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  • 1.
    Anyango, Cartrine
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR).
    Goicolea, Isabel
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Namatovu, Fredinah
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR).
    Women with disabilities’ experiences of intimate partner violence: a qualitative study from Sweden2023Ingår i: BMC Women's Health, E-ISSN 1472-6874, Vol. 23, nr 1, artikel-id 381Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Intimate Partner Violence (IPV) is a prevalent form of gender-based violence affecting one in three women globally. It is also a preventable cause of ill-health, disability, and death. Current research suggests that women with disabilities are at a significantly higher risk of experiencing violence throughout their lifetime. They are almost twice as likely to experience violence compared to men with disabilities or men and women without disabilities. Additionally, they experience higher rates of all types of violence. This increased vulnerability may be due to factors related to disability such as dependence on others for support, mistrust, and social and physical isolation. Although there is existing research on IPV against women in general, there is limited knowledge on IPV against women with disabilities. To address this gap in knowledge, this study aimed to explore women with disabilities’ perceptions and experiences of being victims/survivors of IPV in Sweden.

    Methods: This was a qualitative study conducted through in-depth interviews with eleven women with disabilities. The participants were aged eighteen years upwards. The collected data was analyzed using reflexive thematic analysis with a constructivist epistemological standpoint.

    Results: We developed four themes. Theme one: “multiple abuse by multiple abusers, over time,” describes the participants’ experiences of various types of violence from different perpetrators for prolonged periods. Theme two: “psychological abuse—harmful, but neglected and difficult to prove,” explains how women with disabilities’ perceive psychological abuse as harmful, but not given the same level of seriousness as physical violence. It also expresses the difficulties they encountered in providing tangible evidence to prove instances of psychological abuse. Theme three: “abuse does not end with separation,” highlights how abuse can continue beyond separation/divorce. Theme four: “surviving abusive relationships” describes the different and evolving ways the participants used to navigate their abusive relationships.

    Conclusions: Women with disabilities face all forms of abuse. They find it challenging to prove psychological abuse, and the system is inadequate in addressing its harm. The abuse also continues after separation or divorce. The support system should consider the needs of women with disabilities who experience violence, both during and after the abusive relationship. Service providers should be better equipped to detect and handle all types of IPV, especially psychological abuse.

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  • 2.
    Anyatonwu, Obinna Princewill
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Nwoku, Kelechi Amy
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Jonsson, Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Namatovu, Fredinah
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR).
    The determinants of postpartum contraceptive use in Nigeria2023Ingår i: Frontiers in Global Women's Health, E-ISSN 2673-5059, Vol. 4, artikel-id 1284614Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Postpartum contraception is vital for maternal and child health, and reduces the risk of infant mortality. The Health Belief Model (HBM) is a widely accepted framework for exploring health behaviors, such as contraceptive use. Therefore, this study aimed to investigate the factors influencing postpartum contraceptive use in Nigeria and to contextualize the findings within the framework of the HBM.

    Methods: This study was a secondary analysis of cross-sectional data collected from the Demographic Health Survey conducted in Nigeria (NDHS). In total, 28,041 women were included in this study. Self-reported contraceptive use was the outcome, while the explanatory variables included maternal age, place of residence, region of residence, religion, marital status, educational level, household wealth quintiles, knowledge of the ovulatory cycle, decision-maker for health care, and distance to health care facilities. Descriptive statistics and multivariate logistic regression were used to summarize and identify factors influencing postpartum contraceptive use. The HBM was used to discuss the main findings.

    Results: The prevalence of postpartum contraceptive use in Nigeria is 27%. Our findings showed that the odds of using contraceptives during the postpartum period were higher among women who knew their ovulation cycles, lived in urban areas in the southern region, had no distance barriers to health care, and were 25–49 years old. Education, wealth, and marital status also increase the odds of contraceptive use. However, women who lived in the northeast and northwest regions or shared decision-making with their partners had lower odds.

    Conclusion: This study highlights the need for region-specific and age-focused interventions to increase contraceptive use in Nigeria. Additionally, increasing accessibility and affordability of contraceptives for younger and economically disadvantaged women, along with promoting women's autonomy in decision-making, can further enhance contraceptive use across Nigeria.

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  • 3.
    Baroudi, Mazen
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Petersen, Solveig
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Namatovu, Fredinah
    Umeå universitet, Humanistiska fakulteten, Institutionen för idé- och samhällsstudier.
    Annelie, Carlsson
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Norström, Fredrik
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Preteen children’s health related quality of life in Sweden: changes over time and disparities between different sociodemographic groups2019Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 19, artikel-id 139Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Assessing disparities in health-related quality of Life (HRQoL) is important as a part of health-related disparities in the society. The aim of this study was to explore HRQoL among 12-year-olds in Sweden in terms of differences between years 2005 and 2009 and disparities related to sociodemographic background.

    Methods: During the school years 2005 and 2009, a total of 18,325 sixth grade students in Sweden were invited to a celiac disease screening study; 13,279 agreed to participate. Jointly with the celiac screening, the children answered a questionnaire that included EuroQol 5 Dimensions-youth (EQ-5D-Y) and their parents responded to separate questionnaires about their own and their child’s country of birth, family structure, their employment status, occupation, and education. In total 11,009 child-parent questionnaires were collected. Logistic regression was used to study differences in HRQoL between 2005 and 2009, and between various sociodemographic subgroups.

    Results: Compared with 2005, children in 2009 reported more pain (OR: 1.20, 95% CI: 1.1–1.3) and more mood problems (OR: 1.35, 95% CI: 1.2–1.5). In general, girls reported more pain and mood problems and had more disparities than boys. There were no significant differences based on parents’ occupation, however, children of parents with low or medium education levels reported less “mood problems” than those of parents with high education levels (OR: 0.65, 95% CI: 0.46–0.92) and (OR: 0.84, 95% CI: 0.73–0.96), respectively. A slight variation was seen in HRQoL between children with different migration background. Girls living in small municipalities reported more pain (OR: 1.51, 95% CI: 1.14–2.01), and problems performing usual activities (OR: 3.77, 95% CI: 2.08–6.84), compared to girls living in large municipalities. In addition, children living with two parents had less mood problems than children living in other family constellations.

    Conclusion: More children reported pain and mood problems in 2009 compared with 2005. To study future trends, health outcomes among children in Sweden should continue to be reported periodically. More efforts should be invested to increase the awareness of health-related disparities as highlighted in this study especially for girls living in small municipalities and children of parents with high education level.

