 birth cohorts
- 2021
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Ingår i: BMC Public Health. - : BioMed Central. - 1471-2458. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Having children is a major life course event yet some disabilities could make it biologically challenging and some others could limit access to necessary socioeconomic resources. To date, there is relatively little data on disability and parental status and our study aimed to investigate this relationship.Methods: This longitudinal cohort study was based on register data obtained from all people born in Sweden from 1968 to 1970 (n = 440220). We performed descriptive analyses, graphical plots, logistic regression, and Cox regression analyses.Results: Our findings from both logistic regression and Cox regression indicated that individuals that started to receive disability benefits at an early age had reduced chances of having children during the follow-up duration. Men with disabilities were less likely to have children when compared to women with disabilities and to men and women without disabilities.Conclusions: We found evidence that disability during early adulthood was associated with reduced chances of having children. Findings support policies and programmes aimed at promoting optimal health during early adulthood, as this would promote continued labour force participation, reduce early use of disability benefits, and possibly improve chances of becoming a parent.
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| 14. |
- Namatovu, Fredinah, PhD, 1980-, et al.
(författare)
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Våld i nära relationer bland vuxna med funktionsnedsättning
- 2023
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Denna Genväg till forskning syftar till att ge en översikt av det aktuella kunskapsläget om våld i nära relationer bland vuxna med funktionsnedsättning. Det utgör ett problemområde som har undersökts jämförelse lite hittills. Översikten utgår från Världshälsoorganisationens (WHO) övergripande definition av funktionsnedsättning som avser långvarigt nedsatt förmåga hos individer att fungera fysiskt eller psykiskt i relation till sin omgivning och förhindrar dem från att fullt delta i samhället. Översikten ger en bild av den senaste forskningen beträffande: förekomst och följder av våld i nära relationer bland vuxna män och kvinnor med funktionsnedsättning; riskfaktorer för denna typ av våld; vad som kännetecknar det; samt tillgång till stöd och serviceinsatser. Även om båda könen berörs ligger fokus på hur övergrepp från närstående drabbar kvinnor med funktionsnedsättning generellt sett, där jämförelser mellan olika funktionsnedsättningar ibland förekommer. Vår översikt av forskningsläget blottlägger två kunskapsluckor, varav den första gäller okunskap om de erfarenheter av våld i nära relationer som personer med funktionsnedsättning har. För det andra är forskning om tillgång till stödinsatser bristfällig, inte minst vilka former av stödinsatser som bidrar till skydd och stöd. För att kunna förebygga våld som personer med funktionsnedsättning utsätts för och för att förbättra samhällets stödsystem behöver framtida forskning närmare undersöka dels hur de upplever våld från närstående, dels hur tillgången till stöd fungerar i praktiken. I slutet av rapporten presenteras några resultat från våra projekt som belyser just dessa aspekter avseende kvinnor som utsatts för dessa övergrepp i Sverige. Resultaten bidrar till att täppa till de två forskningsluckor som översikten påvisar.
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| 15. |
- Norström, Fredrik, et al.
(författare)
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Family socio-economic status and childhood coeliac disease seem to be unrelated : a cross-sectional screening study
- 2021
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Ingår i: Acta Paediatrica. - : John Wiley & Sons. - 0803-5253 .- 1651-2227. ; 110:4, s. 1346-1352
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Tidskriftsartikel (refereegranskat)abstract
- AIM: The aim of our study was to examine whether there is a difference in coeliac disease prevalence in regard to parents' education level and occupation, and whether this differs between screened and clinically diagnosed children at the age of 12 years.METHODS: The study, Exploring the Iceberg of Celiacs in Sweden (ETICS), was a school-based screening study of 12-year-old children that was undertaken during the school years 2005/2006 and 2009/2010. Data on parental education and occupation were reported from parents of the children. Specifically, by parents of 10 710 children without coeliac disease, 88 children diagnosed with coeliac disease through clinical care, and 231 who were diagnosed during the study.RESULTS: There were no statistically significant associations between occupation and coeliac disease for either the clinically detected (prevalence ratio 1.16; confidence interval 0.76-1.76) or screening-detected coeliac disease cases (prevalence ratio 0.86; confidence interval 0.66-1.12) in comparison with children with no coeliac disease. Also, there were no statistically significant associations for parental education and coeliac disease diagnosis.CONCLUSION: There was no apparent relationship between coeliac disease and socio-economic position. Using parents' socio-economic status as a tool to help identify children more likely to have coeliac disease is not recommended.
