Projekt

Equity in health is essential in order to reach the Sustainable Development Goals (SDGs). Social justice is not only a cross-cutting theme and a good intention, it is fundamental in order to achieve progress and sustainable living conditions for humanity. To have a fair and equal opportunity for all people to be able to harness their potential. The SDG agenda emphasizes Universal Health Coverage as the way forward to equity in health. This is however not enough, since in order to achieve true equity we also need to look at and understand not only structural barriers in society but also psychological and cultural limitations. The study of and struggle for equity in health is in its nature a transdisciplinary project.

To achieve equity in health, we need to improve and promote good health in the community. It has been stated that health begins at home! And all since Alma Ata conference 40 years ago, there has been a focus on how to promote community health and make sure that basic health services reach everyone. The commitment to primary care has fluctuated a bit over the decades, with a renewed effort in Ouagadougou in 2008. Today we talk about Universal Health Coverage (UHC) and the challenge is how to reach everyone. This is emphasized in the Sustainable Development Goals

Project descriptions

Contextualization the Philani Mentor Mother model – a social innovation for improved child health among the hard-to-reach in Sweden

Children's health in Sweden is good but unequal. Studies show significant correlation between socio-economic status and risk factors and outcomes of ill health. A consequence of the unequal distribution of wealth between native and foreign-born individuals is that children growing up in areas with high numbers of immigrants generally have poorer health and tend to live in social exclusion, which has become evident in a number of quantifiable outcomes. Peer-support may  have the ability to offer something that conventional healthcare systems sometimes lack, in the  form of continuous emotional support and connection through a shared background and  personal experience. Evaluating the contextualisation of an evidence-based peer support model - the Philani Mentor Mother model - in a high-income setting, this project aims to address the  social and cultural barriers to good child health.

Collaborators
Yalla Trappan, Malmö, Sweden
Church of Sweden

Funding
Swedish Medical Society, Clas Groschinskys minnesfond, UU Innovation, DELMOS. Lunds Missionssällskap.

Researchers involved
Per Kåks, per.kaks@kbh.uu.se, doctoral candidate
Anna Bergström, anna.bergstrom@kbh.uu.se, researcher
Sibylle Herzig van Wees, sibylle.herzigvanwees@kbh.uu.se
Mats Målqvist, mats.malqvist@kbh.uu.se, professor

Urbanization, homelessness and the challenges on women mental health in Ethiopia

It is expected that by 2050 the global urban population will have increased from 55 to 68 percent. With growing urbanization, more and more people are exposed to risk factors originating from the urban social or physical environment, contributing to increased stress, negatively associated with mental health. One phenomenon closely related to urban setting is homelessness. This project aims to assess the effect of urbanization and homelessness on women´s mental health through the assessment of causes of homelessness, violence against women, mental health problems, coping strategies, and to identify the barriers to access health services. The project is part of WoMHeR research network.

Collaborators
Addis Continental Insitutie of Public Health, Addis Ababa, Ethiopia

Funding
WoMHeR research school

Researchers involved
Kalkidan Yohannes. kalkidan.yohannes@kbh.uu.se, doctoral candidate
Sibylle Herzig van Wees, sibylle.herzigvanwees@kbh.uu.se
Hannah Bradby, hannah.bradby@soc.uu.se, professor
John Östh. john.osth@klutgeo.uu.se, professor
Mats Målqvist, mats.malqvist@kbh.uu.se, professor

