Improving neonatal survival and development

Brief description of the research field

Despite impressive progress in overall child survival over the past decades, neonatal survival (28 first days of life) is lagging behind and is today accounting for an increasing proportion of deaths in children under the age of five. The highest risk of dying is in connection to delivery, and on top of the millions of babies dying during the first day of life, an equal amount of babies die just before delivery. This is despite the fact that the interventions to save these children are known and cost-effective. Innovative solutions to address the societal and health systems barriers resulting in neonatal mortality are needed.

Project descriptions

Ongoing projects

  • NePeriQIP
    The NePeriQIP project is focusing on improving the quality of maternal and new-born care at district level in Nepal. This scale-up project is taking place in 12 district hospitals and builds on previous research conducted by the research group evaluating the introduction of Helping Babies Breathe with a Quality Improvement strategy at a tertiary hospital in Kathmandu. The NePeriQIP trial departs from the WHO standards for improving maternal and new-born quality of care and intends to deliver a comprehensive Quality Improvement package for the continuum of perinatal care.

    Collaborators
    UNICEF Nepal, Ministry of Health Nepal

    Funding
    Swedish Research Council, UNICEF Nepal, Einhorn Foundation and STINT

    Responsible researcher/contact person
    Mats Målqvist, mats.malqvist@kbh.uu.se
     
  • NepCord
    The NepCord Group is focusing on studies in relation to umbilical cord clamping. In a series of randomized-controlled trials at Paropakar Maternity and Women’s Hospital in Kathmandu, Nepal, the group has investigated the effects of delaying the clamping of the umbilical cord to three minutes compared to the current recommended one minute after birth. Outcome measures studied are iron stores and anemia at 8 and 12 months of age, bilirubin levels during the first week and neurodevelopment at one and two years of age. Further studies are underway examining the effects of delayed cord clamping on heart rate and perinatal survival.

    Collaborators
    UNICEF Nepal, Lifeline Nepal

    Funding
    STINT, SSMF, Swedish Research Council

    Responsible researcher/contact person
    Ola Andersson, ola.andersson@kbh.uu.se
     
  • Improving Quality of Maternal and New Born Care Using Group Model of Antenatal Care in Tanzania
    Antenatal care (ANC) is one area of the skilled care that needs improvement for better maternal and new-born outcomes. Antenatal care attendance is a prioritized area but adequate provision faces many challenges to health systems all over the world with late booking and inadequate attendance. This study is carried out in Tanzania and aims to determine the effectiveness of group antenatal care as a means to improve attendance and better utilization of limited resources.

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

    Funding
    Swedish International Development Cooperation Agency (Sida)