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| 16. |
- Nyandwi, Alypio, et al.
(författare)
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Predictors of physical violence against children in Rwanda : findings from a National Cross-Sectional Survey
- 2022
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Ingår i: BMC Public Health. - : BioMed Central (BMC). - 1471-2458. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: To address the challenges of limited national data on the prevalence and nature of violence experienced by children, Rwanda conducted, in 2015–2016, the first National Survey on Violence among female and male children and youth aged 13–24 years. To further contribute to these efforts to fill existing data gaps, we used the Rwanda survey data to assess the prevalence and predictors of physical violence (PV) in children aged 13–17.Methods: A nationally representative sample of 618 male and 492 female children were analysed. Nationally representative weighted descriptive statistics were used to analyse the prevalence of PV self-reported by children, and logistic regression models were applied to investigate its predictors.Results: Sixty percent of all children, including 36.53% of male and 23.38% of female children, reported having experienced any form of PV in their lifetime. Additionally, 21.81% of male children and 12.73% of female children reported experiences of PV within twelve months before the survey date. Older children (OR: 0.53 [0.40–0.72]), female children (OR: 0.43 [0.31–0.58]), and children not attending school (OR: 0.48 [0.31–0.73]) were less likely to be physically abused. However, sexually active children (OR: 1.66 [1.05–2.63]), children in households from the middle wealth quintile (OR: 1.63 [1.08–2.47]), children living in a larger family (OR: 1.55 [1.07–2.26]), and children who reported not feel close to both biological parents (OR: 2.14 [1.31–3.49]) had increased odds of reporting physical violence.Conclusion: Higher rates of PV in children attending school were the key finding. There is an urgent need to design and implement particular national interventions to prevent and reduce the incidence of PV in schools in Rwanda. PV was also associated with poor parent-child relations. Parents and other adult caregivers should be sensitised to the consequences of PV on children and be urged to adopt positive parenting practices.
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| 17. |
- Nyandwi, Alypio, et al.
(författare)
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Sexual violence against children in Rwanda : prevalence and associated factors
- 2022
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Ingår i: Rwanda Journal of Medicine and Health Sciences. - : University of Rwanda College of Medicine and Health Sciences. - 2616-9819 .- 2616-9827. ; 5:3, s. 302-314
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Tidskriftsartikel (refereegranskat)abstract
- Background: Information and data on the burden and factors associated with violence against children are critical in designing and implementing preventive strategies and interventions. This study aimed to examine patterns of the prevalence of sexual violence (SV) against children in Rwanda and investigate associated factors to contribute to the knowledge about violence against children in Rwanda.Methods: A sample of 1,110 children aged 13-17 years from a cross-sectional national survey done in Rwanda in 2015 was analysed. Weighted descriptive statistics were applied to describe the prevalence of SV against children, and weighted logistic regression allowed us to investigate factors associated with it.Results: Over eight percent (8.4%) of all children, including about three percent (2.8%) of male children and around five percent (5.6%) of female children, reported having experienced SV within the last twelve months. Being a female child, having a romantic partner, and not attending school were some factors associated with SV against children in Rwanda.Conclusion: Female children reported more SV than male children. Factors associated with sexual violence pertained to the child's characteristics, family or household background characteristics, and community relations. The study findings call for an urgent need to prevent SV against children through awareness raising about it amongst children and the general public.
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| 18. |
- Sandström, Glenn, 1971-, et al.
