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Persson, LA
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Publications (10 of 132) Show all publications
Svefors, P., Ekholm Selling, K., Shaheen, R., Khan, A. I., Persson, L. & Lindholm, L. (2018). Cost-effectiveness of prenatal food and micronutrient interventions on under-five mortality and stunting: Analysis of data from the MINIMat randomized trial, Bangladesh.. PLoS ONE, 13(2), Article ID e0191260.
Open this publication in new window or tab >>Cost-effectiveness of prenatal food and micronutrient interventions on under-five mortality and stunting: Analysis of data from the MINIMat randomized trial, Bangladesh.
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2018 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 2, article id e0191260Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Nutrition interventions may have favourable as well as unfavourable effects. The Maternal and Infant Nutrition Interventions in Matlab (MINIMat), with early prenatal food and micronutrient supplementation, reduced infant mortality and were reported to be very cost-effective. However, the multiple micronutrients (MMS) supplement was associated with an increased risk of stunted growth in infancy and early childhood. This unfavourable outcome was not included in the previous cost-effectiveness analysis. The aim of this study is to evaluate whether the MINIMat interventions remain cost-effective in view of both favourable (decreased under-five-years mortality) and unfavourable (increased stunting) outcomes.

METHOD: Pregnant women in rural Bangladesh, where food insecurity still is prevalent, were randomized to early (E) or usual (U) invitation to be given food supplementation and daily doses of 30 mg, or 60 mg iron with 400 μg of folic acid, or MMS with 15 micronutrients including 30 mg iron and 400 μg of folic acid. E reduced stunting at 4.5 years compared with U, MMS increased stunting at 4.5 years compared with Fe60, while the combination EMMS reduced infant mortality compared with UFe60. The outcome measure used was disability adjusted life years (DALYs), a measure of overall disease burden that combines years of life lost due to premature mortality (under five-year mortality) and years lived with disability (stunting). Incremental cost effectiveness ratios were calculated using cost data from already published studies.

RESULTS: By incrementing UFe60 (standard practice) to EMMS, one DALY could be averted at a cost of US$24.

CONCLUSION: When both favourable and unfavourable outcomes were included in the analysis, early prenatal food and multiple micronutrient interventions remained highly cost effective and seem to be meaningful from a public health perspective.

Keywords
cost-effectiveness, stunting, nutrition intervention, DALY, child mortality, nutrition, Bangladesh
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-347520 (URN)10.1371/journal.pone.0191260 (DOI)29447176 (PubMedID)
Available from: 2018-04-04 Created: 2018-04-04 Last updated: 2018-04-26Bibliographically approved
Zelaya Blandon, E., Källestål, C., Peña, R., Pérez, W., Berglund, S., Contreras, M. & Persson, L.-Å. (2017). Breaking the cycles of poverty: Strategies, achievements, and lessons learned in Los Cuatro Santos, Nicaragua, 1990-2014. Global Health Action, 10, Article ID 1272884.
Open this publication in new window or tab >>Breaking the cycles of poverty: Strategies, achievements, and lessons learned in Los Cuatro Santos, Nicaragua, 1990-2014
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2017 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, article id 1272884Article in journal (Refereed) Published
Abstract [en]