Selected publications from the group

1. Kåks P, Målqvist M. Using an urban child health index to detect intra-urban disparities in Sweden. Scand J Public Health. 2020 Dec 18:1403494820980261.
2. Kåks P, Målqvist M. Peer support for disadvantaged parents: a narrative review of strategies used in home visiting health interventions in high-income countries. BMC Health Serv Res. 2020 Jul 23;20(1):682.
3. Niemeyer Hultstrand J, Omer Abuelgasim K, Tydén T, Jonsson M, Maseko N, Målqvist M. The perpetuating cycle of unplanned pregnancy: underlying causes and implications in Eswatini. Cult Health Sex. 2020 Jul 29:1-16.
4. KC A, Nelin V, Raaijmakers H, Kim HJ, Singh C, Målqvist M. Increased immunization coverage addresses the equity gap in Nepal. Bull World Health Organ. 2017 Apr 1;95(4):261-269.
5. Målqvist M, Pun A, Raaijmakers H, Kc A. Persistent inequity in maternal health care utilization in Nepal despite impressive overall gains. Glob Health Action. 2017;10(1):1356083.
6. Sunny AK, Basnet O, Acharya A, Poudel P, Malqvist M, KC A. Impact of free newborn care service package on out of pocket expenditure-evidence from a multicentric study in Nepal. BMC Health Serv Res. 2021 Feb 8;21(1):128. doi: 10.1186/s12913-021-06125-9.
7. Målqvist M, Pun A, KC A. Essential newborn care after home delivery in Nepal, still a long way to go! Scand J Public Health, 2017 Mar;45(2):202-207.
8. Målqvist M. Preserving misconception or a call to action? – a hermeneutical re-reading of the Nativity story. Glob Health Action 2015, 8:30386
9. Binder P, Lien PT, Hoa DP, Målqvist M. Determinants of marginalization and inequitable maternal healthcare in North-Central Vietnam: A framework analysis. Global Health Action 2015, 8: 27554.
10. Målqvist M, Yuan B, Trygg N, Selling K, Thomsen S. Targeted interventions for improved equity in maternal and child health in low- and middle-income settings: a systematic review and meta-analysis. PLoS One 2013 Jun 20;8(6).

The importance of Health Systems Research (HSR) is increasingly acknowledged within the field of Global Health. To understand how health systems cope with their mandate and respond to changes and challenges is paramount in the efforts to improve health. Most low and middle-income countries suffer under weak health systems, not capable of delivering the appropriate and timely services to the population. To enhance understanding of these process a systems thinking approach is needed, expanding the idea of health systems from administrative bodies to encompassing the whole of society. Functioning and implementation need to be strengthened and new methods and policies need to be developed for more efficient service delivery.

It has been stated that health begins at home! Therefore, a wider definition and view on what encompass the health system is needed. And all since Alma Ata conference 40 years ago, there has been a focus on how to promote community health and make sure that basic health services reach everyone. The commitment to primary care has fluctuated a bit over the decades, with a renewed effort in Ouagadougou in 2008. Today we talk about Universal Health Coverage (UHC) and the challenge is how to reach everyone. This is emphasized in the Sustainable Development Goals.

The community health worker (CHW) has received a lot of attention and a lot of responsibility has been placed on this cadre. Many times, the CHW has become the answer to all preventive work challenges, the easy solution when health care planners feel the need to reach outside the medicalized health facility. There are however many testimonies of CHWs being over-burdened, over-stretched and under-paid. The importance of CHWs as the link between community and healthcare system has been established, but lack of resources hampers the possibilities to professionalize this element.

To strengthen health system and make use of accumulated evidence on best practice the Health systems and implementation science sub-group also generates evidence of how to enable successful implementation of well-researched interventions. Health system weaknesses, such as lack of resources (medicines, equipment and staff with adequate knowledge and skills), dysfunctional referral systems and a culture of informal payment and lack of trust in health services. Implementation research is "the scientific study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine practice, and, hence, to improve the quality and effectiveness of health".

Project descriptions

Reorientation of the Health System towards Primary Diabetes Care in Sudan

In 2015, 415 million individuals were living with diabetes, 75% of them in low- and middle-income countries. Estimates suggest that the burden of diabetes will increase to 642 million by 2040. The majority of health systems in low resources settings are organised for the treatment of acute rather than chronic conditions and face an immense challenge to tackle an increasing number of patients with life-long conditions. Diabetes educators has been a successful strategy adopted in several high-income countries and has been put forward as the most cost-effective intervention for low- and middle-income countries. The project aim to investigate diabetes care in Sudan and to evaluate the effect of diabetes educators in governmental primary health care centers in Khartoum towards quality and efficiency of diabetes care.