(författare)
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The Persistence of High Levels of Living Alone Among Adults with Disabilities in Sweden, 1993–2011
- 2021
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Ingår i: Population. - : Springer. - 0167-5923 .- 1573-7829. ; 40:2, s. 163-185
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Tidskriftsartikel (refereegranskat)abstract
- This study investigates how the probability to live alone has developed among working age individuals with and without disabilities in Sweden during the period 1993–2011 when extensive political reforms to improve the integration of disabled individuals in society were implemented. The results show that individuals with disabilities are approximately twice as likely to be living alone when compared to individuals without disabilities. People with disabilities were also more likely to report low life satisfaction, and this was especially true among individuals with disabilities living alone. Men and women with disabilities also tend to experience longer periods of living as a one-person household than non-disabled people. Over time we find no indications of reduced differences in family outcomes between disabled and non-disabled individuals but rather evidence to the contrary. These differences are interpreted as being the result of the disadvantage disabled individual’s experience in the partner market and that people with disabilities are less successful in forming partnerships that can lead to cohabitation and family formation. The results thus show how disabled individuals still face societal barriers that limit their possibilities to find and sustain relationships that result in stable cohabitation despite increased efforts to improve their inclusion in Swedish society.
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| 19. |
- Sowe, Alieu, et al.
(författare)
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Does a pay-for-performance health service model improve overall and rural–urban inequity in vaccination rates? : A difference-in-differences analysis from the Gambia
- 2022
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Ingår i: Vaccine: X. - : Elsevier. - 2590-1362. ; 12
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To assess whether the implementation of a results-based financing (RBF) project in The Gambia resulted in (1) improved national vaccination coverage (2) higher coverage in intervention than non-intervention areas, and (3) improvement in rural–urban coverage inequality.Methods: The study used a difference-in-differences design, based on repeated cross-sectional data from The Gambian Demographic and Health Surveys 2013 (N = 1650) and 2020 (N = 1456). Full vaccination (receipt of one BCG, 3 OPV, 3 DTP, and 1 measles-containing vaccine doses) and rural–urban vaccination inequality were our outcome variables. The intervention, RBF, was implemented in 5 of the 7 health regions. Covariates controlled for included child’s sex, child’s birth order number, socioeconomic status, ethnicity, distance from health facility, maternal education, mother’s age group, mother’s marital status, and mother’s work status. Poisson regression with robust variance was used to estimate whether coverage changed, and difference-in-differences and difference-in-differences-in-differences were used to ‘assess differences in vaccination coverage change and change in inequalities, respectively.Results: Total crude full vaccination coverage in The Gambia was 76% in 2013 and 84.6% in 2020. Overall vaccination significantly increased by 16% (95% CI: 9% to 24%) in 2020 compared to 2013, but with a smaller increase in intervention relative to non-intervention areas [PRR 0.88 (CI: 0.78–0.99)]. Rural-urban inequality in vaccination coverage decreased more – by 13% [0.87 (0.78–0.98)] – in RBF than non-RBF regions.Conclusion: Vaccination coverage improved over the study period though we have no evidence to ascribe the coverage gains to the RBF intervention. However, our study suggests that the RBF project has contributed to reducing rural–urban inequalities in the regions it was implemented.
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| 20. |
- Sowe, Alieu, et al.