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  • 4.
    Birabwa, Catherine
    et al.
    Department of Health Policy, Planning and Management, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda.
    Chemonges, Dennis
    Department of Programs, Population Services International Uganda, Kampala, Uganda; Department of Epidemiology and Biostatistics, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda.
    Tetui, Moses
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Department of Health Policy, Planning and Management, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda; School of Pharmacy, Waterloo University, Waterloo, ON, Canada.
    Baroudi, Mazen
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Namatovu, Fredinah
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Akuze, Joseph
    Department of Health Policy, Planning and Management, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
    Makumbi, Fredrick
    Department of Epidemiology and Biostatistics, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda.
    Ssekamatte, Tonny
    Department of Disease Control and Environmental Health, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda.
    Atuyambe, Lynn
    Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda.
    Hernandez, Alison
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Sewe, Maquins Odhiambo
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Knowledge and information exposure about family planning among women of reproductive age in informal settlements of Kira municipality, Wakiso district, Uganda2021Ingår i: Epidemiologic Methods, ISSN 2194-9263, E-ISSN 2161-962X, Vol. 2, artikel-id 650538Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: A high unmet need for family planning (FP) prevails in sub-Saharan Africa. Knowledge, awareness creation, and ensuring accessibility are frequently used to increase FP uptake. However, evidence on knowledge or information dissemination about FP among marginalized populations in urban settings in Africa is limited. This study explored the knowledge of FP methods, media exposure, and contact with FP providers among women from an informal settlement in Uganda.

    Methods: Using a cross-sectional study design, we interviewed 626 women aged 15–49 years living in informal settlements of Kira municipality, selected through multistage sampling. Using a standard questionnaire, data was collected on socioeconomic characteristics, knowledge of FP methods, and access to media FP messages among others. Binomial log-linear regression was used to assess disparities in exposure to media FP messages or provider information. Data were analyzed using STATA version 14, at a 5% level of statistical significance.

    Results: Nearly all women in the survey were aware of FP methods (99.7%). On average, each woman was aware of 10 FP methods. The most commonly known methods were male condoms (98.2%), injectables (97.4%), and the oral contraceptive pill (95.2%). Use of any contraceptive was found among 42.7% of respondents. Exposure to media was found in 70.6% of the respondents, mostly through television (58.5%) and radio (58.3%). Discussing FP with a provider was significantly associated with media exposure (aPR 1.4, 95% CI: 1.24–1.56). Less than 50% of women who were not using FP had contact with an FP provider. Women in union (aPR 1.6, 95% CI: 1.01–2.68) and those with access to media messages (aPR 2.5, 95% CI: 1.37–4.54) were more likely to have contact with a provider to discuss FP.

    Conclusion: There is high general awareness about FP methods and media exposure, but method use was low. Further exploration of women's understanding of FP methods and the fit between existing education programs and FP knowledge needs in this urban setting should be conducted. The potential for mobile health solutions in this urban population should be explored. Future studies should focus on the knowledge and understanding of FP among unmarried and nulliparous women and those with no access to media information.

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  • 5.
    Daca, Chanvo S. L.
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Directorate of Planning and Cooperation, Ministry of Health, Maputo, Mozambique; Centre for African Studies, Universidade Eduardo Mondlane, Maputo, Mozambique.
    San Sebastian, Miguel
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Arnaldo, Carlos
    Centre for African Studies, Universidade Eduardo Mondlane, Maputo, Mozambique.
    Schumann, Barbara
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden.
    Namatovu, Fredinah
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Socioeconomic and geographical inequalities in health care coverage in Mozambique: a repeated cross-sectional study of the 2015 and 2018 national surveys2023Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 23, nr 1, artikel-id 1007Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Over the past years, Mozambique has implemented several initiatives to ensure equitable coverage to health care services. While there have been some achievements in health care coverage at the population level, the effects of these initiatives on social inequalities have not been analysed.

    Objective: The present study aimed to assess changes in socioeconomic and geographical inequalities (education, wealth, region, place of residence) in health care coverage between 2015 and 2018 in Mozambique.

    Methods: The study was based on repeated cross-sectional surveys from nationally representative samples: the Survey of Indicators on Immunisation, Malaria and HIV/AIDS in Mozambique (IMASIDA) 2015 and the 2018 Malaria Indicator survey. Data from women of reproductive age (15 to 49 years) were analysed to evaluate health care coverage of three indicators: insecticide-treated net use, fever treatment of children, and use of Fansidar malaria prophylaxis for pregnant women. Absolute risk differences and the slope index of inequality (SII) were calculated for the 2015 survey period and the 2018 survey period, respectively. An interaction term between the socioeconomic and geographical variables and the period was included to assess inequality changes between 2015 and 2018.

    Results: The non-use of insecticide-treated nets dropped, whereas the proportion of women with children who were not treated for fever and the prevalence of women who did not take the full Fansidar dose during pregnancy decreased between 2015 and 2018. Significant reductions in the inequality related to insecticide-treated net use were observed for all socioeconomic variables. Concerning fever treatment, some reductions in socioeconomic inequalities were observed, though not statistically significant. For malaria prophylaxis, the SII was significant for education, wealth, and residence in both periods, but no significant inequality reductions were observed in any of these variables over time.

    Conclusions: We observed significant reductions of socioeconomic inequalities in insecticide-treated net use, but not in fever treatment of children and Fansidar prophylaxis for pregnant women. Decision-makers should target underserved populations, specifically the non-educated, poor, and rural women, to address inequalities in health care coverage.

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  • 6. King, Elizabeth J.
    et al.
    Maman, Suzanne
    Namatovu, Fredinah
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Kiwanuka, Deus
    Kairania, Robert
    Ssemanda, John B.
    Nalugoda, Fred
    Wagman, Jennifer A.
    Addressing intimate partner violence among female clients accessing HIV testing and counseling services: pilot testing tools in Rakai, Uganda2017Ingår i: Violence against Women, ISSN 1077-8012, E-ISSN 1552-8448, Vol. 23, nr 13, s. 1656-1668Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The World Health Organization recommends that HIV counseling and testing (HCT) programs implement strategies to address how intimate partner violence (IPV) influences women's ability to protect themselves from and seek care and treatment for HIV infection. We discuss the process used to adapt a screening and brief intervention (SBI) for female clients of HCT services in Rakai, Uganda-a setting with high prevalence of both HIV and IPV. By outlining our collaborative process for adapting and implementing the SBI in Rakai and training counselors for its use, we hope other HCT programs will consider replicating the approach in their settings.

  • 7.
    Mulubwa, Chama
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia.
    Munakampe, Margarate Nzala
    Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia.
    Namakula, Hilda
    Department of Health Policy, Planning, and Management, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda.
    Hernandez, Alison
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Ssekamatte, Tonny
    Department of Disease Control and Environmental Health, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda.
    Atuyambe, Lynn M.
    Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, College of Health Sciences New Mulago Hospital Complex, Kampala, Uganda.
    Birabwa, Catherine
    Department of Health Policy, Planning, and Management, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda.
    Chemonges, Denis
    Department of Epidemiology and Biostatistics, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda.
    Namatovu, Fredinah
    Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR). Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Makumbi, Fredrick
    Department of Epidemiology and Biostatistics, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda.
    Tetui, Moses
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Department of Health Policy, Planning, and Management, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda; School of Pharmacy, University of Waterloo, Waterloo, ON, Canada.
    Framing contraceptive use motivations among adolescents and young adults living in informal settlements in Kira municipality, Wakiso district, Uganda2021Ingår i: Epidemiologic Methods, ISSN 2194-9263, E-ISSN 2161-962X, Vol. 2, artikel-id 658515Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: The use of contraceptives among adolescents and young adults is one of the most cost-effective strategies to address many sexual and reproductive health (SRH) challenges, including unintended pregnancies, early marriages, and sexually transmitted infections. Despite a high burden of SRH challenges, uptake and unmet needs of modern contraceptives remain low in Uganda, especially among adolescents and young adults in informal settlement settings. This study aimed to explore the motivations of adolescents and young people to use modern contraceptives (or not).