Collaborators
Ahfad University for Women (Sudan) and Diabetes Prevention Promotion Organization (Sudan)

Funding
Diabetes Prevention Promotion Organization (Sudan)

Researchers involved
Abubakr Mohamed, abubakr.mohamed@kbh.uu.se, doctoral candidate
Anna Bergström, anna.bergstrom@kbh.uu.se, researcher
Mats Målqvist, mats.malqvist@kbh.uu.se, professor

Strengthening the Maternal and Perinatal Death Surveillance and Response (MPDSR) System in Tanzania

Maternal and Perinatal Death Surveillance and Response (MPDSR) system has been proposed as a quality improvement strategy to tackle maternal and perinatal mortality in weak health systems. The approach builds on the notion that through evaluation and learning from mistakes system failures can be corrected and service delivery improved. Together with Muhimbili University of Health and Applied Sciences (MUHAS) in Tanzania, a project is currently ongoing to further understand the barriers and enablers of the MPDSR and how the development of action plans can facilitate improvement at community level.

Dr Ali Said successfully defended his PhD thesis Maternal Death Surveillance and Response in Tanzania: Challenges to successful implementation on May 21st, 2021.

Collaborators
Muhimbili University of Health and Applied Sciences (MUHAS), Tanzania

Funding
Swedish International Development Cooperation Agency (Sida)

Researchers involved
Ali Said, ali.said@kbh.uu.se, researcher
Mats Målqvist, mats.malqvist@kbh.uu.se, professor

Exploring the Under Reporting of Pregnancy and Adverse Pregnancy Outcomes in Population and Health Surveys in Uganda

Under reporting of Adverse Pregnancy Outcomes (APOs) results in data that indicates a lower prevalence of these events, and yet this information feeds into national and local statistics. These will be used for planning, priority setting and are potentially important for monitoring progress to achieving the sustainable development goals and the Every Newborn Action Plan (ENAP). Therefore, planning will be based on incomplete data and misinformation, resulting in difficulty in identifying the causes of these deaths, the context around their occurrence, and how to potentially avoid them in the future. Knowledge is still lacking of the barriers and enablers to reporting of pregnancy and APOs within the African setting, more so in Uganda. Not much information is available on reporting from the perspective of mothers who have suffered pregnancy losses, from men, and from the interviewers who conduct the surveys. There is also limited information on context specific definitions of pregnancy and the role of gender. This study seeks to investigate these barriers and enablers, with specific focus on population and health surveys in Iganga-Mayuge HDSS, Uganda.

Collaborators
Makerere University, Kampala, Uganda

Researchers involved
Doris Kwesiga, doris.kwesiga@kbh.uu.se, doctoral candidate
Mats Målqvist, mats.malqvist@kbh.uu.se, professor

