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  • 1.
    Ahlberg, Beth Maina
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Krantz, Ingela
    Lindmark, Gunilla
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Warsame, Marian
    A replay to Johnsdotter and Essén2005Other (Other scientific)
  • 2.
    Berg, Marie
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Lundgren, Ingela
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Lindmark, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Childbirth experience in women at high risk: Is it improved by use of a birth plan?2003In: The Journal of Perinatal education, Vol. 12, no 2, p. 1-15Article in journal (Refereed)
    Abstract [en]

    Women at obstetric high risk more often experience negative feelings related to childbirth than women with normal outcomes. For these high-risk women, an individual birth plan does not appear to improve the overall experience of childbirth; rather, it seems to intensify the negative feelings in several aspects. The increased vulnerability in women at high risk warrants special attention to the possibility that types of care routinely offered to all women may negatively influence the experiences of high-risk women.

  • 3.
    Berglund, Anna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Lindberg, Marianne
    Nyström, Lennarth
    Lindmark, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Combining the perspectives of midwives and doctors improves risk assessment early pregnancy2007In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 86, no 2, p. 177-184Article in journal (Refereed)
    Abstract [en]

    Background. Traditionally, risk identification in early pregnancy in Swedish antenatal care [ANC] is performed by the midwife at booking, and confirmed by the doctor at a routine visit in early pregnancy, but this extra visit has been questioned. This study compared the risk assessment by the two professions. Methods. In a cluster randomised trial, a planning conference, where midwives reported new mothers to a doctor, replaced the routine consultation with the doctor. Ten ANC-clinics with the new program (942 mothers) were compared to 10 clinics with standard care (758 mothers). Risk factors were registered independently by midwives and doctors. Degree of agreement in risk identification between midwives and doctors was estimated by the kappa coefficient. Results. The degree of agreement in risk registration was good for previous pregnancy complications (κ=0.62; CI: 0.55-0.68), and recommendations for doctor's consultation (κ=0.67; CI: 0.62-0.72); fair for social problems (κ=0.29; CI: 0.03-0.55), and poor for registration of symptoms and problems in index pregnancy (κ=0.09; CI: 0.03-0.21) and psychosocial aspects, such as anxiety (κ=0.09; CI: 0.03-0.21). Significantly more risk factors were registered in the study group. Conclusions: Replacing the routine consultation with the doctor early in pregnancy with a planning conference had no negative impact on risk identification. The results support that the different perspectives of the two professions in combination are important for the safety of surveillance and the psychosocial support expected from antenatal care.

  • 4.
    Berglund, Anna
    et al.
    Uppsala University, National Centre for Knowledge on Men.
    Lindmark, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Preconception health and care (PHC)a strategy for improved maternal and child health2016In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 121, no 4, p. 216-221Article, review/survey (Refereed)
    Abstract [en]

    Maternal health status before pregnancy is a decisive factor for pregnancy outcomes and for risk for maternal and infant complications. Still, maternity care does not start until the pregnancy is established and in most low-income settings not until more than half of the pregnancy has passed, which often is too late to impact outcomes. In Western societies preconception care (PCC) is widely recognized as a way to optimize women's health through biomedical and behavioural changes prior to conception with the aim of improving pregnancy outcomes. But the content of PCC is inconsistent and limited to single interventions or preconception counselling to women with chronic illnesses. It has been suggested that PCC should be extended to preconception health and care (PHC), including interventions prior to pregnancy in order to optimize women's health in general, and thereby subsequent pregnancy outcomes, the well-being of the family, and the health of the future child. With this definition, almost every activity that can improve the health of girls and women can be included in the concept. In the World Health Report of 2005 a longitudinal approach to women's wellness and reproductive health was highlighted, and the World Health Organization has proposed a more comprehensive maternal and child health care, also including psychosocial issues and intimate partner violence. The present article gives an overview of the recent literature and discusses contents and delivery of PCC/PHC in Western as well as low-income countries. The article puts special emphasis on why violence against women is an issue for PHC.

  • 5. Bergsjö, Per
    et al.
    Bakketeig, Leiv S.
    Lindmark, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Maternal smoking does not affect fetal size as measured in the mid-second trimester2007In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 86, no 2, p. 156-160Article in journal (Refereed)
    Abstract [en]

    Background. Cigarette smoking during pregnancy is causally related to birthweight, but we do not know whether fetal growth restriction is a continuous process or, if not, at what stage of pregnancy it affects weight gain. Material and methods. A random sample of para 1 and 2 mothers, drawn from the population of pregnant women in Bergen and Trondheim, Norway, and Uppsala, Sweden, were examined by a detailed questionnaire concerning smoking habits, menstrual history and pregnancy dating, and subjected to morphometric sonography of their fetuses in or around week 17. Of the 547 study participants, 31.9% were smokers. Gestational age was primarily determined by the last menstrual period [LMP], except in those with irregular cycles, and in 30 cases (6.6% of those with regular cycles) in whom the biparietal diameter [BPD]-determined age deviated >14 days from the LMP-based date. Results. The analysis did not reveal any statistically significant differences between the fetuses of non-smokers, light smokers (0-9 cigarettes per day) and heavy (10+ cigarettes per day) smokers, regarding BPD, mean abdominal diameter [MAD] femur length [FL], and a 'body contour index': [BPD+FL]MAD. Conclusion. Tobacco-induced fetal growth restriction probably begins after gestational week 17.

  • 6.
    Bjerneld, Magdalena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Ahlberg, Beth Maina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Lindmark, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Socialisation of humanitarian aid workers: Interviews with recruitment officersManuscript (Other academic)
    Abstract [en]

    International organisations employ thousands of aid workers for humanitarian aid around the world. One of the problems identified in earlier research is the high turnover of personnel.

    This article is part of a broader research project investigating how humanitarian organisations attract, recruit and prepare expatriate health professionals for field work and how these professionals are utilized in order to identify possible improvements in the human resource management system. The current study describes how recruitment officers in selected large humanitarian organisations perceive humanitarian aid work, how they recruit, prepare, and support their staff in order to achieve high retention, and what concerns and recommendations they have for future work. For the analysis of the interviews content analysis was used.

    The recruitment officers identified the importance of flexibility and diplomacy in complex realities. They confirmed the findings of earlier studies that team work often is a source of frustrations and sometimes disappointment. Their main concern was lack of time to find the right person for the right job, often a person with broad expertise in public health. Another difficulty was to find persons who could take responsibility as leaders and trainers. In order to socialize the newcomers into the organisation short courses and debriefing sessions were used. Persons, who stay too long in the field of humanitarian action and sometimes become cynical to the difficult situation they work in was also discussed as being problematic. This finding contradicts the otherwise frequently discussed question about the high turnover of personnel in humanitarian action. This article argues for the use of socialization theory in order to find sustainable solution to identified problems.

  • 7.
    Bjerneld, Magdalena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Lindmark, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Diskett, Patricia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Garrett, Martha J.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Perceptions of Work in Humanitarian Assistance: Interviews With Returning Swedish Health Professionals2004In: Disaster Management & Response, ISSN 1540-2487, E-ISSN 1540-2495, Vol. 2, no 4, p. 101-108Article in journal (Refereed)
    Abstract [en]

     

    Health personnel volunteering for humanitarian assistance assignments work in increasingly dangerous situations and increasingly complex roles. A qualitative analysis of interviews with returning Swedish aid workers, who collectively had been on 74 missions in 32 different countries, revealed that they felt positive about their contribution, but experienced high levels of stress and frustration. They were also surprised and inadequately prepared for tasks that fell outside their professional health care training, including ones demanding pedagogic and management skills.

