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SPIRIT checklist (DOC 122 kb)
UNCST approval. Approval letter from the Uganda National Council of Science and Technology which provides oversight on research done in Uganda. (PDF 190 kb)
Background Studies evaluating acceptability of simplified follow-up after medical abortion have focused on high-resource or urban settings where telephones, road connections, and modes of transport are available and where women have... more
Background Studies evaluating acceptability of simplified follow-up after medical abortion have focused on high-resource or urban settings where telephones, road connections, and modes of transport are available and where women have formal education. Objective To investigate women’s acceptability of home-assessment of abortion and whether accept-ability of medical abortion differs by in-clinic or home-assessment of abortion outcome in a low-resource setting in India.
Additional file 1.
E-learning has become one of the primary ways of delivering education around the globe. In Somalia, which is a country torn within and from the global community by a prolonged civil war, University of Hargeisa has in collaboration with... more
E-learning has become one of the primary ways of delivering education around the globe. In Somalia, which is a country torn within and from the global community by a prolonged civil war, University of Hargeisa has in collaboration with Dalarna University in Sweden adopted, for the first time, e-learning. This study explores barriers and facilitators to e-learning usage, experienced by students in Somalia's higher education , using the University of Hargeisa as case study. Interviews were conducted with students to explore how University of Hargeisa's novice users perceived e-learning, and what factors positively and negatively affected their e-learning experiences. The Unified Theory of Acceptance and Use of Technology (UTAUT) model was used as a framework for interpreting the results. The findings show that, in general, the students have a very positive attitude towards e-learning, and they perceived that e-learning enhanced their educational experience. The communication a...
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Background Humanitarian settings are characterised by limited access to comprehensive abortion care. At the same time, humanitarian settings can increase the vulnerability of women and girls to unintended pregnancies and unsafe abortions.... more
Background Humanitarian settings are characterised by limited access to comprehensive abortion care. At the same time, humanitarian settings can increase the vulnerability of women and girls to unintended pregnancies and unsafe abortions. Humanitarian actors and health care providers can play important roles in ensuring the availability and accessibility of abortion-related care. This study explores health care providers’ perceptions and experiences of providing comprehensive abortion care in a humanitarian setting in Cox’s Bazar, Bangladesh and identifies barriers and facilitators in service provision. Method In-depth interviews (n = 24) were conducted with health care providers (n = 19) providing comprehensive abortion care to Rohingya refugee women and with key informants (n = 5), who were employed by an organisation involved in the humanitarian response. Data were analysed using an inductive content analysis approach. Results The national menstrual regulation policy provided a f...
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Background: Women's understanding of pregnancy and antenatal care is influneced by their cultural context. In low income settings women may have limited influence over their reproductive health inc ...
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Background Humanitarian settings are characterised by limited access to comprehensive abortion care. At the same time, humanitarian settings can increase the vulnerability of women and girls to unintended pregnancies and unsafe abortions.... more
Background Humanitarian settings are characterised by limited access to comprehensive abortion care. At the same time, humanitarian settings can increase the vulnerability of women and girls to unintended pregnancies and unsafe abortions. Humanitarian actors and health care providers can play important roles in ensuring the availability and accessibility of abortion-related care. This study explores health care providers’ perceptions and experiences of providing comprehensive abortion care in a humanitarian setting in Cox’s Bazar, Bangladesh and identifies barriers and facilitators in service provision. Method In-depth interviews ( n = 24) were conducted with health care providers ( n = 19) providing comprehensive abortion care to Rohingya refugee women and with key informants ( n = 5), who were employed by an organisation involved in the humanitarian response. Data were analysed using an inductive content analysis approach. Results The national menstrual regulation policy provid...
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Barriers to safe motherhood in Rwanda. Explored by in-depth interviews with women experiencing near miss event
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Background: The number of childbearing adolescents in Vietnam is relatively low but they are more prone to experience adverse outcome than adult women. Reports of increasing rates of abortion and p ...
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Is treatment of incomplete abortion with misoprostol by midwives safe and effective? : Randomized controlled equivalence trial to compare physicians and midwives at district level in Uganda
Background: Severe obstetric morbidity and mortality remain a serious challenge in developing countries such as Somaliland. Despite the wide implementation of comprehensive emergency obstetric care in Sub-Saharan Africa, including... more
Background: Severe obstetric morbidity and mortality remain a serious challenge in developing countries such as Somaliland. Despite the wide implementation of comprehensive emergency obstetric care in Sub-Saharan Africa, including Somaliland, the reduction of severe maternal morbidity and mortality has been slow. Aim: This study aims to explore the experiences of healthcare providers (HCPs) regarding the provision of emergency obstetric care in a referral hospital and four maternal and child health centers in Somaliland. Method: An exploratory qualitative approach using focus group discussions was employed at the main referral and teaching hospital and four maternal and child health centers in Hargeisa, Somaliland. Twenty-eight healthcare providers were divided into groups of 6-8 for 1 to 2-hour discussions. HCPs included in the study had experiences in providing care to women with severe maternal complications. Data were analyzed using thematic analysis. Results: Collectivistic dec...