    Methods: We analysed qualitative data from eight focus group discussions with 88 adolescents and young people aged 18-24 years residing in informal settlements of urban communities in Kira Municipality of Wakiso district, Uganda.

    Results: Motivations for use (or not) of modern contraceptives were framed by two interrelated constructs, sources of information on contraception and the unacceptable use of contraceptives among adolescents widespread in the community. These two, in turn, formed the scope of knowledge upon which adolescents and young people based their decision on whether or not to access and use modern contraceptives.

    Conclusion: To be more effective, sexual and reproductive health programs and interventions that aim to motivate the use of modern contraceptives among adolescents and young people in informal settings should be more comprehensive and focused on alleviating individual, health systems, social, religious factors that reinforce negative health-seeking behaviours towards contraceptive use. In addition, there is a need to support adolescents and young people with socio-economic empowering strategies that equip them with sufficient resources to choose contraceptives of their choice.

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  • 8.
    Namatovu, Fredinah
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    The multifactorial etiology of celiac disease explored by combining several national registers2015Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
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  • 9.
    Namatovu, Fredinah
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR).
    Häggström Gunfridsson, Erling
    Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR).
    Vikström, Lotta
    Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR). Umeå universitet, Humanistiska fakulteten, Institutionen för idé- och samhällsstudier.
    Is teenage parenthood associated with early use of disability pension? Evidence from a longitudinal study2023Ingår i: PLOS ONE, E-ISSN 1932-6203, Vol. 18, nr 6, artikel-id e0287265Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Over the past decades the number of young people using disability pensions (DP) has gradually increased in Europe but the reasons for this change are poorly understood. We hypothesize that teenage parenthood could be associated with an increased risk of receiving early DP. The aim of this study was to examine the association between having a first child at age 13-19 and receiving DP at age 20-42 (here called early DP).

    Methods: A longitudinal cohort study was undertaken based on national register data obtained from 410,172 individuals born in Sweden in 1968, 1969, and 1970. Teenage mothers and fathers were followed until age 42 and compared to non-teenage parent counterparts to examine their early receipt of DP. Descriptive analysis, Kaplan-Meier curves, and Cox regression analyses were performed.

    Results: The proportion of teenage parents was more than twice higher in the group that received early DP (16%) compared to the group that did not receive early DP (6%) during the study duration. A higher proportion of teenage mothers and fathers started to receive DP at 20-42 years old compared to non-teenage parents, and the difference between the two groups increased during the observation period. A strong association was observed between being a teenage parent and receiving early DP, significant both independently and after adjusting for the year of birth and the father's level of education. From the age of 30 to 42 years, teenage mothers used early DP more often than teenage fathers or non-teenage parents, and this difference also increased during the follow-up period.

    Conclusion: A strong association was found between teenage parenthood and the use of DP between 20 and 42 years of age. Teenage mothers used DP more than teenage fathers and non-teenage parents.

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  • 10.
    Namatovu, Fredinah
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR). Umeå universitet, Humanistiska fakulteten, Institutionen för idé- och samhällsstudier.
    Häggström Lundevaller, Erling
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Statistik.
    Vikström, Lotta
    Umeå universitet, Humanistiska fakulteten, Institutionen för idé- och samhällsstudier. Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR).
    The impact of disability on partnership formation in Sweden during 1990-20092020Ingår i: The History of the Family, ISSN 1081-602X, E-ISSN 1873-5398, Vol. 25, nr 2, s. 230-245Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Evidence suggests that disability negatively affects people’s propensity to find a partner. Persons with disabilities that eventually find a partner do so later in life compared to the average population. There is a lack of studies on the differences in partnership opportunities for persons with disabilities compared to those without disabilities in Sweden. The aim of this study is to assess the impact of disability on partnership formation and to assess whether partnership formation varies as a function of individual demographic and socio-economic factors. We use nationwide data available in the Swedish Initiative for Research on Microdata in Social and Medical Sciences (Umeå SIMSAM Lab). We follow persons born from 1973 to 1977 when they were from 16 to 37 years of age and analyze their data using logistic regression. Our findings indicate that regardless of whether a person started to receive a disability pension at an early age or later, it was associated with lower odds for partnership formation. For persons who started receiving disability pension from 16 to 20 years of age, chances for partnership formation reduced with increase in age of partnership. Individuals that started to receive disability pension later were more likely to form partnership prior to receiving disability pension. Partnership formation was less likely among persons born outside Sweden, in persons with mothers born outside Sweden, in individuals born by unmarried mothers and in persons, whose mothers had a high level of education. Partnership was high among women and among persons who had many maternal siblings. In conclusion, receiving disability pension was associated with reduced chances for partnership formation. Receiving disability pension might imply financial constraints that negatively influence partnership formation supporting Oppenheimer’s theory on the economic cost of marriage and the uncertainty hypothesis.

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  • 11.
    Namatovu, Fredinah
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR).
    Häggström Lundevaller, Erling
    Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR). Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Statistik.
    Vikström, Lotta
    Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR). Umeå universitet, Humanistiska fakulteten, Institutionen för idé- och samhällsstudier.
    The relationship between disability and parental status: a register study of the 1968 to 1970 birth cohorts2021Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 21, nr 1, artikel-id 343Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Having children is a major life course event yet some disabilities could make it biologically challenging and some others could limit access to necessary socioeconomic resources. To date, there is relatively little data on disability and parental status and our study aimed to investigate this relationship.

    Methods: This longitudinal cohort study was based on register data obtained from all people born in Sweden from 1968 to 1970 (n = 440220). We performed descriptive analyses, graphical plots, logistic regression, and Cox regression analyses.

    Results: Our findings from both logistic regression and Cox regression indicated that individuals that started to receive disability benefits at an early age had reduced chances of having children during the follow-up duration. Men with disabilities were less likely to have children when compared to women with disabilities and to men and women without disabilities.

    Conclusions: We found evidence that disability during early adulthood was associated with reduced chances of having children. Findings support policies and programmes aimed at promoting optimal health during early adulthood, as this would promote continued labour force participation, reduce early use of disability benefits, and possibly improve chances of becoming a parent.

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  • 12.
    Namatovu, Fredinah
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR).
    Häggström Lundevaller, Erling
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Statistik.
    Vikström, Lotta
    Umeå universitet, Humanistiska fakulteten, Institutionen för idé- och samhällsstudier. Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR).
    Ng, Nawi
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Global and Public Health, School of Public Health and Community.
    Adverse perinatal conditions and receiving a disability pension early in life2020Ingår i: PLOS ONE, E-ISSN 1932-6203, Vol. 15, nr 2, artikel-id e0229285Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: The number of young adults on disability pension (DP) is increasing in European countries, creating a need to understand the related risk factors. This study aimed to determine whether adverse perinatal conditions are associated with receiving a DP early in life.