(författare)
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Impact of a performance monitoring intervention on the timeliness of Hepatitis B birth dose vaccination in the Gambia : a controlled interrupted time series analysis
- 2023
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Ingår i: BMC Public Health. - : BioMed Central (BMC). - 1471-2458. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The Hepatitis B virus that can cause liver cancer is highly prevalent in the Gambia, with one in ten babies at risk of infection from their mothers. Timely hepatitis B birth dose administration to protect babies is very low in The Gambia. Our study assessed whether 1) a timeliness monitoring intervention resulted in hepatitis B birth dose timeliness improvements overall, and 2) the intervention impacted differentially among health facilities with different pre-intervention performances.Methods: We used a controlled interrupted time series design including 16 intervention health facilities and 13 matched controls monitored from February 2019 to December 2020. The intervention comprised a monthly hepatitis B timeliness performance indicator sent to health workers via SMS and subsequent performance plotting on a chart. Analysis was done on the total sample and stratified by pre-intervention performance trend.Results: Overall, birth dose timeliness improved in the intervention compared to control health facilities. This intervention impact was, however, dependent on pre-intervention health facility performance, with large impact among poorly performing facilities, and with uncertain moderate and weak impacts among moderately and strongly performing facilities, respectively.Conclusion: The implementation of a novel hepatitis B vaccination timeliness monitoring system in health facilities led to overall improvements in both immediate timeliness rate and trend, and was especially helpful in poorly performing health facilities. These findings highlight the overall effectiveness of the intervention in a low-income setting, and also its usefulness to aid facilities in greatest need of improvement.
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| 21. |
- Sowe, Alieu, et al.
(författare)
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Missed opportunities for vaccination at point of care and their impact on coverage and urban–rural coverage inequity in the Gambia
- 2023
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Ingår i: Vaccine. - : Elsevier. - 0264-410X .- 1873-2518. ; 41:52, s. 7647-7654
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Identifying actionable targets is crucial to improve overall and equity in vaccination coverage, and in line with the global Immunization Agenda 2030. Therefore, this study seeks to assess the prevalence of missed opportunities for simultaneous vaccination (MOSVs) and their impact on vaccination coverage and urban-rural inequity in The Gambia.Methods: We used data of children aged 12-23 months from The Gambia 2019/2020 demographic and health survey (weighted n = 1355) with seen vaccination cards. We analyzed: the frequency of MOSVs; percentage point coverage reduction attributable to MOSVs for 18 vaccine doses and full basic vaccination; and MOSVs' contribution to urban-rural coverage inequity through Blinder-Oaxaca decomposition.Results: Sixty percent of children experienced MOSVs, in both urban and rural areas, but urban MOSVs were more seldom corrected (35.9 % vs 45.3 %). All eighteen vaccine doses assessed could have achieved between one to eleven percentage points higher coverage if MOSVs had been avoided, with full basic vaccination gaining even more. While MOSV correction did not impact overall urban-rural coverage inequity, it did exacerbate (explained coefficient = -0.1007; P = 0.002) inequities among children who experienced MOSVs, explaining 95 % of the observed difference.Conclusion: Our study highlights the prevalence and negative impact of MOSVs on overall vaccination coverage. Although MOSVs did not contribute significantly to the total urban-rural inequity in coverage, they have detrimental effects on vaccination coverage and urban-rural inequity among children who had experienced MOSVs. Addressing MOSVs, can enhance coverage and reduce the risk of under-vaccination, aligning with global initiatives.
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| 22. |
- Sowe, Alieu, et al.
(författare)
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Starting then stopping: a nationwide register-based study on the magnitude, predictors, and urban-rural patterns of under-vaccination variation across health centers in The Gambia
- 2024
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Ingår i: Global Health Action. - : Taylor & Francis. - 1654-9716 .- 1654-9880. ; 17:1
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Six million children were under-vaccinated in 2022. Our study aimed to 1) quantify the magnitude of under-vaccination variation between health facilities, 2) assess to which extent individual and health center level factors contributed to the variation, 3) identify individual and health facility factors associated with under-vaccination, and 4), explore rural vs. urban health facility variations.Methods: We used data from 61,839 children from The Gambia national routine vaccination register. We cross tabulated under-vaccination status across study variables and fitted two-level random intercept multilevel logistic regression models to measure variance, contribution to the variance, and factors associated with the variance and under-vaccination.Results: We found that 7% of the prevalence of under-vaccination was due to variation between health facilities. Thirty-seven percent of the variation was explained by individual and health center variables. The variables explained 36% of the variance in urban and 19% in rural areas. Children who were not vaccinated at 4 months or with delayed history, due for vaccination in the rainy season, and health facilities with very small or large population to health worker ratios had higher under-vaccination odds.Conclusion: Our study indicates that one of the pathways to improving vaccination coverage is addressing factors driving under-vaccination inequities between health facilities through urban-rural differentiated strategies.