    Responsible researcher/contact person
    Mats Målqvist, mats.malqvist@kbh.uu.se

Selected publications from the group

  • Rana N, Kc A, Målqvist M, Subedi K, Andersson O. Effect of Delayed Cord Clamping of Term Babies on Neurodevelopment at 12 Months: A Randomized Controlled Trial. Neonatology. 2018 Oct 2;115(1):36-42
  • Eriksson L, Nga NT, Hoa DTP, Duc DM, Bergström A, Wallin L, Målqvist M, Ewald U, Huy TQ, Thuy NT, Do TT, Lien PTL, Persson LÅ, Selling K. Secular trend, seasonality and effects of a community-based intervention on neonatal mortality. Follow-up of a cluster-randomized trial in Quang Ninh province, Vietnam. J Epidemiol Community Health. 2018 Sep;72(9):776-782
  • KC A, Bergström A, Chaulagain D, Brunell O, Ewald U, Gurung A, Eriksson L, Litorp H, Wrammert J, Grönqvist E, Edin PA, Le Grange C, Lamichhane B, Shrestha P, Pokharel A, Pun A, Singh C, Målqvist M. Scaling up quality improvement intervention for perinatal care in Nepal (NePeriQIP); study protocol of a cluster randomised trial. BMJ Glob Health. 2017 Sep 29;2(3):e000497.
  • Wrammet J, Zetterberg C, KC A, Ewald U, Målqvist M. Resuscitation practices of low and normal birth weight infants in Nepal: an observational study using video camera recordings. Global Health Action 2017;10(1):1322372.
  • KC A, Wrammert J, Nelin V, Clark R, Ewald U, Peterson S, Målqvist M. Evaluation of Helping Babies Breathe Quality Improvement Cycle (HBB-QIC) on retention of neonatal resuscitation skills six months after training in Nepal. BMC Pediatr. 2017 Apr 11;17(1):103.
  • Wrammert J, KC A, Ewald U, Målqvist M. Improved postnatal care needed to maintain gains in neonatal survival after Helping Babies Breathe implementation. Acta Paediatrica 2017 Mar 17.
  • KC A, Rana N, Målqvist M, Ranneberg LJ, Subedi K, Andersson O. Effects of delayed umbilical cord clamping on anemia at 8  and 12 months – A randomized clinical trial. JAMA Ped 2017;171(3):1-7.
  • Wrammert J, Sapkota S, Baral K, KC A, Målqvist M, Larsson M. Teamwork among midwives during neonatal resuscitation at a maternity hospital in Nepal. Women Birth, 2017 Feb 26. pii: S1871-5192(16)30120-2.
  • KC A, Wrammert J, Clark R, Ewald U, Vitrakoti R, Pun A, Raaijmakers H, Målqvist M. Reducing perinatal mortality in Nepal using Helping Babies Breathe. Pediatrics. 2016 Jun;137(6).

To Main fields of research

Global nutrition

Brief description of the research field

Nutrition in early life has both short- and long-term health consequences affecting an individuals’ ability to participate in and contribute to the society she is a member of emphasizing the central role of nutrition in sustainable health and development.

Our research evolves around the mother and infant dyad in disadvantaged settings. By increasing the understanding of biological and socio-behavioural determinants for their food and nutrition security our aim is to identify factors of importance for developing effective community based interventions. When implementing efficacious interventions at large scale the capacity and quality of the system that provides the interventions is critical. Further, as most interventions are directed to mothers and young children the capacity of women to make use of the provided service and other existing resources in their environment is critical. Our research projects in Bangladesh, Ethiopia and Nicaragua have in common a focus on nutrition in early life and the role of mothers in interacting with the resources of their environment.

Project descriptions Ongoing projects

MINIMat trial Bangladesh
The Maternal and Infant Nutrition Interventions trial in Matlab, (ISRRCTN16581394), in short the MINIMat trial, combined a number of early life nutrition interventions (prenatal food and micronutrient supplementations, exclusive breastfeeding promotion) which in line with the Developmental Origins of Health and Disease aims to evaluate both short and long-term health and nutrition related outcomes in the offspring. In addition, efforts were taken to include assessments of environmental exposures such as toxic metals but also exposure to social factors such as domestic violence. The cohort of children has repeatedly (1-24m, 4.5y, 10y) been followed-up on various nutrition, growth and cognitive developmental outcomes. In fall 2017 the follow-up at 15 years of age is starting. So far, more than 100 publications have been published and 18 PhD students have defended their theses based on data from the MINIMat trial.  A bibliography can be found here:
Maternal and Infant Nutrition Interventions in Matlab. (MINIMat trial), Bangladesh

Collaborators (main)
International Centre for Diarrhoeal Disease Research (icddr,b),Bangladesh research groups at Karolinska Institutet, London School of Hygiene and Tropical Medicine, Institute of Child Health, London, UK, University of California at Davis and Cornell University and Ithaca College in Ithaca, USA, Faculty of medicine, University of Tsukuba, Japan, National Institute for Health and Welfare, Helsinki, Finland 

Funding (main)
icddr,b, UNICEF, Swedish International Development Cooperative Agency (Sida), Swedish Research council, Uppsala University, Swedish Research Council for Environment, Agricultural Sciences and Spatial Planning (FORMAS), UK Medical research, Department International Development (DFID), Japan Society for the promotion of Science, Child Health and Nutrition research