    Methods: This longitudinal cohort study consisted of all persons (N = 453,223) born in Sweden during 1973–1977, observed from 1991 through 2010 when they were aged between 16 and 37 years. Statistics Sweden provided linked national data on the children and their parents. We used logistic regression to assess the association between perinatal health conditions (birth defect, Apgar score, and small for gestational age) and receiving a DP, adjusting for maternal education and the sex of the child.

    Results: New recipients of DP were significantly more likely to have had a birth defect (adjusted odds ratio [AOR] 2.74, 95% CI: 2.49–3.00), to have had low Apgar score (AOR 2.12, 95% CI: 1.77–2.52), to have been small for gestational age (AOR 1.73, 95% CI: 1.54–1.94) and to be females (AOR 1.55, 95% CI: 1.46–1.64). Higher maternal education was associated with lower odds of receiving a DP (AOR 0.74, 95% CI: 0.69–0.79) for those with high school education and (AOR 0.67, 95% CI: 0.59–0.75) for those with university education. Age-stratified analysis confirmed increased odds of receiving a DP among those with birth defects and small for gestational age, but this effect reduced with increasing age. Apgar score was significantly associated with starting to receive a DP at ages 16–18 and 19–29, but not at ages 30–33. Women had lower odds of receiving a DP at ages 16–18 (AOR 0.73, 95% CI: 0.64–0.85); however, this reversed from age 19 and upwards (AOR 1.53, 95% CI: 1.41–1.67) and (AOR 2.16, 95% CI: 1.95–2.40) for the age groups of 19–29 and 30–33, respectively. Persons with high maternal education were less likely to receive a DP regardless of age at receiving a DP.

    Conclusion: Having a birth defect was the strongest indicator of receiving a DP during early adulthood, followed by small for gestational age and low Apgar score. Overall, the effects of the studied perinatal health conditions were pronounced in those who received a DP at 16–18 years, but this effect weakened with increasing age at receiving a DP. Our findings suggest that policies and programs geared at promoting optimal health at birth might contribute to a reduction in receiving a DP.

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  • 13.
    Namatovu, Fredinah
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR).
    Ineland, Jens
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Lövgren, Veronica
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Exploring the perspectives of professionals on providing intimate partner violence services to women with disabilities2024Ingår i: Violence against Women, ISSN 1077-8012, E-ISSN 1552-8448, Vol. 30, nr 2, s. 622-640Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This study explored the experiences and perceptions of professional service providers offering services to women with disabilities exposed to intimate partner violence (IPV). Eighteen in-depth interviews were conducted with service providers working in health care, social work, the police, women’s shelters, and the Centre for Violence Against Women. Our findings suggest that providing adequate IPV services to women with disabilities requires coordination and collaboration. IPV services were organized around five overarching themes: finding services; assessing the risk; identification; protection and care; and becoming independent. This approach was helpful for women who faced disability-related challenges in accessing IPV services.

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  • 14.
    Namatovu, Fredinah
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR). Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Umeå Universitet.
    Ineland, Jens
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Lövgren, Veronica
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    The perspectives of professionals on providing services to women withdisabilities that experience intimate-partner violence2021Rapport (Refereegranskat)
    Abstract [en]

    Aim: The aim of this study was to explore the experiences and perceptions of the service providers on the wayexisting intimate-partner violence (IPV) services are organised to address the needs of people with disabilitiesexposedto IPV.

    Methods: The researchers conducted in-depth interviews with 17 IPV service providers working in: health care,social work, police, women’s shelters and at the Center against violence. A semi-structured, open-ended interviewwere conducted between March 2020 and December 2020 and transcribed verbatim. A constructivist groundedtheory approach that is based on the principles of symbolic interactionism was used with the purpose ofexplaining how IPV services are organised for people with disabilities in Sweden.

    Results: In the resulting theoretical framework service providers framed their experience and perceptions ofproviding IPV services to people with disabilities to require coordination and multisectoral collaboration betweendifferent sectors and actors was viewed as ideal for providing adequate services to women with disabilities,however this was not always the actual approach adoptedby all providers. The providers further illustrated thatservice provision for women with disabilities was organised around four overarching themes; pathways; screeningand identification; protection and care; empowerment and independence.

    Conclusion: This study indicates that providing adequate IPV services to people with disabilities requiremultisectoral collaboration. This approach was considered instrumental for women with disabilities that often facedisability-related challenges that created difficulties in navigating several services on their own. 

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  • 15.
    Namatovu, Fredinah
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Lindkvist, Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Olsson, Cecilia
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Sandström, Olof
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. olof.sandstrom@pediatri.umu.se.
    Season and region as risk factors for celiac disease: a key to the aetiology?2016Ingår i: Archives of Disease in Childhood, ISSN 0003-9888, E-ISSN 1468-2044, s. 1114-1118Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Coeliac disease (CD) incidence has increased in recent decades, characterised by variations according to sex, age at diagnosis, year of birth, month of birth and region of birth. Genetic susceptibility and exposure to gluten are the necessary factors in CD aetiology, although several environmental factors are considered.

    Methods: A nationwide prospective cohort longitudinal study was conducted consisting of 1 912 204 children aged 0–14.9 years born in Sweden from 1991 to 2009. A total of 6569 children were diagnosed with biopsy-verified CD from 47 paediatric departments. Using Cox regression, we examined the association between CD diagnosis and season of birth, region of birth and year of birth.

    Results: Overall, CD risk was higher for children born during spring, summer and autumn as compared with children born during winter: adjusted HR for spring 1.08 (95% CI 1.01 to 1.16), summer 1.10 (95% CI 1.03 to 1.18) and autumn 1.10 (95% CI 1.02 to 1.18). Increased CD risk was highest if born in the south, followed by central Sweden when compared with children born in northern Sweden. Children diagnosed at <2 years had an increased CD risk if born in spring while those diagnosed at 2–14.9 years the risk was increased for summer and autumn births. The birth cohort of 1991–1996 had increased CD risk if born during spring, for the 1997–2002 birth cohort the risk increased for summer and autumn births, while for the birth cohort of 2003–2009 the risk was increased if born during autumn.

    Conclusions: Season of birth and region of birth are independently and jointly associated with increased risk of developing CD during the first 15 years of life. Seasonal variation in infectious load is the likely explanation.

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  • 16.
    Namatovu, Fredinah
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR). Umeå Universitet.
    Lövgren, Veronica
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Wickman, Kim
    Umeå universitet, Samhällsvetenskapliga fakulteten, Pedagogiska institutionen.
    Access and utilization of intimate partner violence-related services: The multiple-level barriers encountered by women with disabilities2023Rapport (Övrigt vetenskapligt)
    Abstract [en]

    Background: Current data suggests a high prevalence of intimate partner violence (IPV) among women withdisabilities (WWDs), yet there is still scanty research on the experiences of this population regarding access andutilization of IPV services.

