| 1. |
- Bergström, Anna, et al.
(author)
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Health system context and implementation of evidence-based practices-development and validation of the Context Assessment for Community Health (COACH) tool for low- and middle-income settings
- 2015
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In: Implementation Science. - : Springer Science and Business Media LLC. - 1748-5908. ; 10
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Journal article (peer-reviewed)abstract
- Background: The gap between what is known and what is practiced results in health service users not benefitting from advances in healthcare, and in unnecessary costs. A supportive context is considered a key element for successful implementation of evidence-based practices (EBP). There were no tools available for the systematic mapping of aspects of organizational context influencing the implementation of EBPs in low- and middle-income countries (LMICs). Thus, this project aimed to develop and psychometrically validate a tool for this purpose. Methods: The development of the Context Assessment for Community Health (COACH) tool was premised on the context dimension in the Promoting Action on Research Implementation in Health Services framework, and is a derivative product of the Alberta Context Tool. Its development was undertaken in Bangladesh, Vietnam, Uganda, South Africa and Nicaragua in six phases: (1) defining dimensions and draft tool development, (2) content validity amongst in-country expert panels, (3) content validity amongst international experts, (4) response process validity, (5) translation and (6) evaluation of psychometric properties amongst 690 health workers in the five countries. Results: The tool was validated for use amongst physicians, nurse/midwives and community health workers. The six phases of development resulted in a good fit between the theoretical dimensions of the COACH tool and its psychometric properties. The tool has 49 items measuring eight aspects of context: Resources, Community engagement, Commitment to work, Informal payment, Leadership, Work culture, Monitoring services for action and Sources of knowledge. Conclusions: Aspects of organizational context that were identified as influencing the implementation of EBPs in high-income settings were also found to be relevant in LMICs. However, there were additional aspects of context of relevance in LMICs specifically Resources, Community engagement, Commitment to work and Informal payment. Use of the COACH tool will allow for systematic description of the local healthcare context prior implementing healthcare interventions to allow for tailoring implementation strategies or as part of the evaluation of implementing healthcare interventions and thus allow for deeper insights into the process of implementing EBPs in LMICs.
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| 2. |
- Dalmar, Abdirisak Ahmed, et al.
(author)
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Rebuilding research capacity in fragile states : the case of a Somali-Swedish global health initiative
- 2017
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In: Global Health Action. - Abingdon : Informa UK Limited. - 1654-9716 .- 1654-9880. ; 10:1
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Journal article (peer-reviewed)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.
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| 3. |
- Eriksson, Leif, et al.
(author)
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Evidence-based practice in neonatal health : knowledge among primary health care staff in northern Viet Nam
- 2009
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In: Human Resources for Health. - : Springer Science and Business Media LLC. - 1478-4491. ; 7, s. 36-
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Journal article (peer-reviewed)abstract
- BACKGROUND: An estimated four million deaths occur each year among children in the neonatal period. Current evidence-based interventions could prevent a large proportion of these deaths. However, health care workers involved in neonatal care need to have knowledge regarding such practices before being able to put them into action.The aim of this survey was to assess the knowledge of primary health care practitioners regarding basic, evidence-based procedures in neonatal care in a Vietnamese province. A further aim was to investigate whether differences in level of knowledge were linked to certain characteristics of community health centres, such as access to national guidelines in reproductive health care, number of assisted deliveries and geographical location. METHODS: This cross-sectional survey was completed within a baseline study preparing for an intervention study on knowledge translation (Implementing knowledge into practice for improved neonatal survival: a community-based trial in Quang Ninh province, Viet Nam, the NeoKIP project, ISRCTN44599712). Sixteen multiple-choice questions from five basic areas of evidence-based practice in neonatal care were distributed to 155 community health centres in 12 districts in a Vietnamese province, reaching 412 primary health care workers. RESULTS: All health care workers approached for the survey responded. Overall, they achieved 60% of the maximum score of the questionnaire. Staff level of knowledge on evidence-based practice was linked to the geographical location of the CHC, but not to access to the national guidelines or the number of deliveries at the community level. Two separated geographical areas were identified with differences in staff level of knowledge and concurrent differences in neonatal survival, antenatal care and postnatal home visits. CONCLUSION: We have identified a complex pattern of associations between knowledge, geography, demographic factors and neonatal outcomes. Primary health care staff knowledge regarding neonatal health is scarce. This is a factor that is possible to influence and should be considered in future efforts for improving the neonatal health situation in Viet Nam.
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| 4. |
- Eriksson, Leif, 1971-, et al.