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Research Interests: Psychology and Medicine
Background: A large proportion of abortion-related mortality and morbidity occur in the second trimester of pregnancy. The Uganda Ministry of Health policy restricts management of second trimester incomplete abortion to physicians who are... more
Background: A large proportion of abortion-related mortality and morbidity occur in the second trimester of pregnancy. The Uganda Ministry of Health policy restricts management of second trimester incomplete abortion to physicians who are few and unequally distributed with most practicing in urban regions. Unsafe and outdated methods like sharp curettage are frequently used. Medical management of second trimester post abortion care by midwives offers an advantage given the difficulty in providing surgical management in low-income settings and current health worker shortages. The study aims to assess the safety, effectiveness and acceptability of treatment of incomplete second trimester abortion using misoprostol provided by midwives compared with physicians. Methods: A randomized controlled equivalence trial implemented at eight hospitals and health centers in Central Uganda will include 1192 eligible women with incomplete abortion of uterine size >12 weeks up to 18 weeks. Each p...
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ObjectiveTo assess the effectiveness of midwives administering misoprostol to women with incomplete abortion seeking post-abortion care (PAC), compared with physicians.DesignA multicentre randomised controlled equivalence trial. The study... more
ObjectiveTo assess the effectiveness of midwives administering misoprostol to women with incomplete abortion seeking post-abortion care (PAC), compared with physicians.DesignA multicentre randomised controlled equivalence trial. The study was not masked.SettingsGynaecological departments in two hospitals in a low-resource setting, Kenya.PopulationWomen (n=1094) with incomplete abortion in the first trimester, seeking PAC between 1 June 2013 to 31 May 2016. Participants were randomly assigned to receive treatment from midwives or physicians. 409 and 401 women in the midwife and physician groups, respectively, were included in the per-protocol analysis.Interventions600 µg misoprostol orally, and contraceptive counselling by a physician or midwife.Main outcome measuresComplete abortion not needing surgical intervention within 7–10 days. The main outcome was analysed on the per-protocol population with a generalised estimating equation model. The predefined equivalence range was –4% to ...
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To evaluate the effectiveness of a culturally tailored parenting support programme on Somali-born parents' mental health and sense of competence in parenting. Randomised controlled trial. A city in the middle of Sweden. Somali-born... more
To evaluate the effectiveness of a culturally tailored parenting support programme on Somali-born parents' mental health and sense of competence in parenting. Randomised controlled trial. A city in the middle of Sweden. Somali-born parents (n=120) with children aged 11-16 years and self-perceived stress in their parenting were randomised to an intervention group (n=60) or a waiting-list control group (n=60). Parents in the intervention group received culturally tailored societal information combined with the Connect parenting programme during 12 weeks for 1-2 hours per week. The intervention consisted of a standardised training programme delivered by nine group leaders of Somali background. The General Health Questionnaire 12 was used to measure parents' mental health and the Parenting Sense of Competence scale to measure parent satisfaction and efficacy in the parent role. Analysis was conducted using intention-to-treat principles. The results indicated that parents in the ...
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To explore maternal near miss and death after emergency cesarean delivery in Somaliland, including the impact of the prerequisite for family consent. A facility-based, mixed-methods study was conducted to assess all maternal near misses... more
To explore maternal near miss and death after emergency cesarean delivery in Somaliland, including the impact of the prerequisite for family consent. A facility-based, mixed-methods study was conducted to assess all maternal near misses and deaths recorded at a referral hospital that provided services to women from all regions of Somaliland. The data sources comprised a quantitative prospective cross-sectional study using the WHO near-miss tool (performed from August 1 to December 31, 2015) and qualitative interviews with 17 healthcare providers working at the referral hospital who were in direct contact with the women in labor (performed from January 15 to March 15, 2015). Of the 138 maternal near misses and deaths recorded, 50 (36%) were associated with emergency cesarean delivery. The most frequent maternal complication was severe pre-eclampsia (n=17; 34%), and the most frequent underlying causes were hypertensive disorders (n=31; 62%) and obstetric hemorrhage (n=15; 30%). Health...