    The volunteers perceived their success on humanitarian assistance assignments as being affected not only by their own professional competence and special preparatory training, but also by many other factors. In particular, recruiting organizations could improve volunteer performance by accepting only experienced professionals, requiring special preparatory training, clarifying the exact nature of the work, and providing better support during the assignment. Further analysis of humanitarian assistance as a complex and dynamic system involving multiple ‘actors’ could lead to improved understanding and better performance.

     

  • 8.
    Bjerneld, Magdalena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Lindmark, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    McSpadden, Lucia Ann
    Pacific School of Religion, Berkeley, California.
    Garrett, Martha J.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Motivations, Concerns, and Expectations of Scandinavian Health Professionals Volunteering for Humanitarian Assignments2006In: Disaster Management & Response, ISSN 1540-2487, E-ISSN 1540-2495, Vol. 4, no 2, p. 49-58Article in journal (Refereed)
    Abstract [en]

    International nongovernmental organizations (NGOs) involved in humanitarian assistance employ millions of volunteers. One of the major challenges for the organizations is the high turnover rate among their personnel. Another is recruiting the right persons. As part of a series of studies investigating factors that affect the recruitment process and the success of assignment, this qualitative study examined health professionals' motivations for volunteering, their various concerns, and their expectations about themselves and the organizations for which they would work. The findings from focus group interviews with potential humanitarian volunteers were considered within the framework of Hertzberg's theory of motivations and Maslow's hierarchy of needs.

    The study has significant implications for personnel policy and practice in the humanitarian sector. Recruitment officers should have the self-actualized person, as described by Maslow, in mind when interviewing candidates. This perspective would make it easier for them to understand the candidates' thoughts and concerns and would lead to more effective interventions. Program officers should have satisfiers and dissatisfiers, as identified by Herzberg, in mind when planning programs. The probability that personnel will leave humanitarian work is lower if they perceive working conditions as good.

     

  • 9.
    Chikovore, Jeremiah
    et al.
    HIV/AIDS, Sexually Transmitted Infections, and Tuberculosis Unit, Human Sciences Research Council, Durban, South Africa.
    Nystrom, Lennarth
    Division of Epidemiology and Public Health Sciences, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Lindmark, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Ahlberg, Beth Maina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    "How Can I Gain Skills if I Don't Practice?'' The Dynamics of Prohibitive Silence against Pre-Marital Pregnancy and Sex in Zimbabwe2013In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 1, p. e53058-Article in journal (Refereed)
    Abstract [en]

    Young people face sexual and reproductive health (SRH) problems including Human immunodeficiency virus (HIV) and Acquired immunodeficiency syndrome (AIDS). It is critical to continue documenting their situation including the contexts they live in. As part of a larger study that explored perspectives of men to SRH and more specifically abortion and contraceptive use, 546 pupils (51% female; age range 9-25 years) from a rural area in Zimbabwe were invited to write anonymously questions about growing up or other questions they could not ask adults for fear or shame. The pupils were included following descriptions by adults of the violence that is unleashed on unmarried young people who engaged in sex, used contraceptives, or simply suggested doing so. The questions by the young people pointed to living in a context of prohibitive silence; their sexuality was silenced and denied. As a consequence they had poor knowledge and their fears and internal conflicts around sexuality and pregnancy were not addressed. Current action suggests concerted effort at the policy level to deal with young people's SRH in Zimbabwe. It nevertheless remains necessary, as a way to provide support to these efforts, to continue examining what lessons can be drawn from the past, and how the past continues to reflect in and shape present dynamics and relations. There is also need to look more critically at life skill education, which has previously been described as having failed to address adequately the practical needs of young people. Life skill education in Zimbabwe has rarely been systematically evaluated. A fuller understanding is also needed of the different factors co-existing in contemporary African societies and how they have been and continue to be constituted within history, and the implications to the promotion of adolescent SRH.

  • 10.
    Darj, Elisabeth
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Norwegian Univ Sci & Technol, NTNU, Dept Publ Hlth & Nursing, Trondheim, Norway.;St Olavs Hosp, Dept Obstet & Gynecol, Trondheim, Norway..
    Wijewardena, Kumudu
    Univ Sri Jayewardenepura, Dept Community Med Hlth, Colombo, Sri Lanka..
    Lindmark, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Axemo, Pia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    'Even though a man takes the major role, he has no right to abuse': future male leaders' views on gender-based violence in Sri Lanka2017In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, no 1, article id 1348692Article in journal (Refereed)
    Abstract [en]

    Background: Distinct gender roles influence gender inequality and build the foundation for gender-based violence. Violence against women is a major public health problem in all societies, and a violation of human rights. Prevalence surveys on gender-based violence have been published from Sri Lanka, but qualitative studies on men's perceptions are lacking. Objectives: The aim of this study was to explore young educated Sri Lankan men's perceptions of violence against women. Methods: Seven focus-group discussions were held. Men at the end of their university studies were purposefully selected. A topic guide was used, covering various scenarios of violence against women. Qualitative content analysis was carried out. Results: Four categories were developed through the analytic process: fixed gender roles patriarchal values are accepted in society, female mobility control, and slowly changing attitudes; violence not accepted but still exists - sexual harassment exists everywhere, different laws for different people, female tolerance of violence, and men's right to punish; multiple factors cause violence - alcohol, violent behavior is inherited, violence culturally accepted, low education, and lack of communication; and prevention of violence against women - both parents must engage and socialize girls and boys equally, life skills education, premarital counselling, working places value clarification, and more women in politics and boards are suggested. Conclusions: Medical and management students, possible future male leaders of the country, have suggestions of prevention strategies in life skills to reduce gender-based violence and to increase knowledge of health consequences with the aim of changing attitudes.

  • 11.
    Eriksson, Elisabet
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Lindmark, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Axemo, Pia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Haddad, Beverley
    School of Religion and Theology, University of KwaZulu-Natal, South Africa .
    Ahlberg, Beth Maina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Faith, Premarital Sex and Relationships: Are Church Messages in Accordance with the Perceived Realities of the Youth?: A Qualitative Study in KwaZulu–Natal, South Africa2013In: Journal of religion and health, ISSN 0022-4197, E-ISSN 1573-6571, Vol. 52, no 2, p. 454-466Article in journal (Refereed)
    Abstract [en]

    Since religious messages on life style have a strong impact in South Africa, it is important to assess how they relate to the situation for young people at risk of HIV infection. Nine focus group discussions were conducted with youth (n=62), aged 13–20 years, from the Roman Catholic Church, the Lutheran Church, and the Assemblies of God. Young people were ambivalent toward sexual contacts since these generally were expected to be part of a relationship even though the church condemns premarital sex. Girls perceived the moral norms to concern them more than the boys for whom sexual needs were more accepted. These moral barriers lead to lack of information about protection and may increase the risk of HIV. The realities young people facing should be a major concern for the faith communities.