Responsible researcher/contact person
Eva-Charlotte Ekström, lotta.ekstrom@kbh.uu.se

EAT Addis, Ethiopia
Food and nutrition security is a cornerstone for achieving global sustainable development. In Africa’s rapidly growing cities, unemployment and widespread poverty currently leads to high levels of food and nutrition insecurity for a large share of the population. Undernutrition as well as overnutrition cause health related problems affecting individuals and society at large. In spite of these pressing challenges, the factors influencing the access to and consumption of food among urban people in low-income countries, remain insufficiently studied and understood. In the research project EAT Addis we aim to evaluate the social, economic and gender stratification of household food security and their accessibility to safe and nutritious foods with a particular focus on young children. The influence of the urban food environment and its seasonal dynamic will be evaluated as well as the role of women empowerment in their role as gatekeeper between the food environment and the family.

Collaborators
Addis Continental Institute of Public Health, Addis Ababa, Ethiopia, Lund University, Swedish University of Agricultural Sciences, Lund

Funding
Swedish Research Council FORMAS

Responsible researcher/contact person
Eva-Charlotte Ekström, lotta.ekstrom@kbh.uu.se

Betel chewing in pregnancy, Bangladesh
Betel chewing is prevalent in Asia including among women in pregnancy. Betel is known as carcinogenic but little is known about health risks for mother and fetus. Studies suggest that health risks are similar to that of undernourishment in early life; adverse pregnancy outcome, poor fetal and infant growth and increased risk for metabolic syndrome in adulthood. Thus if poor nutrition and betel chewing are combined synergetic affects are plausible. Set in a rural Bangladesh our is aim of this project is to evaluate the health consequences for mother and offspring of betel chewing.

Collaborators
International Centre for Diarrhoeal Disease Research (icddr,b), Bangladesh, and BRAC, Dhaka, Bangladesh

Funding
Swedish Research Council

Responsible researcher/contact person
Eva-Charlotte Ekström, lotta.ekstrom@kbh.uu.se

Community based management of severe acute child malnutrition rural Ethiopia
Effective nutrition interventions exist to prevent and manage mother and child malnutrition. Scaling up of such interventions is less successful and influenced by the context where it is implemented. This study was done within Ethiopia’s community-based program for management of severe acute malnourished children. The study was done within a nationally scaled up nutrition program. It analyses the influence of women’s empowerment on the outcome of rehabilitation of their severely malnourished children as well as the importance of the quality of the program.   

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

Funding
Swedish Agency for Research Cooperation (SAREC), and Uppsala University

Responsible researcher/contact person
Eva-Charlotte Ekström, lotta.ekstrom@kbh.uu.se

Food and nutrition security in young children, rural Nicaragua
Recent calls to tackle child malnutrition include interventions to improve quality of infants and young children’s diet. Our project was set in a community undergoing the nutrition transition in which traditional diets and ways of feeding young children are influenced by the increased availability of commercial infant foods as well as high-energy dense (but nutrient poor) snack foods and sugar-sweetened beverages.  Our aims were to evaluate the diet of young children both in terms of recommended feeding practices but also to understand feeding of food items with limited nutritional benefits. This included analysing the role of household socio-economic situation and food security and empowerment of women (such as education, autonomy and social support).

Collaborators
Aphrodese (non-governmental organisation), and The National Autonomous University of Nicaragua, Leon, Nicaragua

Funding
Swedish Agency for Research Cooperation (SAREC) and Uppsala University

Responsible researcher/contact person
Eva-Charlotte Ekström, lotta.ekstrom@kbh.uu.se

To Main fields of research

Improved childhood fever and malaria case management

Brief description of the research field

Malaria, pneumonia and diarrhoeal diseases that present as acute febrile illness, account for more than half of the deaths among children 1 to 59 months old. Fever case management is a major challenge for improved child health globally.