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Unsafe abortion in Africa continues to be a major contributor to the global maternal mortality which affects young women in particular. In Uganda, where abortion is legally restricted and stigmatised, unsafe abortion is a major public... more
Unsafe abortion in Africa continues to be a major contributor to the global maternal mortality which affects young women in particular. In Uganda, where abortion is legally restricted and stigmatised, unsafe abortion is a major public health issue. We explored reproductive agency in relation to unsafe abortion among young women seeking post-abortion care. Through in-depth interviews we found that reproductive agency was constrained by gender norms and power imbalances and strongly influenced by stigma. Lack of resources and the need for secrecy resulted in harmful abortion practices and delayed care-seeking. Women did not claim ownership of the abortion decision, but the underlying meaning in the narratives positioned abortion as an agentive action aiming to regain control over one's body and future. Women's experiences shaped contraceptive intentions and discourse, creating a window of opportunity that was often missed. This study provides unique insight into how young wome...
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The aim of this study is to explore women's experiences and perceptions of home use of misoprostol and of the self-assessment of the outcome of early medical abortion in a low-resource setting in India. In-depth interviews were... more
The aim of this study is to explore women's experiences and perceptions of home use of misoprostol and of the self-assessment of the outcome of early medical abortion in a low-resource setting in India. In-depth interviews were conducted with 20 women seeking early medical abortion, who administered misoprostol at home and assessed their own outcome of abortion using a low-sensitivity pregnancy test. With home use of misoprostol, women were able to avoid inconvenience of travel, child care, and housework, and maintain confidentiality. The use of a low-sensitivity pregnancy test alleviated women's anxieties about retained products. Majority said they would prefer medical abortion involving a single visit in future. This study provides nuanced understanding of how women manage a simplified medical abortion in the context of low literacy and limited communication facilities. Service delivery guidelines should be revised to allow women to have medical abortion with fewer visits.
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Pregnancies among young women force girls to compromise education, resulting in low educational attainment with subsequent poverty and vulnerability. A pronounced focus is needed on contraceptive use, pregnancy, and unsafe abortion among... more
Pregnancies among young women force girls to compromise education, resulting in low educational attainment with subsequent poverty and vulnerability. A pronounced focus is needed on contraceptive use, pregnancy, and unsafe abortion among young women. This study aims to explore healthcare providers' (HCPs) perceptions and practices regarding contraceptive counselling to young people. We conducted 27 in-depth interviews with doctors and midwives working in seven health facilities in central Uganda. Interviews were open-ended and allowed the participant to speak freely on certain topics. We used a topic guide to cover areas topics of interest focusing on post-abortion care (PAC) but also covering contraceptive counselling. Transcripts were transcribed verbatim and data were analysed using thematic analysis. The main theme, HCPs' ambivalence to providing contraceptive counselling to sexually active young people is based on two sub-themes describing the challenges of contraceptiv...
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Pre- and post-migration trauma due to forced migration may impact negatively on parents' ability to care for their children. Little qualitative work has examined Somali-born refugees' experiences. The aim of this study is to... more
Pre- and post-migration trauma due to forced migration may impact negatively on parents' ability to care for their children. Little qualitative work has examined Somali-born refugees' experiences. The aim of this study is to explore Somali-born refugees' experiences and challenges of being parents in Sweden, and the support they need in their parenting. A qualitative descriptive study was undertaken. Data were collected from four focus group discussions (FGDs) among 23 Somali-born mothers and fathers living in a county in central Sweden. Qualitative content analysis has been applied. A main category, Parenthood in Transition, emerged as a description of a process of parenthood in transition. Two generic categories were identified: Challenges, and Improved parenting. Challenges emerged from leaving the home country and being new and feeling alienated in the new country. In Improved parenting, an awareness of opportunities in the new country and ways to improve their paren...
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Research Interests: Nursing, Qualitative Research, Midwifery, Adolescent, Rwanda, and 14 moreMedicine, Pregnancy, Humans, Female, Male, Young Adult, Adult, Public health systems and services research, Communication barriers, Prenatal Care, Quality of health care, Paediatrics and reproductive medicine, Spouses, and HIV infections
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With the objective to improve access to safe abortion services in India, the Ministry of Health and Welfare, with approval of the Law Ministry, published draft amendments of the MTP Act on October 29, 2014. Instead of the expected... more
With the objective to improve access to safe abortion services in India, the Ministry of Health and Welfare, with approval of the Law Ministry, published draft amendments of the MTP Act on October 29, 2014. Instead of the expected support, the amendments created a heated debate within professional medical associations of India. In this commentary, we review the evidence in response to the current discourse with regard to the amendments. It would be unfortunate if unsubstantiated one-sided arguments would impede the intention of improving access to safe abortion care in India.