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| 23. |
- Sowe, Alieu, et al.
(författare)
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The frequency of missed opportunities for simultaneous vaccination and their impact on vaccination of children in The Gambia
- 2023
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Ingår i: Population Medicine. - : European Publishing. - 2654-1459. ; 5, s. 563-563
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Tidskriftsartikel (refereegranskat)abstract
- Background and Objective: The number of zero-dose and under-vaccinated children has passed 20 million following the COVID-19 pandemic. Reducing missed opportunities for vaccination is recommended as a key strategy for increasing coverage because it involves utilising existing vaccination sites. To generate actionable evidence for coverage and equality improvement targeting, this study aimed to estimate the frequencies of missed opportunities for simultaneous vaccination (MOSVs) and their correction by residential area and assess the impact of MOSVs on full vaccination and coverage of vaccine doses in The Gambia.Methods: Data of children with cards aged 12–23 months from The Gambia 2019/2020 demographic and health survey was used (weighted n = 1355). We measured the number of children who experienced at least 1 MOSV any time before the survey and the proportions of children who later 1) received all doses, 2) received some doses, and 3) never received any dose by residence. Finally, valid coverage with and without MOSVs was estimated for all eligible vaccine doses.Results: More than half of the children surveyed experienced at least one MOSV, and more than half of the MOSVs were later corrected. A quarter of the children who experienced MOSVs did not have them corrected. Rural and urban residents had similar experiences in the proportion of MOSVs, but children in urban areas had their MOSVs not corrected more frequently. Seventeen of eighteen vaccine doses in the national schedule would have coverage gains without MOSVs, with some gaining as much as nine percentage points in coverage.Conclusions: Missed opportunities for simultaneous vaccination are frequent, negatively affecting coverage and differentially impacting rural and urban areas, and should be targeted for vaccination improvement. Our study emphasizes the importance of MOSVs for vaccination coverage and the need to implement the WHO missed opportunities for vaccination strategy.
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| 24. |
- Vikström, Lotta, 1971-, et al.
(författare)
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A longitudinal study of how disability affects mortality in Swedish Populations from the 1800s, 1900s and 2000s
- 2021
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- BACKGROUND: Studies from across the world show that disability limits people’s health and social wellbeing in present-day populations. This disadvantage can lead to premature death, but there is dearth knowledge about the relationship between disability and mortality and changes over time. OBJECTIVES: Unique access to longitudinal micro data on comprehensive Swedish populations enabled us to examine how disability affects premature death in men and women from the 1800s until 2010. METHODS: Cox proportional regressions were used to estimate mortality hazards by disability status, gender and socio-economic indicators in three study populations from the 1800s, 1900s and 2000s. We followed all adults having disability from age 25 to compare their premature death risks (< age 43) relative to non-disabled groups.RESULTS: Irrespective of gender and century studied, the adjusted hazard ratios show that adults with disabilities had a significantly higher premature death risk relative to adults without disabilities, and it increased over time. In the 1800s, disability about doubled this risk (HR: 2.31, CI: 1.65–3.22) and it tripled from 1900–1959 (HR 3.01, CI 2.60– 3.48). At the turn of the 21th century, the mortality risk was almost ten-folded (HR 9.90, CI 8.03–10.5). CONCLUSIONS: This study provides the first comprehensive estimates on how disability increased mortality in Swedish populations from the 1800s until the 2000s. Across three centuries, disability was associated with a profoundly higher relative death risk in adults aged 25–42. This risk grew when the general survival in Sweden improved and it was the highest in the 1990–2010 period. Fundamental societal changes and extensive welfare provisions promoting equality in gender, health and social wellbeing of all citizens have not come to include younger generations with disabilities.
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