The changing malaria epidemiology in sub-Saharan Africa have provided opportunities but also added to the current challenges encountered in management of febrile children. Availability of reliable and accurate malaria rapid diagnostic tests promotes the targeting of effective artemisinin-based combination therapies (ACT) to parasitologically confirmed malaria cases. Increasingly, it has become important to also detect and manage non-malaria febrile illnesses and malnutrition. Integrated community case management intervention improves the appropriateness of care for malaria, pneumonia symptoms and diarrhoeal diseases among the poor in rural areas of low and middle income countries. Rational use of ACT and appropriate antibiotics for pneumonia conserves and sustains their efficacy, respectively. Other interventions used are vaccinations for bacterial and viral infections, and malaria preventive measures such as insecticide treated nets and indoor residual spraying. 

The success of malaria control efforts has created regions that are heterogenous in malaria endemicity, that require different combinations and intensities of implementation of malaria and other child survival interventions. Delivery of child survival interventions can be a challenge in resource constrained health systems, threatened farther by antimicrobial resistance. Hence, our research group is implementing research activities to provide evidence for febrile illness management and malaria control interventions in high malaria transmission setting of Uganda and Tanzania, and for malaria elimination in low malaria transmission setting of Zanzibar.

Project descriptions

Ongoing projects in Uganda
Together with Makerere University and other collaborators, we are conducting studies to increase coverage and penetration of the integrated community case management (iCCM) intervention for febrile children in rural areas in Uganda. Our studies have shown improvement in the quality of diagnosis and management of febrile children and findings have contributed to changing the policy on community case management of malaria, pneumonia, and diarrhoea at national level, in UNICEF, WHO and Global Fund. Currently, together with collaborators in Uganda, we are evaluating how to embed the iCCM intervention in the existing health systems and scale it up while applying real-world supervision models and medicine supply chains. In addition, we have proposed to develop and implement a franchise model for the drug shops implementing iCCM intervention and management of moderate malnutrition.

Collaborators
Makerere University, Clinton Health Access Initiative, Uganda, UNICEF, Uganda Country Office

Funding
WHO affiliated Alliance for Health Policy and Systems Research, Swedish Research Council, Einhorn Family Foundation and friends, UNICEF, Uganda Country Office.

Responsible researcher/contact person
Stefan Swartling Peterson, stefan.peterson@kbh.uu.se

Ongoing projects in Tanzania
Together with partners in Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, we are conducting longitudinal surveillance of the efficacy of the first line ACT, i.e. artemether-lumefantrine (AL), for the treatment of uncomplicated Plasmodium falciparum malaria in Bagamoyo district. The efficacy of AL is assessed by parasite clearance times, crude and PCR adjusted cure rates, and temporal selection of genetic markers of drug resistance among the parasite population. In addition we are evaluating the diagnostic accuracy and utility of new point-of-care diagnostic tools for improved malaria case detection.

Collaborators
MUHAS, KI.

Funding
Swedish Research Council, Sida

Responsible researcher/contact person
Andreas Mårtensson, andreas.martensson@kbh.uu.se

Ongoing projects in Zanzibar
Together with the Zanzibar Malaria Elimination Programme (ZAMEP) and partners, we are conducting longitudinal surveillance of the impact of malaria interventions on community parasite prevalence, confirmed malaria infections at public health care facilities and all cause child mortality, as well as uptake of the interventions by triangulating data from community based cross sectional surveys, records on confirmed malaria infection from all public health care facilities and vital statistics. The aim of the project is to assess if it is possible to eliminate malaria in Zanzibar as a case study for sub-Saharan Africa.

Collaborators
ZAMEP, KI, UCSF, CDC/PMI.

Funding
Swedish Research Council

Responsible researcher/contact person
Andreas Mårtensson, andreas.martensson@kbh.uu.se

To Main fields of research

Social determinants of health

Brief description of the research field

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

Responsible researcher/contact person
Mats Målqvist, mats.malqvist@kbh.uu.se

Selected publications from the group

  1. 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.
  2. 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.
  3. Målqvist M, Singh C, KC A. Care seeking for childen with fever/cough or diarrhoea in Nepal, equity trends over the last 15 years. Scand J Public Health 2017 Mar;45(2):195-201.
  4. 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.
  5. Målqvist M. Preserving misconception or a call to action? – a hermeneutical re-reading of the Nativity story. Glob Health Action 2015, 8:30386
  6. 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.
  7. 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).
  8. Bergman M, Nygren-Brunell O, Vilakati D, Målqvist M. Prolonged Exclusive Breastfeeding Through Peer Support: A Cohort Study From a Community Outreach Project in Swaziland. J Community Health, 2016 Oct;41(5):932-8.