Background: In a post-war frontier area in north-western Nicaragua that was severely hit by Hurricane Mitch in 1998, local stakeholders embarked on and facilitated multi-dimensional development initiatives to break the cycles of poverty. Objective: The aim of this paper is to describe the process of priority-setting, and the strategies, guiding principles, activities, achievements, and lessons learned in these local development efforts from 1990 to 2014 in the Cuatro Santos area, Nicaragua. Methods: Data were derived from project records and a Health and Demographic Surveillance System that was initiated in 2004. The area had 25,893 inhabitants living in 5,966 households in 2014. Results: A participatory process with local stakeholders and community representatives resulted in a long-term strategic plan. Guiding principles were local ownership, political reconciliation, consensus decision-making, social and gender equity, an environmental and public health perspective, and sustainability. Local data were used in workshops with communities to re-prioritise and formulate new goals. The interventions included water and sanitation, house construction, microcredits, environmental protection, school breakfasts, technical training, university scholarships, home gardening, breastfeeding promotion, and maternity waiting homes. During the last decade, the proportion of individuals living in poverty was reduced from 79 to 47%. Primary school enrolment increased from 70 to 98% after the start of the school breakfast program. Under-five mortality was around 50 per 1,000 live births in 1990 and again peaked after Hurricane Mitch and was approaching 20 per 1,000 in 2014. Several of the interventions have been scaled up as national programs. Conclusions: The lessons learned from the Cuatro Santos initiative underline the importance of a bottom- up approach and local ownership of the development process, the value of local data for monitoring and evaluation, and the need for multi-dimensional local interventions to break the cycles of poverty and gain better health and welfare.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD, 2017
Keywords
Poverty alleviation, community participation, microcredits, education, water and sanitation, scale-up, under-five mortality, Health and Demographic Surveillance, System
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-320817 (URN)10.1080/16549716.2017.1272884 (DOI)000397603200001 ()28136698 (PubMedID)
Available from: 2017-04-26 Created: 2017-04-26 Last updated: 2017-12-07
Persson, L.-Å., Rahman, A., Peña, R., Pérez, W., Musafili, A. & Hoa, D. P. (2017). Child survival revolutions revisited: lessons learned from Bangladesh, Nicaragua, Rwanda and Vietnam. Acta Paediatrica, 106(6), 871-877
Open this publication in new window or tab >>Child survival revolutions revisited: lessons learned from Bangladesh, Nicaragua, Rwanda and Vietnam
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2017 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 106, no 6, p. 871-877Article, review/survey (Refereed) Published
Abstract [en]

Analysing child mortality may enhance our perspective on global achievements in child survival. We used data from surveillance sites in Bangladesh, Nicaragua and Vietnam and Demographic Health Surveys in Rwanda to explore the development of neonatal and under-five mortality. The mortality curves showed dramatic reductions over time, but child mortality in the four countries peaked during wars and catastrophes and was rapidly reduced by targeted interventions, multisectorial development efforts and community engagement.

CONCLUSION: Lessons learned from these countries may be useful when tackling future challenges, including persistent neonatal deaths, survival inequalities and the consequences of climate change and migration.

Keywords
Child mortality, Migration, Natural catastrophes, Sustainable Development Goals, War
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-329091 (URN)10.1111/apa.13830 (DOI)000401011500006 ()28295602 (PubMedID)
Available from: 2017-09-08 Created: 2017-09-08 Last updated: 2017-10-19Bibliographically approved
Khan, A. I., Kabir, I., Eneroth, H., El Arifeen, S., Ekström, E.-C., Frongillo, E. A. & Persson, L. Å. (2017). Effect of a randomised exclusive breastfeeding counselling intervention nested into the MINIMat prenatal nutrition trial in Bangladesh. Acta Paediatrica, 106(1), 49-54
Open this publication in new window or tab >>Effect of a randomised exclusive breastfeeding counselling intervention nested into the MINIMat prenatal nutrition trial in Bangladesh
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2017 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 106, no 1, p. 49-54Article in journal (Refereed) Published
Abstract [en]

AIM: It is unknown whether maternal malnutrition reduces the effect of counselling on exclusive breastfeeding. This study evaluated the effect of breastfeeding counselling on the duration of exclusive breastfeeding, and whether the timing of prenatal food and different micronutrient supplements further prolonged this duration.

METHODS: Pregnant women in Matlab, Bangladesh, were randomised to receive daily food supplements of 600 kcal at nine weeks of gestation or at the standard 20 weeks. They also were allocated to either 30 mg of iron and 400 μg folic acid, or the standard programme 60 mg of iron and folic acid or multiple micronutrients. At 30 weeks of gestation, 3188 women were randomised to receive either eight breastfeeding counselling sessions or the usual health messages.