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Misoprostol is established for the treatment of incomplete abortion but has not been systematically assessed when provided by midwives at district level in a low-resource setting. We investigated the effectiveness and safety of midwives... more
Misoprostol is established for the treatment of incomplete abortion but has not been systematically assessed when provided by midwives at district level in a low-resource setting. We investigated the effectiveness and safety of midwives diagnosing and treating incomplete abortion with misoprostol, compared with physicians. We did a multicentre randomised controlled equivalence trial at district level at six facilities in Uganda. Eligibility criteria were women with signs of incomplete abortion. We randomly allocated women with first-trimester incomplete abortion to clinical assessment and treatment with misoprostol either by a physician or a midwife. The randomisation (1:1) was done in blocks of 12 and was stratified for study site. Primary outcome was complete abortion not needing surgical intervention within 14-28 days after initial treatment. The study was not masked. Analysis of the primary outcome was done on the per-protocol population with a generalised linear-mixed effects m...
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Research Interests: Health Sciences, Focus Groups, Adolescent, Counseling, Pregnancy, and 15 moreHumans, Sex Education, Public, Female, Male, Physicians, Risk factors, Middle Aged, Questionnaires, Adult, Public health systems and services research, Risk Factors, Professional Competence, Adolescent Behavior, and professional patient relations
Adolescent&a... more
Adolescent's sexuality and related reproductive health and rights problems are sensitive issues in Vietnam. Globalisation has had an impact on the lifestyles of young people, and rising numbers of abortion and STI/HIV risks among youth are posing major health concerns in the country. These problems need to be addressed. Midwives belong to a key category of health personnel in Vietnam,
Research Interests: Nursing, Sexual and Reproductive Health, Sexuality, Qualitative Research, Adolescent, and 15 moreMedicine, Empathy, Self Efficacy, Humans, Reproductive health, Female, Male, Nursing Students, Education and Training, Questionnaires, Adult, Nursing Studies, Clinical Competence, Adolescent Behavior, and Health Personnel
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ObjectiveTo describe birth rates and pregnancy outcomes, specifically stillbirth, preterm delivery and low birth weight (LBW) in relation to socio-demographic characteristics, among adolescent women in a rural district in northern Vietnam.
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To describe how Somali immigrant women in a Swedish county use the antenatal care and health services, their reported and observed health problems and the outcome of their pregnancies. Retrospective, case-control study, comparing data... more
To describe how Somali immigrant women in a Swedish county use the antenatal care and health services, their reported and observed health problems and the outcome of their pregnancies. Retrospective, case-control study, comparing data obtained from the records of antenatal and obstetric care for Somali born women with the same data for parity matched women born in Sweden giving birth between 2001 and 2009. Utilisation of antenatal health care (timing and number of visits), pregnancy complications (severe hyperemesis, anaemia, preeclampsia), mode of birth (normal vaginal, operative vaginal, caesarean), and infant outcomes (preterm birth, birth weight, and perinatal mortality). Compared to the 523 Swedish-born women the 262 Somali women booked later and made less visits for antenatal care. They were more likely to have anaemia, severe hyperemesis and a few patients were found to have very serious health conditions. Emergency caesarean section (OR 1.90, CI 1.16-3.10), especially before start of labour (OR 4.96, CI 1.73-14.22), high perinatal mortality with seven versus one perinatal deaths and small for date infants (OR 2.95, CI 1.49-5.82) was also more prevalent. Pregnant Somali immigrant women still constitute a vulnerable group, which implicates that there is a missing link in the surveillance system that needs attention. There is an increased risk for intrauterine foetal death, small for date and low birth weight infants as well as serious maternal morbidity.
Research Interests: Somalia, Adolescent, Sweden, Birth Weight, Pregnancy, and 15 moreHumans, Female, Anemia, Adult, Retrospective Studies, Cesarean Section, Perinatal mortality, Vomiting, Prenatal Care, Pregnancy Outcome, Premature Birth, Case Control Studies, Pre Eclampsia, Pregnancy complications, and Paediatrics and reproductive medicine
Adolescent's sexuality and related reproductive health and rights problems are sensitive issues in Vietnam. Globalisation has had an impact on the lifestyles of young people, and rising numbers of abortion and STI/HIV risks among... more
Adolescent's sexuality and related reproductive health and rights problems are sensitive issues in Vietnam. Globalisation has had an impact on the lifestyles of young people, and rising numbers of abortion and STI/HIV risks among youth are posing major health concerns in the country. These problems need to be addressed. Midwives belong to a key category of health personnel in Vietnam,