    Methods: Using qualitative in-depth data obtained from WWDs, our current study sought to identify factors thathinder WWDs from accessing and utilizing IPV services.

    Results: This study showed that WWDs exposed to IPV encountered multilevel barriers nested at differentsocietal levels as they attempted to access violence-rated services. At the individual level, the identity category ofdisability, not knowing about certain forms of violence, and being better off silent were the main explanations fornot using IPV services. The role of personal connections was the main factor that influenced the utilization ofIPV services, at the interpersonal level while at the organizational level, a lack of effective communication, powerimbalances, inadequate resources, and failures to follow response standards were identified as the major barriers tousing IPV services. Societal incompetence, as exemplified by treating violence as a taboo and the lack ofregulations criminalizing psychological violence, was the main barrier at the societal level.

    Conclusions: Our findings suggest that regarding WWDs, improving their access and utilization of IPV servicesrequires interventions that address barriers at societal multiple levels including the individual, interpersonal,organizational, and societal levels. This should include early interventions and programs that not only targetWWDs but also include other key players such as service providers on violence recognition and improve thequality of services. There is a need to also review laws and regulations regarding psychological violence and thenature of interventions in place for this type of violence. 

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  • 17.
    Namatovu, Fredinah N.
    Umeå universitet, Humanistiska fakulteten, Institutionen för idé- och samhällsstudier.
    Disability and family formation2017Ingår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, nr Suppl_3, s. 352-Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Few studies have investigated family formation among people with disabilities. Available evidence on disability and family formation shows people with disabilities to have a low propensity of finding a life partner. Being married or cohabiting has been associated with improved health in children. There is a general lack of investigations on how family formation among people with disability has changed in recent decades. Important to note, there is scanty of evidence of how the situation of disability and family formation looks like in Sweden today.

    Methods: Using Swedish national register data obtained from the Umeå SIMSAM Lab, the study applies statistical life course techniques such as Cox regression and sequence analysis to identify factors affecting the relationship between disability and family formation. We follow the life courses of persons with disability born in 1973-1977 up to when they are aged 16-37 years, which is in 1990 and 2010. The selected age interval represents the time when crucial transitioning often takes place i.e. transition into education, independent living, work and family formation. Disability based on having received early retirement pension during the follow-up period.

    Results: Out of 700000 individuals born during 1973-1977, the study shows differences in partnership chances for people with disability and not.

    Conclusions: There is need for further investigations on why people with work related disability have lower rates of cohabitation and marriage compared to the general population.

    Key messages:

    • Despite the major improvements in the lives of people with disability.
    • There is need for to look into ways of increasing their chances of finding a partner.
  • 18.
    Namatovu, Fredinah
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Olsson, Cecilia
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Lindkvist, Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Myléus, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Högberg, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Department of Women’s and Children’s Health, Obstetrics and Gynaecology, Uppsala University, Uppsala, Sweden.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Sandström, Olof
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Maternal and perinatal conditions and the risk of developing celiac disease during childhood2016Ingår i: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 16, artikel-id 77Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Celiac disease (CD) is increasing worldwide, which might be due to the changing environmental and lifestyle exposures. We aimed to explore how conditions related to maternity, delivery and the neonatal period influence CD onset during childhood.

    Methods: Using Sweden’s national registers we had access to information on 1 912 204 children born between 1991 and 2009, 6 596 of whom developed CD before 15 years of age. Logistic regression analyses were performed to determine how CD is associated with maternity, delivery and the neonatal period.

    Results: Regardless of sex, a reduction in CD risk was observed in children born to mothers aged ≥35 years (odds ratio [OR] 0.8; 95 % confidence interval [CI] 0.7–0.9) and with high maternal income (OR 0.9; 95 % CI 0.8–0.9). Being a second-born child, however, was positively associated with CD. Among boys, elective caesarean delivery increased the risk of CD (OR 1.2; 95 % CI 1.0–1.4), while maternal overweight (OR 0.9; 95 % CI 0.8-0.9), premature rupture of the membrane (OR 0.4; 95 % CI 0.2–0.8) and low birth weight showed a negative association. Girls had an increased CD risk compared to boys and in girls the risk was increased by repeated maternal urinary tract infections (OR 1.1; 95 % CI 1.0–1.2).

    Conclusions: Elective caesarean delivery and repeated maternal urinary tract infections during pregnancy are associated with increased risk of CD onset during childhood, suggesting the role of dysbiosis during early life. High maternal age and high income reduced the risk of CD, which might be due to infant-feeding practices and life style.

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  • 19.
    Namatovu, Fredinah
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR).
    Preet, Raman
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Goicolea, Isabel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Gender-based violence among people with disabilities is a neglected public health topic2018Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 11, s. 97-100Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This paper aims to provide an analytical insight on the current state of knowledge on gender-based violence among people with disabilities, a topic where the level of data is relatively low. We briefly discuss the current research on: (a) the prevalence, risk factors and the theoretical approaches for gender-based violence among people with disabilities. (b) Service provision among people with disabilities who experience gender-based violence. (c) We also highlight areas where further research is required, the applicable theoretical approaches and provide an example on how Sweden is attempting to bridge this knowledge gap through implementing the Disability and Intimate-partner violence project (DIS-IPV) project

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  • 20.
    Namatovu, Fredinah
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Sandström, Olof
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. olof.sandstrom@pediatri.umu.se.
    Olsson, Cecilia
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Lindkvist, Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Celiac disease risk varies between birth cohorts, generating hypotheses about causality: evidence from 36 years of population-based follow-up2014Ingår i: BMC Gastroenterology, ISSN 1471-230X, E-ISSN 1471-230X, Vol. 14, artikel-id 59Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Celiac disease (CD) is a major public health problem with estimated 1-3% prevalence in the general population. In recent years an increase in CD prevalence has been reported both in Sweden and worldwide. This study aimed at examining the annual incidence rate of biopsy-proven celiac disease among children in Sweden over a 36-year period, to assess variations by age, sex and birth cohort, and to assess the clinical impact of these changes.

    METHODS: The National Swedish Childhood CD Register was used to identify 9107 children aged 0-14.9 years who were diagnosed with CD during the period 1973 to 2009. From 1973 to 1990 the register covered 15% of the nation, this increased to 40% during 1991-1997; a full national coverage was obtained from 1998 onwards. Estimations for the annual incidence rate, cumulative incidence and clinical impact by age groups, calendar month and birth cohorts were made.

    RESULTS: CD incidence is continuing to increase in the child population aged 2-14.9 years. A continued variation in CD incidence was observed in children aged 0-1.9 years, characterized by a marked decrease in most recent years. The median age at diagnosis has increased from 1.0 year in the 1970s to 6.8 years in 2009. The average number of new cases has risen from ~200 during 1973-1983 to ~600 during 2004-2009. In the birth cohorts of 2000-2002 the cumulative incidence even exceeded that of the epidemic cohorts at comparable ages. The highest cumulative incidence was observed in the birth cohorts of 1985-1995 and 2000-2002.