RESULTS: The median duration of exclusive breastfeeding was 135 days in the counselling group and 75 days in the usual health message group (p < 0.001). Prenatal supplements did not modify the effects of counselling. Women in the usual health message group who were randomised to multiple micronutrients exclusively breastfed for 12 days longer than mothers receiving the standard iron-folate combination (p = 0.003).

CONCLUSION: Breastfeeding counselling increased the duration of exclusive breastfeeding by 60 days. This duration was not influenced by the supplements.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-312335 (URN)10.1111/apa.13601 (DOI)000390597700011 ()27659772 (PubMedID)
Funder
Swedish Research CouncilSida - Swedish International Development Cooperation Agency
Available from: 2017-01-09 Created: 2017-01-09 Last updated: 2018-09-28Bibliographically approved
Persson, L.-Å., El Arifeen, S., Khan, A., Rahman, A. & Ekström, E.-C. (2017). Effects of early prenatal food supplementation and multiple micronutrients on under-five survival, linear growth, metabolic markers and blood pressure up to 10 years of age: The MINIMat trial in rural Bangladesh. Paper presented at Annual Meeting of the American-Society-for-Pharmacology-and-Experimental-Therapeutics (ASPET) at Experimental Biology Meeting, APR 22-26, 2017, Chicago, IL. The FASEB Journal, 31(1), Article ID 786.35.
Open this publication in new window or tab >>Effects of early prenatal food supplementation and multiple micronutrients on under-five survival, linear growth, metabolic markers and blood pressure up to 10 years of age: The MINIMat trial in rural Bangladesh
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2017 (English)In: The FASEB Journal, ISSN 0892-6638, E-ISSN 1530-6860, Vol. 31, no 1, article id 786.35Article in journal, Meeting abstract (Other academic) Published
National Category
Nutrition and Dietetics Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-335021 (URN)000405461405213 ()
Conference
Annual Meeting of the American-Society-for-Pharmacology-and-Experimental-Therapeutics (ASPET) at Experimental Biology Meeting, APR 22-26, 2017, Chicago, IL
Available from: 2017-12-01 Created: 2017-12-01 Last updated: 2017-12-01Bibliographically approved
Smith, E. R., Shankar, A., Wu, L., Aboud, S., Adu-Afarwuah, S., Ali, H., . . . Sudfeld, C. (2017). Modifiers of the Effect of Maternal Multiple Micronutrient Supplementation: an individual patient data meta-analysis of 17 randomized trials. Paper presented at Annual Meeting of the American-Society-for-Pharmacology-and-Experimental-Therapeutics (ASPET) at Experimental Biology Meeting, APR 22-26, 2017, Chicago, IL. The FASEB Journal, 31(1), Article ID 638.1.
Open this publication in new window or tab >>Modifiers of the Effect of Maternal Multiple Micronutrient Supplementation: an individual patient data meta-analysis of 17 randomized trials
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2017 (English)In: The FASEB Journal, ISSN 0892-6638, E-ISSN 1530-6860, Vol. 31, no 1, article id 638.1Article in journal, Meeting abstract (Other academic) Published
National Category
Nutrition and Dietetics Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-335022 (URN)000405461405467 ()
Conference
Annual Meeting of the American-Society-for-Pharmacology-and-Experimental-Therapeutics (ASPET) at Experimental Biology Meeting, APR 22-26, 2017, Chicago, IL
Available from: 2017-12-01 Created: 2017-12-01 Last updated: 2017-12-01Bibliographically approved
Smith, E. R., Shankar, A. H., Wu, L.-F. S., Aboud, S., Adu-Afarwuah, S., Ali, H., . . . Sudfeld, C. R. (2017). Modifiers of the effect of maternal multiple micronutrient supplementation on stillbirth, birth outcomes, and infant mortality: a meta-analysis of individual patient data from 17 randomised trials in low-income and middle-income countries.. The Lancet Global Health, 5(11), e1090-e1100
Open this publication in new window or tab >>Modifiers of the effect of maternal multiple micronutrient supplementation on stillbirth, birth outcomes, and infant mortality: a meta-analysis of individual patient data from 17 randomised trials in low-income and middle-income countries.
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2017 (English)In: The Lancet Global Health, E-ISSN 2214-109X, Vol. 5, no 11, p. e1090-e1100Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Micronutrient deficiencies are common among women in low-income and middle-income countries. Data from randomised trials suggest that maternal multiple micronutrient supplementation decreases the risk of low birthweight and potentially improves other infant health outcomes. However, heterogeneity across studies suggests influence from effect modifiers. We aimed to identify individual-level modifiers of the effect of multiple micronutrient supplements on stillbirth, birth outcomes, and infant mortality in low-income and middle-income countries.