  • 12.
    Eriksson, Elisabet
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Lindmark, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Haddad, Beverley
    School of Religion and Theology, University of KwaZulu-Natal, South Africa .
    Axemo, Pia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Involvement of religious leaders in HIV prevention, South Africa2011In: Svensk Missionstidsskrift, ISSN 0346-217X, Vol. 99, no 2, p. 119-135Article in journal (Refereed)
    Abstract [en]

    Religious leaders do not easily get involved in HIV prevention for young people since discussing sexuality publicly is taboo. A self-administrated questionnaire survey was conducted among local religious leaders (n=215) August-October 2008, when they convened at regional meetings in KwaZulu-Natal, South Africa. The questionnaire included socio-demographic data, previous HIV education and attitudes to HIV prevention for young people, policy issues, and questions on stigma. The participants (186 males, 29females) were affiliated to the Catholic Church (66), Lutheran church (82),and the Assemblies of God (67). Religious leaders regarded themselves as responsible for educating young people about HIV, and were interested in topics concerning young people’s sexuality. However, only 39% reported that their church had run a life-skill programme for youth in the last six months. The results indicated that religious leaders who had participated in HIV training were more likely to have arranged a life-skill programme for young people and also more likely to have taken an HIV test.

    Religious leaders were positive about further training on HIV- related issues, and if learning opportunities are offered to them, this might increase their involvement in HIV prevention among young people.

  • 13.
    Eriksson, Elisabet
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Lindmark, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Haddad, Beverley
    School of Religion, Philosophy and Classics, University of KwaZulu-Natal, Pietermaritzburg, South Africa.
    Axemo, Pia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Young people, sexuality, and HIV prevention within Christian faith communities in South Africa: a cross-sectional survey2014In: Journal of religion and health, ISSN 0022-4197, E-ISSN 1573-6571, Vol. 53, no 6, p. 1662-1675Article in journal (Refereed)
    Abstract [en]

    Faith communities exert a powerful influence on the life of their members, and studies are needed about how they may be able to influence young people's attitudes regarding sexuality and HIV prevention. Data were collected through a self-administered questionnaire from young people (811), aged 15-24 years, affiliated to the Roman Catholic Church, the Lutheran Church and the Assemblies of God. The majority of participants perceived themselves at risk of HIV infection (53 %). Premarital sexual abstinence was the most frequently (88 %) reported prevention message, followed by faithfulness (23 %), HIV testing (18 %) and condom use (17 %). Furthermore, religious affiliation was associated with education on sexuality and HIV in youth groups, with better information given to members of the Lutheran and Catholic churches. Faith communities need to strengthen their capacity to educate young people in a more holistic way about sexuality and HIV prevention.

  • 14. Gottlieb, Philip
    et al.
    Bergström, Staffan
    Silfverdal, Sven-Arne
    Wesström, Göran
    Silfverdal, Lena
    Lindmark, Gunilla
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    [Time for the Medical Society to comment the issue of the apathetic refugee children]2005In: Lakartidningen, ISSN 0023-7205, Vol. 102, no 32-33, p. 2236; discussion 2237-Article in journal (Other scientific)
  • 15.
    Kidanto, Hussein L
    et al.
    Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
    Mogren, Ingrid
    Department of Clinical Science, Obstetrics and Gynaecology, Umeå University, Umeå, Sweden.
    van Roosmalen, Jos
    Department of Obstetrics, Leiden University Medical Centre and Section of Health care and Culture, VU University Medical Centre, Amsterdam, The Netherlands.
    Thomas, Angela N
    Department of Obstetrics and Gynaecology, Muhimbili National Hospital, Dar es Salaam, Tanzania.
    Massawe, Siriel N
    Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
    Nystrom, Lennarth
    Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences, Umeå University, Umeå, Sweden.
    Lindmark, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Introduction of a qualitative perinatal audit at Muhimbili National Hospital, Dar es Salaam, Tanzania2009In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 9, p. 45-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Perinatal death is a devastating experience for the mother and of concern in clinical practice. Regular perinatal audit may identify suboptimal care related to perinatal deaths and thus appropriate measures for its reduction. The aim of this study was to perform a qualitative perinatal audit of intrapartum and early neonatal deaths and propose means of reducing the perinatal mortality rate (PMR).

    METHODS:

    From 1st August, 2007 to 31st December, 2007 we conducted an audit of perinatal deaths (n = 133) with birth weight 1500 g or more at Muhimbili National Hospital (MNH). The audit was done by three obstetricians, two external and one internal auditors. Each auditor independently evaluated the cases narratives. Suboptimal factors were identified in the antepartum, intrapartum and early neonatal period and classified into three levels of delay (community, infrastructure and health care). The contribution of each suboptimal factor to adverse perinatal outcome was identified and the case graded according to possible avoidability. Degree of agreement between auditors was assessed by the kappa coefficient.

    RESULTS:

    The PMR was 92 per 1000 total births. Suboptimal factors were identified in 80% of audited cases and half of suboptimal factors were found to be the likely cause of adverse perinatal outcome and were preventable. Poor foetal heart monitoring during labour was indirectly associated with over 40% of perinatal death. There was a poor to fair agreement between external and internal auditors.

    CONCLUSION:

    There are significant areas of care that need improvement. Poor monitoring during labour was a major cause of avoidable perinatal mortality. This type of audit was a good starting point for quality assurance at MNH. Regular perinatal audits to identify avoidable causes of perinatal deaths with feed back to the staff may be a useful strategy to reduce perinatal mortality.

  • 16.
    Kidanto, Hussein Lesio
    et al.
    Dept of Obstetrics and Gynaecology, Muhimbili National Hospital, Dar es Salaam, Tanzania.
    Mogren, Ingrid
    Dep of Clinical Science, Obstetrics and Gynaecology, Umeå University, Sweden.
    Massawe, Siriel N.
    Dept of Obstetrics and Gynaecology, Muhimbili National Hospital, Dar es Salaam, Tanzania.
    Lindmark, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Nyström, Lennarth
    Dept of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences, Umeå University, Sweden.
    Criteria-based audit on management of eclampsia patients at a tertiary hospital in Dar es Salaam, Tanzania2009In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 9, article id 13Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Criteria-based audits have been used to improve clinical management in developed countries, but have only recently been introduced in the developing world. This study discusses the introduction of a criteria-based audit in a tertiary hospital in an African setting, assesses the quality of care among eclampsia patients and discusses possible interventions in order to improve the quality of care. METHODS: We conducted a criteria based audit of 389 eclampsia patients admitted to Muhimbili National Hospital (MNH), Dar es Salaam Tanzania between April 14, 2006 and December 31, 2006. Cases were assessed using evidence-based criteria for appropriate care. RESULTS: Antepartum, intrapartum and postpartum eclampsia constituted 47%, 41% and 12% of the eclampsia cases respectively. Antepartum eclampsia was mostly (73%) preterm whereas the majority (71%) of postpartum eclampsia cases ware at term. The case fatality rate for eclampsia was 7.7%. Medical histories were incomplete, the majority (75%) of management plans were not reviewed by specialists in obstetrics, specialist doctors live far from the hospital and do not spend nights in hospital even when they are on duty, monitoring of patients on magnesium sulphate was inadequate, and important biochemical tests were not routinely done. Two thirds of the patient scheduled for caesarean section did not undergo surgery within agreed time. CONCLUSION: Potential areas for further improvement in quality of emergency care for eclampsia relate to standardizing management guidelines, greater involvement of specialists in the management of eclampsia and continued medical education on current management of eclampsia for junior staff.

  • 17.
    Kidanto, Hussein Lesio
    et al.
    Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
    Wangwe, Peter
    Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
    Kilewo, Charles D
    Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
    Nystrom, Lennarth
    Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Sweden.
    Lindmark, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Improved quality of management of eclampsia patients through criteria based audit at Muhimbili National Hospital, Dar es Salaam, Tanzania. Bridging the quality gap2012In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 12, no 1, p. 134-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Criteria-based audits (CBA) have been used to improve clinical management in developed countries, but have only recently been introduced in the developing world. This study discusses the use of a CBA to improve quality of care among eclampsia patients admitted at a University teaching hospital in Dar es Salaam Tanzania.