    CONCLUSIONS: CD risk varies between birth cohorts, suggesting cyclic environmental and/or lifestyle risk factors in CD etiology. More research on underlying risk factors is required in order to move forward with preventive strategies.

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  • 21.
    Namatovu, Fredinah
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Strandh, Mattias
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Nilsson, Karina
    Umeå universitet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen.
    Effect of childhood coeliac disease on ninth grade school performance: evidence from a population-based study2018Ingår i: Archives of Disease in Childhood, ISSN 0003-9888, E-ISSN 1468-2044, Vol. 103, nr 2, s. 143-148Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Coeliac disease might affect school performance due to its effect on cognitive performance and related health consequences that might increase school absenteeism. The aim of this study was to investigate whether children with coeliac disease performed differently on completion of ninth grade in school compared with children without coeliac disease.

    Methods: Analysis was performed on a population of 445 669 children born in Sweden between 1991 and 1994 of whom 1767 were diagnosed with coeliac disease. School performance at ninth grade was the outcome and coeliac disease was the exposure. Other covariates included sex, Apgar score at 5 min, small for gestational age, year of birth, family type, parental education and income.

    Results: There was no association between coeliac disease and school performance at ninth grade (adjusted coefficient -2.4, 95% CI 5.1 to 0.4). A weak association was established between late coeliac diagnosis and higher grades, but this disappeared after adjusting for parent socioeconomic conditions. Being small for gestational age affected performance negatively (adjusted coefficient -6.9, 95% CI 8.0 to 5.7). Grade scores were significantly lower in children living with a single parent (adjusted coefficient -20.6, 95% CI 20.9 to 20.2), compared with those with married/cohabiting parents. A positive association was found between scores at ninth grade and parental education and income.

    Conclusion: Coeliac disease diagnosis during childhood is not associated with poor school performance at ninth grade.

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  • 22.
    Namatovu, Fredinah
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Strömgren, Magnus
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för geografi och ekonomisk historia.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Lindgren, Urban
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för geografi och ekonomisk historia.
    Olsson, Cecilia
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Lindkvist, Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Sandström, Olof
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Neighborhood conditions and celiac disease risk among children in Sweden2014Ingår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 42, nr 7, s. 572-580Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: To investigate celiac disease (CD) clustering at different geographical levels and to examine the association between neighborhood demographic and socioeconomic conditions and the risk of neighborhood CD.

    Methods: We included 2080 children diagnosed with CD between 1998 and 2003, identified from 43 of the 47 reporting hospitals in Sweden. A total of 8036 small area market statistics (SAMS) areas were included; these were nested in 253 municipalities that were further nested into eight ‘nomenclature of territorial units for statistics’ (NUTS) 2 regions. We performed multilevel logistic regression analyses.

    Results: We found the highest geographical variation in CD incidence at the municipality level, compared to the region level. The probability of having CD increased in the statistical areas of (SAMS) areas with higher average annual work income, with an odds ratio (OR) of 2.24 and 95% CI of 1.76–2.85. Reduced CD risk in neighborhoods was associated with higher average age (OR 0.96; 95% CI 0.95–0.97), higher proportion of residents with a university education (OR 0.98; 95% CI 0.97–0.99), and higher level of industrial and commercial activity (OR 0.59; 95% CI 0.44–0.82). We found no significant association between CD risk and population density, proportion of Nordic to non-Nordic inhabitants, nor share of the population with only a compulsory education.

    Conclusions: Neighborhood composition influences CD risk. This is one of the first attempts to identify factors explaining geographical variation in CD.

  • 23.
    Namatovu, Fredinah
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Vikström, Lotta
    Umeå universitet, Humanistiska fakulteten, Institutionen för idé- och samhällsstudier.
    Våld i nära relationer bland vuxna med funktionsnedsättning2023Rapport (Övrigt vetenskapligt)
    Abstract [sv]

    Denna Genväg till forskning syftar till att ge en översikt av det aktuella kunskapsläget om våld i nära relationer bland vuxna med funktionsnedsättning. Det utgör ett problemområde som har undersökts jämförelse lite hittills. Översikten utgår från Världshälsoorganisationens (WHO) övergripande definition av funktionsnedsättning som avser långvarigt nedsatt förmåga hos individer att fungera fysiskt eller psykiskt i relation till sin omgivning och förhindrar dem från att fullt delta i samhället. Översikten ger en bild av den senaste forskningen beträffande: förekomst och följder av våld i nära relationer bland vuxna män och kvinnor med funktionsnedsättning; riskfaktorer för denna typ av våld; vad som kännetecknar det; samt tillgång till stöd och serviceinsatser. Även om båda könen berörs ligger fokus på hur övergrepp från närstående drabbar kvinnor med funktionsnedsättning generellt sett, där jämförelser mellan olika funktionsnedsättningar ibland förekommer. Vår översikt av forskningsläget blottlägger två kunskapsluckor, varav den första gäller okunskap om de erfarenheter av våld i nära relationer som personer med funktionsnedsättning har. För det andra är forskning om tillgång till stödinsatser bristfällig, inte minst vilka former av stödinsatser som bidrar till skydd och stöd. För att kunna förebygga våld som personer med funktionsnedsättning utsätts för och för att förbättra samhällets stödsystem behöver framtida forskning närmare undersöka dels hur de upplever våld från närstående, dels hur tillgången till stöd fungerar i praktiken. I slutet av rapporten presenteras några resultat från våra projekt som belyser just dessa aspekter avseende kvinnor som utsatts för dessa övergrepp i Sverige. Resultaten bidrar till att täppa till de två forskningsluckor som översikten påvisar.

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  • 24.
    Norström, Fredrik
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Namatovu, Fredinah
    Umeå universitet, Humanistiska fakulteten, Institutionen för idé- och samhällsstudier.
    Carlsson, Annelie
    Pediatrik, Lunds Universitet.
    Högberg, Lotta
    Pediatriska kliniken, Vrinnevisjukhuset, Norrköping.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Myléus, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin. Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Family socio-economic status and childhood coeliac disease seem to be unrelated: a cross-sectional screening study2021Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 110, nr 4, s. 1346-1352Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: The aim of our study was to examine whether there is a difference in coeliac disease prevalence in regard to parents' education level and occupation, and whether this differs between screened and clinically diagnosed children at the age of 12 years.

    METHODS: The study, Exploring the Iceberg of Celiacs in Sweden (ETICS), was a school-based screening study of 12-year-old children that was undertaken during the school years 2005/2006 and 2009/2010. Data on parental education and occupation were reported from parents of the children. Specifically, by parents of 10 710 children without coeliac disease, 88 children diagnosed with coeliac disease through clinical care, and 231 who were diagnosed during the study.