Selected publications from the group

1. Said A, Sirili N, Massawe S, Pembe AB, Hanson C, Malqvist M. Mismatched ambition, execution and outcomes: implementing maternal death surveillance and response system in Mtwara region, Tanzania. BMJ Glob Health. 2021 May;6(5):e005040.
2. Said A, Pembe AB, Massawe S, Hanson C, Malqvist M. Maternal death surveillance and response in Tanzania: comprehensiveness of narrative summaries and action points from maternal death reviews. BMC Health Serv Res. 2021 Jan 11;21(1):52.
3. Niemeyer Hultstrand J, Engström E, Målqvist M, Tydén T, Maseko N, Jonsson M. Evaluating the implementation of the Reproductive Life Plan in disadvantaged communities: A mixed-methods study using the i-PARIHS framework. PLoS One. 2020 Sep 11;15(9):e0236712.
4. Said A, Malqvist M, Pembe AB, Massawe S, Hanson C. Causes of maternal deaths and delays in care: comparison between routine maternal death surveillance and response system and an obstetrician expert panel in Tanzania. BMC Health Serv Res. 2020 Jul 6;20(1):614.
5. Eltom MA, Babiker Mohamed AH, Elrayah-Eliadarous H, Yassin K, Noor SK, Elmadhoun WM, Ahmed MH. Increasing prevalence of type 2 diabetes mellitus and impact of ethnicity in north Sudan. Diabetes Res Clin Pract. 2018 Feb;136:93-99. doi: 10.1016/j.diabres.2017.11.034. Epub 2017 Dec 2.
6. Almblad AC, Målqvist M, Engvall G. From skepticism to assurance and control; Implementation of a patient safety system at a pediatric hospital in Sweden. PLoS One. 2018 Nov 26;13(11):e0207744.
7. Almblad AC, Målqvist M, Engvall G. Caring for the Acutely, Severely Ill Child-A Multifaceted Situation with Paradoxical Elements: Swedish Healthcare Professionals' Experiences. J Pediatr Nurs. 2016 Sep-Oct;31(5):e293-300.
8. Baker U, Petro A, Marchant T, Peterson S, Manzi F, Hanson C†, Bergström A†. Health workers' experiences of collaborative quality improvement for maternal and newborn care in rural Tanzanian health facilities: A process evaluation using the integrated 'Promoting Action on Research Implementation in Health Services' framework. PLoS One (2018), 13(12), e0209092. doi:10.1371/journal.pone.0209092
9. Pallangyo E, Mbekenga C, Olsson P, Eriksson L†, Bergström A†. Implementation of a facilitation intervention to improve postpartum care in a low-resource suburb of Dar es Salaam, Tanzania. Implement Sci (2018) 13:102.
10. Eriksson L, Bergström A, Hoa DP, Nguyen NT, Eldh AC. Sustainability of knowledge implementation in a low- and middle- income context: Experiences from a facilitation project in Vietnam targeting maternal and neonatal health. PLoS ONE, 2016, 12(8): e0182626.

Project descriptions

Evaluating implementation strategies for improved food safety in Vietnam

To build resilient and healthy societies is at the core of Global Health. In this, food security and food safety are vital, as illustrated by the sustainable development goals (SDG) 2 (no hunger) and 3 (health and well-being), but also for aspects such as equity and sustainable consumption. This project evaluates implementation strategies on how one commodity, pork, can be made safer in order to improve human health, and how these interventions can be made more sustainable by studying the economic incentives and how consumers, mainly women, are willing to pay for safer products, and how they prioritize food safety and the health of the family.

Collaborators
Hanoi University of Public Health, Hanoi, Vietnam

Researchers involved
Hai Ngo, hai.ngo@kbh.uu.se, doctoral candidate
Mats Målqvist, mats.malqvist@kbh.uu.se, professor
Johanna Lindahl, johanna.lindahl@imbim.uu.se, principal investigator

AMR-drivers: addressing the distal drivers of AMR through targeted AMR-, or integrated SDG-policy and action

This study focuses on answering the question to which extent drivers of the development and spread of anti-microbial resistance (AMR) are being addressed through explicit AMR interventions and policies compared to integrated societal agendas for sustainable development, specifically the Sustainable Development Goals (SDGs). AMR drivers are those distal causal factors that can be targeted for action to reduce the challenge. While drivers often take a larger action effort to change, they are important as they set the conditions for how the problem manifests.

Collaborators
University of Geneva

Funding
Uppsala Antibiotic Center (UAC)

Researchers involved
Luong Nguyen Thanh, nguyen.luong@kbh.uu.se, doctoral candidate
Mats Målqvist, mats.malqvist@kbh.uu.se, professor
Didier Wernli, dier-werrnli@unige.ch, researcher
Peter Søgaard Jørgensen, peter.sogaard.jorgensen@su.se, principal investigator