    OBJECTIVE:

    The prevalence of eclampsia in MNH is high ([almost equal to]6%) with the majority of cases arriving after start of convulsions. In 2004--2005 the case-fatality rate in eclampsia was 5.1% of all pregnant women admitted for delivery (MNH obstetric data base). A criteria-based audit (CBA) was used to evaluate the quality of care for eclamptic mothers admitted at Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania after implementation of recommendations of a previous audit.

    METHODS:

    A CBA of eclampsia cases was conducted at MNH. Management practices were evaluated using evidence-based criteria for appropriate care. The Ministry of Health (MOH) guidelines, local management guidelines, the WHO manual supplemented by the WHO Reproductive Health Library, standard textbooks, the Cochrane database and reviews in peer reviewed journals were adopted. At the initial audit in 2006, 389 case notes were assessed and compared with the standards, gaps were identified, recommendations made followed by implementation. A re-audit of 88 cases was conducted in 2009 and compared with the initial audit. RESULTS: There was significant improvement in quality of patient management and outcome between the initial and re-audit: Review of management plan by senior staff (76% vs. 99%; P=0.001), urine for albumin test (61% vs. 99%; P=0.001), proper use of partogram to monitor labour (75% vs. 95%; P=0.003), treatment with steroids for lung maturity (2.0% vs. 24%; P=0.001), Caesarean section within 2 hours of decision (33% vs. 61%; P=0.005), full blood count (28% vs. 93%; P=0.001), serum urea and creatinine (44% vs. 86%; P=0.001), liver enzymes (4.0% vs. 86%; P=0.001), and specialist review within 2 hours of admission (25% vs. 39%; P=0.018). However, there was no significant change in terms of delivery within 24 hours of admission (69% vs. 63%; P=0.33). There was significant reduction of maternal deaths (7.7% vs. 0%; P=0.001).

    CONCLUSION:

    CBA is applicable in low resource setting and can help to improve quality of care in obstetrics including management of pre-eclampsia and eclampsia.

  • 18.
    Laisser, Rose M
    et al.
    Institute of Allied Health Sciences Midwifery School, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania.
    Nyström, Lennarth
    Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Sweden.
    Lindmark, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Lugina, Helen I
    Archbishop Anthony Mayalla School of Nursing, Weill Bugando University College of Health Sciences, Mwanza, Tanzania.
    Emmelin, Maria
    Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Sweden.
    Screening of women for intimate partner violence: a pilot intervention at an outpatient department in Tanzania2011In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 4, p. 7288-Article in journal (Refereed)
    Abstract [en]

    Intimate partner violence (IPV) is a public health problem in Tanzania with limited health care interventions.

    OBJECTIVES:

    To study the feasibility of using an abuse screening tool for women attending an outpatient department, and describe how health care workers perceived its benefits and challenges.

    METHODS:

    Prior to screening, 39 health care workers attended training on gender-based violence and the suggested screening procedures. Seven health care workers were arranged to implement screening in 3 weeks, during March-April 2010. For screening evaluation, health care workers were observed for their interaction with clients. Thereafter, focus group discussions (FGDs) were conducted with 21 health care workers among those who had participated in the training and screening. Five health care workers wrote narratives. Women's responses to screening questions were analyzed with descriptive statistics, whereas qualitative content analysis guided analysis of qualitative data.

    RESULTS:

    Of the 102 women screened, 78% had experienced emotional, physical, or sexual violence. Among them, 62% had experienced IPV, while 22% were subjected to violence by a relative, and 9.2% by a work mate. Two-thirds (64%) had been abused more than once; 14% several times. Almost one-quarter (23%) had experienced sexual violence. Six of the health care workers interacted well with clients but three had difficulties to follow counseling guidelines. FGDs and narratives generated three categories Just asking feels good implied a blessing of the tool; what next? indicated ethical dilemmas; and fear of becoming a 'women hospital' only indicated a concern that abused men would be neglected.

    CONCLUSIONS:

    Screening for IPV is feasible. Overall, the health care workers perceived the tool to be advantageous. Training on gender-based violence and adjustment of the tool to suit local structures are important. Further studies are needed to explore the implications of including abuse against men and children in future screening.

  • 19. Leon, David A
    et al.
    Koupil, Ilona
    Mann, Vera
    Tuvemo, Torsten
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Lindmark, Gunilla
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Mohsen, Rawya
    Department of Public Health and Caring Sciences.
    Byberg, Liisa
    Department of Public Health and Caring Sciences.
    Lithell, Hans
    Department of Public Health and Caring Sciences.
    Fetal, developmental, and parental influences on childhood systolic blood pressure in 600 sib pairs: The Uppsala Family study.2005In: Circulation, ISSN 1524-4539, Vol. 112, no 22, p. 3478-85Article in journal (Refereed)
  • 20.
    Lindmark, G
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Langhoff-Roos, J
    Regional quality assessment in perinatal care2004In: Seminars in Neonatology: Saunders, Vol. 9, p. 145-153Article in journal (Refereed)
  • 21.
    Lindmark, Gunilla
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Läkemedel och vaccinering: Läkemedelsbehandling under graviditet2004In: Obstetrisk öppenvård, 2004, p. 91-102Chapter in book (Refereed)
  • 22.
    Lugina, Helen I
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Nyström, Lennarth
    Christensson, Kyllike
    Lindmark, Gunilla
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Assessing mothers' concerns in the postpartum period: methodological issues.2004In: J of Adv Nurs, ISSN 0309-2402, Vol. 48, no 3, p. 279-90Article in journal (Refereed)
  • 23.
    Lundgren, I
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Berg, Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Lindmark, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Is childbirth experience improved by a birth plan?2003In: Journal of midwifery & women's health, ISSN 1526-9523, E-ISSN 1542-2011, Vol. 48, no 5, p. 322-328Article in journal (Refereed)
    Abstract [en]

    From antenatal clinics in Sweden, 271 women were recruited after week 33 of pregnancy and given a questionnaire designed to assess their attitudes and feelings about the coming childbirth. Thereafter, they formulated a birth plan. The midwife in attendance at the birth was able to refer to this plan. Women who followed this program were compared with women from the same clinics who were asked to complete a questionnaire during the first postpartum week to assess their birth experience. A questionnaire at the end of pregnancy, followed by a birth plan, was not effective in improving women's experiences of childbirth. In the birth plan group, women gave significantly lower scores for the relationship to the first midwife they met during delivery, with respect to listening and paying attention to needs and desires, support, guiding, and respect. Although a birth plan did not improve the experience of childbirth in the overall group, there may be beneficial effects with regard to fear, pain, and concerns about the newborn for certain subgroups of women.