    RESULTS: There were no statistically significant associations between occupation and coeliac disease for either the clinically detected (prevalence ratio 1.16; confidence interval 0.76-1.76) or screening-detected coeliac disease cases (prevalence ratio 0.86; confidence interval 0.66-1.12) in comparison with children with no coeliac disease. Also, there were no statistically significant associations for parental education and coeliac disease diagnosis.

    CONCLUSION: There was no apparent relationship between coeliac disease and socio-economic position. Using parents' socio-economic status as a tool to help identify children more likely to have coeliac disease is not recommended.

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  • 25.
    Nyagwui, Asonganyi Edwin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Fredinah, Namatovu
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Che, Longho Bernard
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Yulia, Blomstedt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Motorcycle injury among secondary school students in the Tiko municipality, Cameroon2016Ingår i: Pan African Medical Journal, E-ISSN 1937-8688, Vol. 24, artikel-id 116Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: injury from motorcycle is a considerable cause of disability and death in the world and especially in low and middle-income countries; it is one of the most serious public health problems. In Cameroon, motorcycle is commonly used for transportation particularly among students. The aim of this paper is to study the risk-factors of the motorcycle-related accidents and injuries among secondary school students’ in the Tiko municipality, Cameroon.

    Methods: a cross sectional study was conducted in January 2012 on 391 students age 16-24 from public and private schools in the Tiko Municipality. Logistic regression was used to estimate the association between risk factors and injuries. A closed-ended and few open-ended questionnaire was used to collect data.

    Results: the study showed that over 70% of students used motorcycles always or often. Few had undergone any formal training for driving a motorcycle. The vast majority reported not wearing protective gear while driving or riding a motorcycle. Usage of protective gear was particularly low among girls. Over 16% reported using a motorbike always or occasionally under the influence of alcohol or drugs. Over 58% of respondents reported having an accident and over 35% were injured when driving or riding a motorcycle. Those who lived at the Tiko-Douala road have three times higher probability to sustain accidents and injuries than students residing elsewhere (OR 3.19 (1.20-8.46).

    Conclusion: it is deeply alarming that every second respondent in the study reported having been in an accident and every third motorcycle user was somehow injured. We therefore call for an immediate attention and a deeper investigation into the highlighted situation, particularly at Tiko-Douala road.

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  • 26.
    Nyandwi, Alypio
    et al.
    School of Public Health, University of Rwanda, Kigali, Rwanda.
    Namatovu, Fredinah
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Rusanganwa, Vincent
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi.
    Munyanshongore, Cyprien
    School of Public Health, University of Rwanda, Kigali, Rwanda.
    Nyirazinyoye, Laetitia
    School of Public Health, University of Rwanda, Kigali, Rwanda.
    Ndola, Prata
    University of California, Berkeley, United States.
    Nshimiyimana, Jean Damascene
    National Rehabilitation Service, Kigali, Rwanda.
    Ingabire, Marie-Gloriose
    International Development Research Centre, Ottawa, Canada.
    Anastasie, Nyirabahinde
    Ministry of Gender and Family Promotion, Kigali, Rwanda.
    Salant, Natasha
    Clinton Health Access Initiative, Boston, United States.
    Mecthilde, Kamukunzi
    World Health Organization, Freetown, Sierra Leone.
    Emmanuel, Hakomeza
    Rwanda Biomedical Centre, Kigali, Rwanda.
    Mukabutera, Assumpta
    School of Public Health, University of Rwanda, Kigali, Rwanda.
    Predictors of physical violence against children in Rwanda: findings from a National Cross-Sectional Survey2022Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 22, nr 1, artikel-id 2375Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: To address the challenges of limited national data on the prevalence and nature of violence experienced by children, Rwanda conducted, in 2015–2016, the first National Survey on Violence among female and male children and youth aged 13–24 years. To further contribute to these efforts to fill existing data gaps, we used the Rwanda survey data to assess the prevalence and predictors of physical violence (PV) in children aged 13–17.

    Methods: A nationally representative sample of 618 male and 492 female children were analysed. Nationally representative weighted descriptive statistics were used to analyse the prevalence of PV self-reported by children, and logistic regression models were applied to investigate its predictors.

    Results: Sixty percent of all children, including 36.53% of male and 23.38% of female children, reported having experienced any form of PV in their lifetime. Additionally, 21.81% of male children and 12.73% of female children reported experiences of PV within twelve months before the survey date. Older children (OR: 0.53 [0.40–0.72]), female children (OR: 0.43 [0.31–0.58]), and children not attending school (OR: 0.48 [0.31–0.73]) were less likely to be physically abused. However, sexually active children (OR: 1.66 [1.05–2.63]), children in households from the middle wealth quintile (OR: 1.63 [1.08–2.47]), children living in a larger family (OR: 1.55 [1.07–2.26]), and children who reported not feel close to both biological parents (OR: 2.14 [1.31–3.49]) had increased odds of reporting physical violence.

    Conclusion: Higher rates of PV in children attending school were the key finding. There is an urgent need to design and implement particular national interventions to prevent and reduce the incidence of PV in schools in Rwanda. PV was also associated with poor parent-child relations. Parents and other adult caregivers should be sensitised to the consequences of PV on children and be urged to adopt positive parenting practices.

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  • 27.
    Nyandwi, Alypio
    et al.
    African Population and Health Research Center, Kenya; School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
    Namatovu, Fredinah
    Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR). Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Rusanganwa, Vincent
    Rwanda Ministry of Health, Rwanda.
    Munyanshongore, Cyprien
    School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
    Nyirazinyoye, Laetitia
    School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
    Ndola, Prata
    University of California, United States.
    Nshimiyimana, Jean Damascene
    National Rehabilitation Service, Rwanda.
    Ingabire, Marie-Gloriose
    International Development Research Centre, Canada.
    Nyirabahinde, Anastasie
    Rwanda Ministry of Gender and Family Promotion, Rwanda.
    Salant, Natasha
    Clinton Health Access Initiative, United States.
    Kamukunzi, Mecthilde
    World Health Organization, Switzerland.
    Sexual violence against children in Rwanda: prevalence and associated factors2022Ingår i: Rwanda Journal of Medicine and Health Sciences, ISSN 2616-9819, Vol. 5, nr 3, s. 302-314Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Information and data on the burden and factors associated with violence against children are critical in designing and implementing preventive strategies and interventions. This study aimed to examine patterns of the prevalence of sexual violence (SV) against children in Rwanda and investigate associated factors to contribute to the knowledge about violence against children in Rwanda.

    Methods: A sample of 1,110 children aged 13-17 years from a cross-sectional national survey done in Rwanda in 2015 was analysed. Weighted descriptive statistics were applied to describe the prevalence of SV against children, and weighted logistic regression allowed us to investigate factors associated with it.

    Results: Over eight percent (8.4%) of all children, including about three percent (2.8%) of male children and around five percent (5.6%) of female children, reported having experienced SV within the last twelve months. Being a female child, having a romantic partner, and not attending school were some factors associated with SV against children in Rwanda.

    Conclusion: Female children reported more SV than male children. Factors associated with sexual violence pertained to the child's characteristics, family or household background characteristics, and community relations. The study findings call for an urgent need to prevent SV against children through awareness raising about it amongst children and the general public.