(author)
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Secular trend, seasonality and effects of a community-based intervention on neonatal mortality : follow-up of a cluster-randomised trial in Quang Ninh province, Vietnam
- 2018
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In: Journal of Epidemiology and Community Health. - : BMJ. - 0143-005X .- 1470-2738. ; 72:9, s. 776-782
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Journal article (peer-reviewed)abstract
- Background: Little is know about whether the effects of community engagement interventions for child survival in low-income and middle-income settings are sustained. Seasonal variation and secular trend may blur the data. Neonatal mortality was reduced in a cluster-randomised trial in Vietnam where laywomen facilitated groups composed of local stakeholders employing a problem-solving approach for 3 years. In this analysis, we aim at disentangling the secular trend, the seasonal variation and the effect of the intervention on neonatal mortality during and after the trial.Methods: In Quang Ninh province, 44 communes were allocated to intervention and 46 to control. Births and neonatal deaths were assessed in a baseline survey in 2005, monitored during the trial in 2008–2011 and followed up by a survey in 2014. Time series analyses were performed on monthly neonatal mortality data.Results: There were 30 187 live births and 480 neonatal deaths. The intervention reduced the neonatal mortality from 19.1 to 11.6 per 1000 live births. The reduction was sustained 3 years after the trial. The control areas reached a similar level at the time of follow-up. Time series decomposition analysis revealed a downward trend in the intervention areas during the trial that was not found in the control areas. Neonatal mortality peaked in the hot and wet summers.Conclusions: A community engagement intervention resulted in a lower neonatal mortality rate that was sustained but not further reduced after the end of the trial. When decomposing time series of neonatal mortality, a clear downward trend was demonstrated in intervention but not in control areas.Trial registration number: ISRCTN44599712, Post-results.
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| 5. |
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| 6. |
- Lind, Lars, et al.
(author)
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Obesity is associated with coronary artery stenosis independently of metabolic risk factors : the population-based SCAPIS study
- 2022
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In: Atherosclerosis. - : Elsevier. - 0021-9150 .- 1879-1484. ; 362, s. 1-10
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Journal article (peer-reviewed)abstract
- Background and aims: Previous studies reported divergent results on whether metabolically healthy obesity is associated with increased coronary artery calcium and carotid plaques. We investigated this in a cross-sectional fashion in a large, well-defined, middle-aged population using coronary CT angiography (CCTA) and carotid ultrasound. Methods: In the SCAPIS study (50–65 years, 51% female), CCTA and carotid artery ultrasound were performed in 23,674 individuals without clinical atherosclerotic disease. These subjects were divided into six groups according to BMI (normal weight, overweight, obese) and the presence of metabolic syndrome (MetS) according to the NCEP consensus criteria. Results: The severity of coronary artery stenosis was increased in individuals with obesity without MetS compared to normal-weight individuals without MetS (OR 1.47, 95%CI 1.34–1.62; p < 0.0001), even after adjusting for non-HDL-cholesterol and several lifestyle factors. Such difference was not observed for the presence of carotid artery plaques (OR 0.94, 95%CI 0.87–1.02; p = 0.11). Obese or overweight individuals without any MetS criteria (except the waist criterion) showed significantly more pronounced stenosis in the coronary arteries as compared to the normal-weight individuals, while one criterion was needed to show increased plaque prevalence in the carotid arteries. High blood pressure was the most important single criterion for increased atherosclerosis in this respect. Conclusions: Individuals with obesity without MetS showed increased severity of coronary artery stenosis, but no increased occurrence of carotid artery plaques compared to normal-weight individuals without MetS, further emphasizing that obesity is not a benign condition even in the absence of MetS.
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| 7. |
- Målqvist, Mats, 1971-, et al.
(author)
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Ethnic inequity in neonatal survival : a case-referent study in northern Vietnam
- 2011
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In: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 100:3, s. 340-346
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Journal article (peer-reviewed)abstract
- Aim: In this study from Quang Ninh province in northern Vietnam (sub-study of the trial Neonatal Health - Knowledge into Practice, NeoKIP, ISRCTN 44599712), we investigated determinants of neonatal mortality through a case-referent design, with special emphasis on socio-economic factors and health system utilization. Methods: From July 2008 until December 2009, we included 183 neonatal mortality cases and 599 referents and their mothers were interviewed. Results: Ethnicity was the main socio-economic determinant for neonatal mortality (OR 2.08, 95% CI 1.39-3.10, adjusted for mothers' education and household economic status). Health system utilization before and at delivery could partly explain the risk elevation, with an increased risk of neonatal mortality for mothers who did not attend antenatal care and who delivered at home (OR 4.79, 95% CI 2.98-7.71). However, even if mothers of an ethnic minority attended antenatal care or delivered at a health facility, the increased risk for this group was sustained. Conclusion: Our study demonstrates inequity in neonatal survival that is related to ethnicity rather than family economy or education level of the mother and highlights the need to include the ethnic dimension in the efforts to reduce neonatal mortality.