  • 24.
    Majoko, F
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Munjanja, S
    Nystrom, L
    Mason, E
    Lindmark, G
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Field efficiency of syphilis screening in antenatal care: lessons from Gutu District in Zimbabwe.2003In: Cent Afr J Med, ISSN 0008-9176, Vol. 49, no 7-8, p. 90-3Article in journal (Refereed)
  • 25.
    Majoko, F
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Nyström, L
    Munjanja, SP
    Manson, E
    Lindmark, G
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Relation of parity to pregnancy outcome in a rural community in Zimbabwe2004In: African Journal of Reproductive Healt, Vol. 8, no 3, p. 198-206Article in journal (Refereed)
  • 26.
    Majoko, Franz
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Munjanja, Stephen
    Nyström, Lennarth
    Mason, Elizabeth
    Lindmark, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Randomised controlled trial of two antenatal care models in rural Zimbabwe2007In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 114, no 7, p. 802-811Article in journal (Refereed)
    Abstract [en]

    Objective To compare a five-visit antenatal care (ANC) model with specified goals with the standard model in a rural area in Zimbabwe. Design Cluster randomised controlled trial with the clinic as the randomisation unit. Setting Primary care setting in a developing country where care was provided by nurse-midwives. Population Women booking for ANC in the clinics were eligible. Main outcome measures Number of antenatal visits, antepartum and intrapartum referrals, utilization of health centre for delivery and perinatal outcomes. Methods Twenty-three rural health centres were stratified prior to random allocation to the new (n= 11) or standard (n= 12) model of care. Results We recruited 13 517 women (new, n= 6897 and standard, n= 6620) in the study, and 78% (10 572) of their pregnancy records were retrieved. There was no difference in median maternal age, parity and gestational age at booking between women in the standard model and those in the new model. The median number of visits was four for both models. The proportion of women with five or less visits was 77% in the new and 69% in the standard model (OR 1.5; 95% CI 1.08-2.2). The likelihood of haemoglobin testing was higher in the new model (OR 2.4; 95% CI 1.0-5.7) but unchanged for syphilis testing. There were fewer intrapartum transfers (5.4 versus 7.9% [OR 0.66; 95% CI 0.44-0.98]) in the new model but no difference in antepartum or postpartum transfers. There was no difference in rates of preterm delivery or low birthweight. The perinatal mortality was 25/1000 in standard model and 28/1000 in new model. Conclusion In Gutu district, a focused five-visit schedule did not change the number of contacts but was more effective as expressed by increased adherence to procedures and better use of institutional health care.

  • 27.
    Majoko, Franz
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Nyström, Lennarth
    Munjanja, Stephen
    Mason, Elizabeth
    Lindmark, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Does maternity care improve pregnancy outcomes in women with previous complications?: A study from Zimbabwe2005In: Tropical doctor, ISSN 0049-4755, E-ISSN 1758-1133, Vol. 35, no 4, p. 195-198Article in journal (Refereed)
    Abstract [en]

    To determine the utilization of maternal health care services and pregnancy outcomes for women with a history of complications in previous pregnancy, we analysed the pregnancy records of multiparous women (parity > or =1) who booked and completed follow-up in Gutu district, Zimbabwe between January 1995 and June 1998. Women with previous uncomplicated pregnancies (n = 6140) were classified as low risk, whereas those with complications of previous pregnancy (n = 1077) were classified high risk. At enrolment, there was no difference in maternal age and parity between low- and high-risk women. A higher proportion of high-risk women had more than five antenatal visits (32% versus 21%; P<0.001) and gave birth in hospital (47% versus 18%; P<0.001). The risk of antenatal (relative risk [RR] 1.57; 95% confidence interval [CI] 1.32-1.88), labour/delivery (RR 1.98; 95% CI 1.75-2.25) and neonatal (RR 1.83; 95% CI 1.44-2.34) complications was elevated in high-risk women. There was increased risk for perinatal death in high-risk women, but this did not reach statistical significance (RR 1.56; 95% CI 0.98-2.49). The recurrence ratio for most complications was low and the sensitivity of historical risk markers in predicting women likely to develop further complicated pregnancies was only 23%. Most women with previous pregnancy complications can safely give birth in the rural health centre. We concluded that high-risk women had an elevated risk of complications in the index pregnancy and that better utilization of maternal health care, especially for delivery, reduced adverse perinatal outcomes.

  • 28.
    Mathole, T
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Lindmark, G
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Ahlberg, Bm
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Dilemmas and paradoxes in providing and changing antenatal care: a study of nurses and midwives in rural Zimbabwe.2005In: Health Policy Plan, ISSN 0268-1080, Vol. 20, no 6, p. 385-93Article in journal (Other scientific)
  • 29.
    Mathole, T
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Lindmark, G
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Majoko, F
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Ahlberg, BM
    A qualitative study of women´s perspectives of antenatal care in a rural area of Zimbabwe2004In: Midwifery, Vol. 20, p. 122-132Article in journal (Refereed)
  • 30.
    Mathole, Thubelihle
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Lindmark, Gunilla
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Ahlberg, Beth Maina
    Competing knowledge claims in the provision of antenatal care: a qualitative study of traditional birth attendants in rural zimbabwe.2005In: Health Care Women Int, ISSN 0739-9332, Vol. 26, no 10, p. 937-56Article in journal (Refereed)
  • 31.
    Mathole, Thubelihle
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Lindmark, Gunilla
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Ahlberg, Beth Maina
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Knowing but not knowing: providing maternity care in the contest of HIV/AIDS in rural Zimbabwe2006In: African Journal of AIDS Res, Vol. 5, no 2, p. 133-139Article in journal (Refereed)
  • 32.
    Muganyizi, Projestine
    et al.
    Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences (MUHAS), Dar Es Salaam, Tanzania.
    Nyström, Lennarth
    Umeå University, Epidemiology and Public Health Sciences, Dept of Public Health and Clinical Medicine.
    Lindmark, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Emmelin, Maria
    Umeå University, Epidemiology and Public Health Sciences, Dept of Public Health and Clinical Medicine.
    Massawe, Siriel
    Muhimbili University of Health and Allied Sciences (MUHAS)School of Medicine, Department of Obstetrics and Gynecology.
    Axemo, Pia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Effect of Supporter Characteristics on Expression of Negative Social Reactions Toward Rape Survivors in Dar Es Salaam, Tanzania2010In: Health Care for Women International, ISSN 0739-9332, E-ISSN 1096-4665, Vol. 31, no 8, p. 668-685Article in journal (Refereed)
    Abstract [en]

    Using a community representative sample of 1,505 adults we examined interpretations of rape situations in order to establish attitudes toward rape. We assessed their intentions to express negative social reactions (NSRs) toward rape survivors. We then determined effects of attitudinal and sociodemographic characteristics in logistic regression models assessing the odds of expressing NSRs. Being old, male, and Muslim, and failing to interpret the legal circumstances of rape increased their risks of expressing NSRs. The degree of interpretation of lack of consent as rape affected their intentions to express NSRs, but not how they responded to survivors of different social status.

     

  • 33.
    Muganyizi, Projestine S.
    et al.
    Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
    Hogan, Nora
    Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
    Emmelin, Maria
    Umeå University, Umeå, Sweden.
    Lindmark, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Massawe, Siriel
    Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
    Nystrom, Lennarth
    Axemo, Pia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Social reactions to rape: experiences and perceptions of women rape survivors and their potential support providers in Dar es Salaam, Tanzania2009In: Violence and Victims, ISSN 0886-6708, E-ISSN 1945-7073, Vol. 24, no 5, p. 607-626Article in journal (Refereed)
    Abstract [en]

    Social reactions to rape are socioculturally determined and have a strong influence on the coping and recovery of the survivor. The existing knowledge on social reactions emanates from Western countries with limited research attention on non-Western populations, particularly sub-Saharan Africa. We aimed to establish the types and perceptions of social reactions that are expressed to rape survivors and people's intentions to express them to survivors of varied social backgrounds in Tanzania. Using triangulation of research methods, experiences of social reactions among rape survivors (n = 50) and nurses (n = 44) from a community in Tanzania were explored, and the intentions to express typical social reactions to rape survivors of different social backgrounds were established from a representative community sample (n = 1,505). Twelve typical social reactions were identified with the positive reactions more commonly mentioned than the negative reactions. Nondisclosure of rape events and distracting the survivor from the event were perceived as both positive and negative. A commercial sex worker was most vulnerable to negative reactions. The cultural influences of social reactions and implications for practical applicability of the results are discussed.