METHODS: This two-stage meta-analysis of individual patient included data from 17 randomised controlled trials done in 14 low-income and middle-income countries, which compared multiple micronutrient supplements containing iron-folic acid versus iron-folic acid alone in 112 953 pregnant women. We generated study-specific estimates and pooled subgroup estimates using fixed-effects models and assessed heterogeneity between subgroups with the χ(2) test for heterogeneity. We did sensitivity analyses using random-effects models, stratifying by iron-folic acid dose, and exploring individual study effect.

FINDINGS: Multiple micronutrient supplements containing iron-folic acid provided significantly greater reductions in neonatal mortality for female neonates compared with male neonates than did iron-folic acid supplementation alone (RR 0·85, 95% CI 0·75-0·96 vs 1·06, 0·95-1·17; p value for interaction 0·007). Multiple micronutrient supplements resulted in greater reductions in low birthweight (RR 0·81, 95% CI 0·74-0·89; p value for interaction 0·049), small-for-gestational-age births (0·92, 0·87-0·97; p=0·03), and 6-month mortality (0·71, 0·60-0·86; p=0·04) in anaemic pregnant women (haemoglobin <110g/L) as compared with non-anaemic pregnant women. Multiple micronutrient supplements also had a greater effect on preterm births among underweight pregnant women (BMI <18·5 kg/m(2); RR 0·84, 95% CI 0·78-0·91; p=0·01). Initiation of multiple micronutrient supplements before 20 weeks gestation provided greater reductions in preterm birth (RR 0·89, 95% CI 0·85-0·93; p=0·03). Generally, the survival and birth outcome effects of multiple micronutrient supplementation were greater with high adherence (≥95%) to supplementation. Multiple micronutrient supplements did not significantly increase the risk of stillbirth or neonatal, 6-month, or infant mortality, neither overall or in any of the 26 examined subgroups.

INTERPRETATION: Antenatal multiple micronutrient supplements improved survival for female neonates and provided greater birth-outcome benefits for infants born to undernourished and anaemic pregnant women. Early initiation in pregnancy and high adherence to multiple micronutrient supplements also provided greater overall benefits. Studies should now aim to elucidate the mechanisms accounting for differences in the effect of antenatal multiple micronutrient supplements on infant health by maternal nutrition status and sex.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-331995 (URN)10.1016/S2214-109X(17)30371-6 (DOI)000412525400022 ()29025632 (PubMedID)
Available from: 2017-10-20 Created: 2017-10-20 Last updated: 2018-05-14Bibliographically approved
Kallioinen, M., Ekström, E.-C., Khan, A. I., Lindström, E., Persson, L.-Å., Rahman, A. & Ekholm Selling, K. (2017). Prenatal early food and multiple micronutrient supplementation trial reduced infant mortality in Bangladesh, but did not influence morbidity. Acta Paediatrica, 106(12), 1979-1986
Open this publication in new window or tab >>Prenatal early food and multiple micronutrient supplementation trial reduced infant mortality in Bangladesh, but did not influence morbidity
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2017 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 106, no 12, p. 1979-1986Article in journal (Refereed) Published
Abstract [en]

AIM: A previous maternal and infant nutrition intervention in rural Matlab, Bangladesh, showed that prenatal nutrient supplements improved child survival, but had no effect on size at birth. This secondary analysis examined whether prenatal multiple micronutrient supplements (MMS), on their own or combined with an early invitation to receive prenatal food supplements, affected child morbidity.