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| 8. |
- Målqvist, Mats, et al.
(author)
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Unreported births and deaths, a severe obstacle for improved neonatal survival in low-income countries; a population based study
- 2008
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In: BMC International Health and Human Rights. - 1472-698X. ; 8, s. 4-
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Journal article (peer-reviewed)abstract
- ABSTRACT: BACKGROUND: In order to improve child survival there is a need to target neonatal mortality. In this pursuit, valid local and national statistics on child health are essential. We analyze to what extent births and neonatal deaths are unreported in a low-income country and discuss the consequences at local and international levels for efforts to save newborn lives. METHODS: Information on all births and neonatal deaths in Quang Ninh province in Northern Vietnam in 2005 was ascertained by systematic inventory through group interviews with key informants, questionnaires and examination of health facility records. Health care staff at 187 Community Health Centers (CHC) and 18 hospitals, in addition to 1372 Village Health Workers (VHW), were included in the study. Results were compared with the official reports of the Provincial Health Bureau. RESULTS: The neonatal mortality rate (NMR) was 16/1000 (284 neonatal deaths/17 519 births), as compared to the official rate of 4.2/1000. The NMR varied between 44/1000 and 10/1000 in the different districts of the province. The under-reporting was mainly attributable to a dysfunctional reporting system and the fact that families, not the health system, were made responsible to register births and deaths. This under-reporting has severe consequences at local, national and international levels. At a local level, it results in a lack of awareness of the magnitude and differentials in NMR, leading to an indifference towards the problem. At a national and international level the perceived low mortality rate is manifested in a lack of investments in perinatal health programs. CONCLUSION: This example of a faulty health information system is reportedly not unique in low and middle income countries where needs for neonatal health reforms are greatest. Improving reporting systems on births and neonatal deaths is a matter of human rights and a prerequisite for reducing neonatal mortality in order to reach the fourth millennium goal.
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| 9. |
- Nga, Nguyen T., et al.
(author)
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Perinatal services and outcomes in Quang Ninh province, Vietnam
- 2010
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In: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 99:10, s. 1478-1483
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Journal article (peer-reviewed)abstract
- Aim: We report baseline results of a community-based randomized trial for improved neonatal survival in Quang Ninh province, Vietnam (NeoKIP; ISRCTN44599712). The NeoKIP trial seeks to evaluate a method of knowledge implementation called facilitation through group meetings at local health centres with health staff and community key persons. Facilitation is a participatory enabling approach that, if successful, is well suited for scaling up within health systems. The aim of this baseline report is to describe perinatal services provided and neonatal outcomes. Methods: Survey of all health facility registers of service utilization, maternal deaths, stillbirths and neonatal deaths during 2005 in the province. Systematic group interviews of village health workers from all communes. A Geographic Information System database was also established. Results: Three quarters of pregnant women had >= 3 visits to antenatal care. Two hundred and five health facilities, including 18 hospitals, provided delivery care, ranging from 1 to 3258 deliveries/year. Totally there were 17 519 births and 284 neonatal deaths in the province. Neonatal mortality rate was 16/1000 live births, ranging from 10 to 44/1000 in the different districts, with highest rates in the mountainous parts of the province. Only 8% had home deliveries without skilled attendance, but those deliveries resulted in one-fifth of the neonatal deaths. Conclusion: A relatively good coverage of perinatal care was found in a Vietnamese province, but neonatal mortality varied markedly with geography and level of care. A remaining small proportion of home deliveries generated a substantial part of mortality.
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| 10. |
- Nordlander, Svante, et al.
(author)
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Computer modelling of wood pellet stoves and boilers connected to solar heating systems
- 2006
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In: Proc on USB of Pellets 2006, 30 May - 1 June, Jönköping, Sweden. - Jönköping, Sweden.
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Conference paper (other academic/artistic)abstract
- When optimizing systems for wood pellet and solar heating, there is a need for realistic computer models of stoves and boilers in order to perform simulation studies. The objective of this work was to develop and verify a mathematical model for wood pellet stoves and boilers for use in system simulations with TRNSYS calculating both the energy balance and CO-emissions (carbon monoxide). Laboratory measurements have been carried out on three pellet stoves, one traditional and two with gas-liquid heat exchangers, and four pellet boilers. A mathematical two-node model of a stove was developed and implemented as a TRNSYS component. Parameters were identified for two stoves and three boilers. This new model makes it possible to perform detailed simulations with time steps less than a minute of complete wood pellet heating systems and to derive long term values, such as annual values, of efficiency and emissions for the boiler or stove in a system context under realistic conditions. In addition, parametric studies can be used in order to investigate how different operation principles and system design affect these values. The simulated energy balance of a water jacketed stove investigated in this work agreed well with measured data during both stationary and dynamic conditions.
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