  • 34. Nyamtema, A S
    et al.
    Urassa, D P
    Massawe, S
    Massawe, A
    Lindmark, G
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    van Roosmalen, J
    Partogram use in the Dar es Salaam perinatal care study2008In: International Journal of Gynecology & Obstetrics, ISSN 0020-7292, E-ISSN 1879-3479, Vol. 100, no 1, p. 37-40Article in journal (Refereed)
    Abstract [en]

    Objective: To assess the quality of partograms used to monitor tabor in Dar es Salaam hospitals, Tanzania. Methods: The study team reviewed the records of the parameters of tabor, and maternal and fetal conditions in 367 partograms, and interviewed 20 midwives. Results: All midwives interviewed had been previously trained to use the partogram. Of all partograms reviewed, 50% had no records of duration of tabor. Although cervical dilation and fetal heart rates were recorded in 97% and 94% of the partograms respectively, 63% and 91% of these were judged to be substandard. Substandard monitoring of fetal heart rates was strongly associated with poor fetal outcome (P<0.001). Blood pressure, temperature, and pulse rates were not recorded in 47%-76% of partograms. Conclusion: These findings reflect poor management of tabor and indicate urgent in-service training to address the importance of documentation and regular partogram audit in order to reduce maternal and perinatal deaths. (c) 2007 International Federation of Gynecology and Obstetrics.

  • 35. Nyamtema, A S
    et al.
    Urassa, D P
    Massawe, S
    Massawe, A
    Mtasiwa, D
    Lindmark, G
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    van Roosmalen, J
    Dar es salaam perinatal care study: Needs assessment for quality of care2008In: East African Journal of Public Health, Vol. 5, p. 17-21Article in journal (Refereed)
  • 36.
    Pembe, Andrea Barnabas
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Carlstedt, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Urassa, David Paradiso
    Department of Community Health, Muhimbili University of Health and Allied Sciences.
    Lindmark, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Nyström, Lennarth
    Department of Public Health and Clinical Medicine, Umeå University.
    Darj, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Quality of antenatal care in rural Tanzania: counselling on pregnancy danger signs2010In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 10, article id 35Article in journal (Refereed)
    Abstract [en]

    Background: The high rate of antenatal care attendance in sub-Saharan Africa, should facilitate information on signs of potential pregnancy complications and advice the women on referral where indicated. The aim of this study was to assess quality of antenatal care with respect to providers’ counselling of pregnancy danger signs and adherence to referral criteria in Rufiji district, Tanzania.

    Methods: A cross-sectional study was conducted in 18 primary health facilities. Thirty two providers were observed providing antenatal care to 438 pregnant women. Information on counselling on pregnancy danger signs and women’s use of health facility for delivery was collected by an observer. Exit interviews were conducted to 435 women.

    Results: One hundred and eighty five (42%) clients were not informed of any pregnancy danger signs. The most common pregnancy danger sign informed on was vaginal bleeding 50% followed by severe headache/blurred vision 45%. Maternal Child Health Aides (MCHAs) were three times more likely to inform a client of a danger sign than nurse auxiliaries (OR=3.7; 95% CI: 2.1-6.5) while public health nurses and registered/enrolled nurses were both two times more likely to inform on danger signs (OR=2.3: 95% CI: 1.3-4.3 and OR=2.4; CI: 1.4-4.2 respectively). Among grand multiparous and primigravida below 20 years identified on exit interview, 63% and 71% had been informed of the risk factors during the during interaction with providers.

    Conclusion: Two out of five clients were not counselled on danger signs of obstetric complication and not advised to use referral services, despite of having a risk factor. Nurse auxiliaries were less capable of counselling clients. Supportive supervision should be made to enhance counselling of danger signs and adherence to referral indications. Nurse auxiliaries should be encouraged and given chance for further training and upgrading to improve their performance and increase human resource for health.

  • 37.
    Pembe, Andrea
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Urassa, David
    Carlstedt, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Lindmark, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Nystrom, Lennarth
    Dept of Public Health and Clinical Medicine, Umeå University, SE-901 85, Umeå, Sweden.
    Darj, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Rural Tanzanian women's awareness of danger signs of obstetric complications2009In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 9, no 12Article in journal (Refereed)
    Abstract [en]

    ABSTRACT: BACKGROUND: Awareness of the danger signs of obstetric complications is the essential first step in accepting appropriate and timely referral to obstetric and newborn care. The objectives of this study were to assess women's awareness of danger signs of obstetric complications and to identify associated factors in a rural district in Tanzania. METHODS: A total of 1118 women who had been pregnant in the past two years were interviewed. A list of medically recognized potentially life threatening obstetric signs was obtained from the responses given. Chi- square test was used to determine associations between categorical variables and multivariate logistic regression analysis was used to identify factors associated with awareness of obstetric danger signs. RESULTS: More than 98% of the women attended antenatal care at least once. Half of the women knew at least one obstetric danger sign. The percentage of women who knew at least one danger sign during pregnancy was 26%, during delivery 23% and after delivery 40%. Few women knew three or more danger signs. According to multivariate logistic regression analysis having secondary education or more increased the likelihood of awareness of obstetric danger signs six-fold (OR=5.8; 95% CI: 1.8-19) in comparison with no education at all. The likelihood to have more awareness increased significantly by increasing age of the mother, number of deliveries, number of antenatal visits, whether the delivery took place at a health institution and whether the mother was informed of having a risks/complications during antenatal care. CONCLUSION: Women had low awareness of danger signs of obstetric complications. We recommend the following in order to increase awareness of danger signs of obstetrical complications: to improve quality of counseling and involving other family members in antenatal and postnatal care, to use radio messages and educational sessions targeting the whole community and to intensify provision of formal education as emphasized in the second millennium development goal.

  • 38. Prathapan, R.
    et al.
    Prathapan, S.
    Lindmark, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Fonseka, P.
    Lokubalasooriya, A.
    Quality of detection of pregnancy induced hypertension to reduce maternal mortality to one digit in Sri Lanka2012In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 119, p. 4-5Article in journal (Other academic)
  • 39. Prathapan, Shamini
    et al.
    Lindmark, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Fonseka, Pushpa
    Lokubalasooriya, Ayesha
    Prathapan, Rasiah
    How good is the quality of antenatal care in the Colombo district of Sri Lanka in diagnosing and treating anaemia?2011In: Quality in Primary Care, ISSN 1479-1072, E-ISSN 1479-1064, Vol. 19, no 4, p. 245-250Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Sri Lanka has shown relatively good maternal outcome indicators for a developing country. However, high maternal deaths from haemorrhage and anaemia raise questions about the quality of detection and treatment of anaemia at field antenatal clinics, which is the primary care setting for pregnant women.

    AIM:

    The aim of the study was to assess the quality of facilities and services and how satisfactory antenatal care is with regard to diagnosis and treatment of anaemia.

    METHODS:

    This study was set in field antenatal clinics and conducted in two stages based on the Lot Quality Assurance Sampling method. In the first stage 55 antenatal clinics were selected, and in the second stage 275 pregnant women were recruited from these 55 clinics. Quality of services and quality of facilities were assessed using observation, and an interviewer administered questionnaire was used to measure client satisfaction. The validity of haemoglobin colour scale results was investigated by comparing them with results from a quality assured laboratory.