METHODS: This randomised trial enrolled 4436 pregnant women from November 2001 to October 2003 and allocated them to early or standard invitations to food supplements, in the ninth and 20th weeks of pregnancy, respectively, and supplements of either the standard 60 mg iron with 400 μg folic acid, 30 mg iron with 400 μg folic acid or MMS. Quasi-Poisson regression was used to analyse morbidity.

RESULTS: There were 3560 single live births and 3516 had morbidity data. The incidence rates of fever, diarrhoea and acute lower respiratory tract infection were 15.3, 3.6 and 2.3 episodes per person-year, respectively. The separate or combined interventions had no effect on morbidity up to 24 months.

CONCLUSION: Early invitations to prenatal food supplements or prenatal MMS had no effect on common infections in rural Bangladesh, suggesting that earlier findings on improved child survival were not mediated by an effect on child morbidity.

Keywords
Child morbidity, Food supplements, Maternal nutrition, Multiple micronutrient supplements, Pregnancy
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-335625 (URN)10.1111/apa.14009 (DOI)000414913500017 ()28779492 (PubMedID)
Available from: 2017-12-07 Created: 2017-12-07 Last updated: 2018-02-19Bibliographically approved
Svefors, P., Ekholm Selling, K., Shaheen, R., Persson, L. Å. & Lindholm, L. (2017). Prenatal food and micronutrient interventions in rural Bangladesh remain cost-effective when assessing both favorable and unfavorable outcomes: Cost-effectiveness analysis of the MINIMat trial on under five-mortality and stunting.. Paper presented at Annual Meeting of the American-Society-for-Pharmacology-and-Experimental-Therapeutics (ASPET) at Experimental Biology Meeting, APR 22-26, 2017, Chicago, IL. The FASEB Journal, 31(1), Article ID 786.33.
Open this publication in new window or tab >>Prenatal food and micronutrient interventions in rural Bangladesh remain cost-effective when assessing both favorable and unfavorable outcomes: Cost-effectiveness analysis of the MINIMat trial on under five-mortality and stunting.
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2017 (English)In: The FASEB Journal, ISSN 0892-6638, E-ISSN 1530-6860, Vol. 31, no 1, article id 786.33Article in journal, Meeting abstract (Other academic) Published
National Category
Nutrition and Dietetics Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-335023 (URN)000405461405222 ()
Conference
Annual Meeting of the American-Society-for-Pharmacology-and-Experimental-Therapeutics (ASPET) at Experimental Biology Meeting, APR 22-26, 2017, Chicago, IL
Available from: 2017-12-01 Created: 2017-12-01 Last updated: 2017-12-01Bibliographically approved
Dalmar, A. A., Hussein, A. S., Walhad, S. A., Ibrahim, A. O., Abdi, A. A., Ali, M. K., . . . Wall, S. (2017). Rebuilding research capacity in fragile states: the case of a Somali-Swedish global health initiative. Global Health Action, 10(1), Article ID 1348693.
Open this publication in new window or tab >>Rebuilding research capacity in fragile states: the case of a Somali-Swedish global health initiative
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2017 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, no 1, article id 1348693Article in journal (Refereed) Published
Abstract [en]

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.

Keywords
Somalia, fragile states, health systems, health research training, Diaspora
National Category
Public Health, Global Health, Social Medicine and Epidemiology Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:uu:diva-332661 (URN)10.1080/16549716.2017.1348693 (DOI)000407952800001 ()28799463 (PubMedID)
Available from: 2017-11-08 Created: 2017-11-08 Last updated: 2017-11-08Bibliographically approved
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