To Main fields of research

Health Systems and implementation science

Brief description of the research field

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

Ongoing projects

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)

Responsible researcher/contact person
Mats Målqvist, mats.malqvist@kbh.uu.se

Strengthening Maternal and Perinatal Death Review Systems

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.

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

Funding
Swedish International Development Cooperation Agency (Sida)

Responsible researcher/contact person
Mats Målqvist, mats.malqvist@kbh.uu.se

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

Responsible researcher/contact person
Mats Målqvist, mats.malqvist@kbh.uu.se

Context Assessment for Community Health (COACH) project

The COACH project initially aimed to develop a tool that focused on modifiable aspects of local health care context in low- and middle-income settings, i.e. aspects of context that could be intervened upon to enhance health system strengthening. The development of the COACH tool was undertaken with partners in Bangladesh, Vietnam, Uganda, South Africa and Nicaragua. The application and continued psychometric evaluation of the COACH tool (© Bergström and Estabrooks 2015) is still ongoing.

Collaborators (during the development to the tool)
ICDDR,B (Bangladesh), Hanoi University of Public Health (Vietnam), Makerere University College of Health Sciences (Uganda), Stellenbosch University (South Africa), Fundacion Coordinación de Hermanamientos e Iniciativas de Cooperación (Nicaragua), University of Alberta (Canada) and Dalarna University (Sweden).

Funding (during the development to the tool)
The Swedish International Development Cooperation Agency

Responsible researcher/contact person
Anna Bergström, anna.bergstrom@kbh.uu.se

NePeriQIP

The NePeriQIP project is focusing on improving the quality of maternal and new-born care at district level in Nepal. This scale-up project is taking place in 12 district hospitals and builds on previous research conducted by the research group evaluating the introduction of Helping Babies Breathe with a Quality Improvement strategy at a tertiary hospital in Kathmandu. The NePeriQIP trial departs from the WHO standards for improving maternal and new-born quality of care and intends to deliver a comprehensive Quality Improvement package for the continuum of perinatal care.

Collaborators
UNICEF Nepal, Ministry of Health Nepal

Funding
Swedish Research Council, UNICEF Nepal, Einhorn Foundation and STINT

Responsible researcher/contact person
Mats Målqvist, mats.malqvist@kbh.uu.se

Selected publications from the group

  1. Trimmer C, Målqvist M. Clinical communication and caregivers’ satisfaction with child healthcare in Nepal; results from Nepal Health Facility Survey 2015. BMC Health Serv Res (2019) 19:17.
  2. Målqvist M. Community agency and empowerment - a need for new perspectives and deepened understanding. Ups J Med Sci. 2018 Jun;123(2):123-130.
  3. 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.
  4. 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.
  5. 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.
  6. Bergström A, Skeen S, Duc DM, Blandon E., Estabrooks C, Gustavsson P, Hoa DT, Kallestal C, Malqvist M, Nga NT, Persson L-A, Pervin J, Peterson S, Rahman A, Selling K, Squires JE, Tomlinson M, Waiswa P, Wallin L. Health system context and implementation of evidence-based practices-development and validation of the Context Assessment for Community Health (COACH) tool for low- and middle-income settings. Implement Sci, 2015. 10(1): p. 120.
  7. 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
  8. Mocumbi S, McKee K, Munguambe K, Chiau R, Högberg U, Hanson C, Wallin L, Sevene E, Bergström A. Ready to deliver maternal and newborn care? Health providers’ perceptions of their work context in rural Mozambique. Global Health Action (2018), 11:1, 1532631,
  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.

To Main fields of research