    RESULTS:

    Eleven health areas, other than the seven areas which had the haemoglobin investigated, were unacceptable as regards the quality of services. The quality of facilities was better than the quality of services in the Colombo district. Information and counselling was provided for only 4% of women in the clinics. The sensitivity and the specificity for the haemoglobin colour scale was 62% (95% CI: 52.9%-71.1%) and 86% (95% CI: 79.6%-93.0%) respectively.

    CONCLUSION:

    Urgent steps should be taken to improve the quality of care in the health areas where care is substandard, in order to reduce morbidity and mortality due to anaemia.

  • 40. Rioux, France M
    et al.
    Lindmark, Gunilla
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Hernell, Olle
    Does inadequate maternal iron or DHA status have a negative impact on an infant's functional outcomes?2006In: Acta Paediatr, ISSN 0803-5253, Vol. 95, no 2, p. 137-44Article in journal (Refereed)
  • 41.
    Rodriguez, A
    et al.
    Uppsala University, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Faculty of Social Sciences, Department of Psychology.
    Bohlin, G
    Uppsala University, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Faculty of Social Sciences, Department of Psychology.
    Lindmark, G
    Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Psychosocial predictors of smoking and exercise during pregnancy2000In: Journal of Reproductive and Infant Psychology, Vol. 18, p. 203-223Article in journal (Refereed)
  • 42.
    Rodriguez, A
    et al.
    Uppsala University, Department of Comparative Medicine.
    Bohlin, G
    Humanistisk-samhällsvetenskapliga vetenskapsområdet, Faculty of Social Sciences, Department of Psychology.
    Lindmark, G
    Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Symptoms across pregnancy in relation to psychosocial and biomedical factors2001In: ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA, ISSN 0001-6349, Vol. 80, no 3, p. 213-223Article in journal (Refereed)
    Abstract [en]

    Background. There is current interest in symptoms during pregnancy, but yet little is known about their prevalence and how often they are experienced across pregnancy. The reasons why some women experience more symptoms or experience them more often than

  • 43. Schytt, Erica
    et al.
    Lindmark, Gunilla
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Waldenström, Ulla
    Physical symptoms after childbirth: prevalence and associations with self-rated health.2005In: BJOG, ISSN 1470-0328, Vol. 112, no 2, p. 210-7Article in journal (Refereed)
  • 44. Schytt, Erica
    et al.
    Lindmark, Gunilla
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Waldenström, Ulla
    Symptoms of stress incontinence 1 year after childbirth: prevalence and predictors in a national Swedish sample.2004In: Acta Obstet Gynecol Scand, ISSN 0001-6349, Vol. 83, no 10, p. 928-36Article in journal (Other scientific)
  • 45.
    Souza, João Paulo
    et al.
    UNDP/UNFPA/UNICEF/WHO/Word Bank Special Programme of Research, Development and Research Training in Human Reproduction, WHO, Geneva, Switzerland.
    Gülmezoglu, Ahmet Metin
    UNDP/UNFPA/UNICEF/WHO/Word Bank Special Programme of Research, Development and Research Training in Human Reproduction, WHO, Geneva, Switzerland.
    Vogel, Joshua
    UNDP/UNFPA/UNICEF/WHO/Word Bank Special Programme of Research, Development and Research Training in Human Reproduction, WHO, Geneva, Switzerland.
    Carroli, Guillermo
    Centro Rosarino de Estudios Perinatales, Rosario, Argentina.
    Lumbiganon, Pisake
    Khon Kaen University, Khon Kaen, Thailand.
    Qureshi, Zahida
    University of Nairobi, Nairobi, Kenya.
    Costa, Maria José
    WHO Angola, Luanda, Angola.
    Fawole, Bukola
    University of Ibadan, Ibadan, Nigeria.
    Mugerwa, Yvonne
    Makerere University, Makerere, Uganda.
    Nafiou, Idi
    Université Abdou Moumouni de Niamey, Niamey, Niger.
    Neves, Isilda
    Delegação Provincial de Saúde de Luanda, Luanda, Angola.
    Wolomby-Molondo, Jean-José
    Cliniques Universitaires de Kinshasa, Kinshasa, DR Congo.
    Bang, Hoang Thi
    WHO, Hanoi, Vietnam.
    Cheang, Kannitha
    WHO, Phnom Penh, Cambodia.
    Chuyun, Kang
    Peking University, Beijing, China.
    Jayaratne, Kapila
    Ministry of Health, Government of Sri Lanka, Colombo, Sri Lanka.
    Jayathilaka, Chandani Anoma
    WHO, Colombo, Sri Lanka.
    Mazhar, Syeda Batool
    Pakistan Institute of Medical Sciences, Islamabad, Pakistan.
    Mori, Rintaro
    Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan.
    Mustafa, Mir Lais
    Afghan Public Health Institute, Kabul, Afghanistan.
    Pathak, Laxmi Raj
    Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal.
    Perera, Deepthi
    Ministry of Health, Government of Sri Lanka, Colombo, Sri Lanka.
    Rathavy, Tung
    National Maternal and Child Health Center, Phnom Penh, Cambodia.
    Recidoro, Zenaida
    National Center for Disease Prevention and Control, Manila, Philippines.
    Roy, Malabika
    Indian Council of Medical Research, New Delhi, India.
    Ruyan, Pang
    Peking University, Beijing, China.
    Shrestha, Naveen
    Central Institute of Science and Technology (CIST) College, Pokhara University, Kathmandu, Nepal.
    Taneepanichsku, Surasak
    Chulalongkorn University, Bangkok, Thailand.
    Tien, Nguyen Viet
    National Obstetrics and Gynaecology Hospital, Hanoi, Vietnam.
    Ganchimeg, Togoobaatar
    The University of Tokyo, Tokyo, Japan.
    Wehbe, Mira
    American University of Beirut, Beirut, Lebanon.
    Yadamsuren, Buyanjargal
    Ministry of Health, Government of Mongolia, Ulaanbaatar, Mongolia.
    Yan, Wang
    Peking University, Beijing, China.
    Yunis, Khalid
    American University of Beirut, Beirut, Lebanon.
    Bataglia, Vicente
    Hospital Nacional de Itauguá, Itauguá, Paraguay.
    Cecatti, José Guilherme
    University of Campinas, Campinas, SP, Brazil.
    Hernandez-Prado, Bernardo
    Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
    Nardin, Juan Manuel
    Centro Rosarino de Estudios Perinatales, Rosario, Argentina.
    Narváez, Alberto
    Colegio Medico de Pichincha and Fundación Salud, Ambiente y Desarollo, Pichincha, Ecuador.
    Ortiz-Panozo, Eduardo
    Instituto Nacional de Salud Pública, Cuernavaca, Mexico.
    Pérez-Cuevas, Ricardo
    Social Protection and Health Division, Inter American Development Bank, Mexico City, Mexico.
    Valladares, Eliette
    Universidad Nacional Autónoma de Nicaragua, León, Nicaragua.
    Zavaleta, Nelly
    Instituto de Investigación Nutricional, Lima, Peru.
    Armson, Anthony
    Dalhousie University, Halifax, Canada.
    Crowther, Caroline
    University of Adelaide, Adelaide, Australia.
    Hogue, Carol
    Emory University, Atlanta, GA, USA.
    Lindmark, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Mittal, Suneeta
    All India Institute of Medical Sciences, New Delhi, India.
    Pattinson, Robert
    University of Pretoria, Pretoria, South Africa.
    Stanton, Mary Ellen
    United States Agency for International Development, Washington, DC, USA.
    Campodonico, Liana
    Centro Rosarino de Estudios Perinatales, Rosario, Argentina.
    Cuesta, Cristina
    Centro Rosarino de Estudios Perinatales, Rosario, Argentina.
    Giordano, Daniel
    Centro Rosarino de Estudios Perinatales, Rosario, Argentina.
    Intarut, Nirun
    Chulalongkorn University, Bangkok, Thailand.
    Laopaiboon, Malinee
    Khon Kaen University, Khon Kaen, Thailand.
    Bahl, Rajiv
    WHO, Geneva, Switzerland.
    Martines, Jose
    WHO, Geneva, Switzerland.
    Mathai, Matthews
    WHO, Geneva, Switzerland.
    Merialdi, Mario
    UNDP/UNFPA/UNICEF/WHO/Word Bank Special Programme of Research, Development and Research Training in Human Reproduction, WHO, Geneva, Switzerland.
    Say, Lale
    UNDP/UNFPA/UNICEF/WHO/Word Bank Special Programme of Research, Development and Research Training in Human Reproduction, WHO, Geneva, Switzerland.
    Moving beyond essential interventions for reduction of maternal mortality (the WHO Multicountry Survey on Maternal and Newborn Health): a cross-sectional study2013In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 381, no 9879, p. 1747-1755Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: We report the main findings of the WHO Multicountry Survey on Maternal and Newborn Health (WHOMCS), which aimed to assess the burden of complications related to pregnancy, the coverage of key maternal health interventions, and use of the maternal severity index (MSI) in a global network of health facilities.

    METHODS: In our cross-sectional study, we included women attending health facilities in Africa, Asia, Latin America, and the Middle East that dealt with at least 1000 childbirths per year and had the capacity to provide caesarean section. We obtained data from analysis of hospital records for all women giving birth and all women who had a severe maternal outcome (SMO; ie, maternal death or maternal near miss). We regarded coverage of key maternal health interventions as the proportion of the target population who received an indicated intervention (eg, the proportion of women with eclampsia who received magnesium sulphate). We used areas under the receiver operator characteristic curves (AUROC) with 95% CI to externally validate a previously reported MSI as an indicator of severity. We assessed the overall performance of care (ie, the ability to produce a positive effect on health outcomes) through standardised mortality ratios.

    RESULTS: From May 1, 2010, to Dec 31, 2011, we included 314,623 women attending 357 health facilities in 29 countries (2538 had a maternal near miss and 486 maternal deaths occurred). The mean period of data collection in each health facility was 89 days (SD 21). 23,015 (7.3%) women had potentially life-threatening disorders and 3024 (1.0%) developed an SMO. 808 (26.7%) women with an SMO had post-partum haemorrhage and 784 (25.9%) had pre-eclampsia or eclampsia. Cardiovascular, respiratory, and coagulation dysfunctions were the most frequent organ dysfunctions in women who had an SMO. Reported mortality in countries with a high or very high maternal mortality ratio was two-to-three-times higher than that expected for the assessed severity despite a high coverage of essential interventions. The MSI had good accuracy for maternal death prediction in women with markers of organ dysfunction (AUROC 0.826 [95% CI 0.802-0.851]).

    INTERPRETATION: High coverage of essential interventions did not imply reduced maternal mortality in the health-care facilities we studied. If substantial reductions in maternal mortality are to be achieved, universal coverage of life-saving interventions need to be matched with comprehensive emergency care and overall improvements in the quality of maternal health care. The MSI could be used to assess the performance of health facilities providing care to women with complications related to pregnancy.

  • 46.
    Talungchit, Pattarawalai
    et al.
    Mahidol Univ, Maternal & Fetal Med Unit, Dept Obstet & Gynecol, Siriraj Hosp, Bangkok 10700, Thailand.
    Liabsuetrakul, Tippawan
    Prince Songkla Univ, Obstet & Gynecol Epidemiol Unit, Hat Yai, Thailand.
    Lindmark, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). INFORM Hlth, Norwood, MA USA.
    Development and Assessment of Indicators for Quality of Care in Severe Preeclampsia/Eclampsia and Postpartum Hemorrhage2013In: Journal for healthcare quality, ISSN 1945-1474, Vol. 35, no 3, p. 22-34Article in journal (Refereed)
    Abstract [en]

    Severe preeclampsia/eclampsia and postpartum hemorrhage (PPH) are serious obstetric problems worldwide. Quality improvement of care measured by evidence-based indicators is recommended as a recent important strategy; however, the indicators for quality of care of these two conditions have not been established. This study aimed to develop such indicators and assess their validity, reliability, and feasibility at different contextual levels. Of 32 initially valid indicators for care of severe preeclampsia/eclampsia, after two rounds of Delphi technique, 21 and 30 indicators were agreed to be suitable to monitor care at district and referral hospitals. Of 13 initial indicators for PPH, 8 and 13 indicators were selected, respectively. The interrater reliability of indicators varied from 0.28 to 0.63. At least three-fourths of all indicators rated by local doctors and nurses were assessed as feasible in terms of relevance, measurability, and improvability. The process identified reliable and feasible performance indicators to monitor quality of care in severe preeclampsia/eclampsia and PPH for either basic or comprehensive emergency obstetric care (EmOC). The informative applicability of these indicators in clinical practice needs further evaluation.

  • 47. Talungchit, Pattarawalai
    et al.
    Liabsuetrakul, Tippawan
    Lindmark, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Multifaceted intervention to implement indicators of quality of care for severe pre-eclampsia/eclampsia2014In: International Journal of Gynecology & Obstetrics, ISSN 0020-7292, E-ISSN 1879-3479, Vol. 124, no 2, p. 106-111Article in journal (Refereed)
    Abstract [en]

    Objective: To assess the acceptability of implementing indicators of quality of care for severe pre-eclampsia/eclampsia to health providers, and to evaluate the effect of a multifaceted intervention on adherence to these indicators. Methods: A multifaceted approach was used to implement indicators of quality of care for severe pre-eclampsia/eclampsia that were relevant to both district and referral hospitals. Healthcare providers at 9 hospitals in Southern Thailand rated the acceptability and priority of each indicator. In addition, medical records were reviewed before and after the intervention. Results: More than 90% of the indicators were considered to be acceptable by the 145 health providers who participated in the study. After the intervention, adherence to most indicators was significantly increased. However, adherence after the intervention was lower than 80% for one-third of the indicators at district hospitals, compared with less than 10% of the indicators at referral hospitals. Common barriers to indicator implementation were lack of resources and skills, difficulty in making early and accurate diagnoses, and management. Conclusion: The indicators for the quality of care for severe pre-eclampsia/eclampsia were acceptable. Adherence to the indicators increased through a multifaceted intervention; however, the adherence varied considerably depending on the hospital referral level.

  • 48.
    Urasa, David P
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Carlstedt, Anders
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Nyström, Lennarth
    Massawe, Siriel N
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Lindmark, Gunilla
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Are process indicators adequate to assess essential obstetric care at district level? - A case study from Rufiji District, Tanzania2005In: Rev Afr Santé Repro, Vol. 9, no 3, p. 100-111Article in journal (Refereed)
  • 49.
    Urassa, David P
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Carlstedt, Anders
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Nyström, Lennarth
    Massawe, Siriel N
    Lindmark, Gunilla
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Eclampsia in Dar es Salaam, Tanzania -- incidence, outcome, and the role of antenatal care.2006In: Acta Obstet Gynecol Scand, ISSN 0001-6349, Vol. 85, no 5, p. 571-8Article in journal (Refereed)
1 - 49 of 49
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