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  • 28.
    Sandström, Glenn
    et al.
    Umeå universitet, Humanistiska fakulteten, Institutionen för idé- och samhällsstudier. Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR). Stockholm University Demography Unit (SUDA), Stockholm University, Stockholm, Sweden.
    Namatovu, Fredinah
    Umeå universitet, Humanistiska fakulteten, Institutionen för idé- och samhällsstudier.
    Ineland, Jens
    Umeå universitet, Samhällsvetenskapliga fakulteten, Pedagogiska institutionen.
    Larsson, Daniel
    Umeå universitet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen.
    Ng, Nawi
    Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR). Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Stattin, Mikael
    Umeå universitet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen.
    The Persistence of High Levels of Living Alone Among Adults with Disabilities in Sweden, 1993–20112021Ingår i: Population: Research and Policy Review, ISSN 0167-5923, E-ISSN 1573-7829, Vol. 40, nr 2, s. 163-185Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This study investigates how the probability to live alone has developed among working age individuals with and without disabilities in Sweden during the period 1993–2011 when extensive political reforms to improve the integration of disabled individuals in society were implemented. The results show that individuals with disabilities are approximately twice as likely to be living alone when compared to individuals without disabilities. People with disabilities were also more likely to report low life satisfaction, and this was especially true among individuals with disabilities living alone. Men and women with disabilities also tend to experience longer periods of living as a one-person household than non-disabled people. Over time we find no indications of reduced differences in family outcomes between disabled and non-disabled individuals but rather evidence to the contrary. These differences are interpreted as being the result of the disadvantage disabled individual’s experience in the partner market and that people with disabilities are less successful in forming partnerships that can lead to cohabitation and family formation. The results thus show how disabled individuals still face societal barriers that limit their possibilities to find and sustain relationships that result in stable cohabitation despite increased efforts to improve their inclusion in Swedish society.

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  • 29.
    Sowe, Alieu
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Expanded Program on Immunization, Ministry of Health, Banjul, Gambia; Shifo Foundation, Stockholm, Sweden.
    Namatovu, Fredinah
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Cham, Bai
    Medical Research Council Unit The Gambia at the London, School of Hygiene and Tropical Medicine, Bakau, Gambia.
    Gustafsson, Per E.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Does a pay-for-performance health service model improve overall and rural–urban inequity in vaccination rates?: A difference-in-differences analysis from the Gambia2022Ingår i: Vaccine: X, ISSN 2590-1362, Vol. 12, artikel-id 100206Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To assess whether the implementation of a results-based financing (RBF) project in The Gambia resulted in (1) improved national vaccination coverage (2) higher coverage in intervention than non-intervention areas, and (3) improvement in rural–urban coverage inequality.

    Methods: The study used a difference-in-differences design, based on repeated cross-sectional data from The Gambian Demographic and Health Surveys 2013 (N = 1650) and 2020 (N = 1456). Full vaccination (receipt of one BCG, 3 OPV, 3 DTP, and 1 measles-containing vaccine doses) and rural–urban vaccination inequality were our outcome variables. The intervention, RBF, was implemented in 5 of the 7 health regions. Covariates controlled for included child’s sex, child’s birth order number, socioeconomic status, ethnicity, distance from health facility, maternal education, mother’s age group, mother’s marital status, and mother’s work status. Poisson regression with robust variance was used to estimate whether coverage changed, and difference-in-differences and difference-in-differences-in-differences were used to ‘assess differences in vaccination coverage change and change in inequalities, respectively.

    Results: Total crude full vaccination coverage in The Gambia was 76% in 2013 and 84.6% in 2020. Overall vaccination significantly increased by 16% (95% CI: 9% to 24%) in 2020 compared to 2013, but with a smaller increase in intervention relative to non-intervention areas [PRR 0.88 (CI: 0.78–0.99)]. Rural-urban inequality in vaccination coverage decreased more – by 13% [0.87 (0.78–0.98)] – in RBF than non-RBF regions.

    Conclusion: Vaccination coverage improved over the study period though we have no evidence to ascribe the coverage gains to the RBF intervention. However, our study suggests that the RBF project has contributed to reducing rural–urban inequalities in the regions it was implemented.

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  • 30.
    Sowe, Alieu
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Expanded Program On Immunization, Ministry of Health, Banjul, The Gambia .
    Namatovu, Fredinah
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Cham, Bai
    Medical Research Council Unit The Gambia at the London, School of Hygiene and Tropical Medicine, Bakau, The Gambia; School of Public Health, Georgia State University, Atlanta, GA, USA.
    Gustafsson, Per E.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Impact of a performance monitoring intervention on the timeliness of Hepatitis B birth dose vaccination in the Gambia: a controlled interrupted time series analysis2023Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 23, nr 1, artikel-id 568Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: The Hepatitis B virus that can cause liver cancer is highly prevalent in the Gambia, with one in ten babies at risk of infection from their mothers. Timely hepatitis B birth dose administration to protect babies is very low in The Gambia. Our study assessed whether 1) a timeliness monitoring intervention resulted in hepatitis B birth dose timeliness improvements overall, and 2) the intervention impacted differentially among health facilities with different pre-intervention performances.

    Methods: We used a controlled interrupted time series design including 16 intervention health facilities and 13 matched controls monitored from February 2019 to December 2020. The intervention comprised a monthly hepatitis B timeliness performance indicator sent to health workers via SMS and subsequent performance plotting on a chart. Analysis was done on the total sample and stratified by pre-intervention performance trend.

    Results: Overall, birth dose timeliness improved in the intervention compared to control health facilities. This intervention impact was, however, dependent on pre-intervention health facility performance, with large impact among poorly performing facilities, and with uncertain moderate and weak impacts among moderately and strongly performing facilities, respectively.

    Conclusion: The implementation of a novel hepatitis B vaccination timeliness monitoring system in health facilities led to overall improvements in both immediate timeliness rate and trend, and was especially helpful in poorly performing health facilities. These findings highlight the overall effectiveness of the intervention in a low-income setting, and also its usefulness to aid facilities in greatest need of improvement.

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  • 31.
    Sowe, Alieu
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Expanded Program on Immunization, Ministry of Health, Banjul, the Gambia.
    Namatovu, Fredinah
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Cham, Bai
    Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Bakau, the Gambia; School of Public Health, Georgia State University, Atlanta, GA, USA.
    Gustafsson, Per E.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Missed opportunities for vaccination at point of care and their impact on coverage and urban–rural coverage inequity in the Gambia2023Ingår i: Vaccine, ISSN 0264-410X, E-ISSN 1873-2518, Vol. 41, nr 52, s. 7647-7654Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Identifying actionable targets is crucial to improve overall and equity in vaccination coverage, and in line with the global Immunization Agenda 2030. Therefore, this study seeks to assess the prevalence of missed opportunities for simultaneous vaccination (MOSVs) and their impact on vaccination coverage and urban-rural inequity in The Gambia.

    Methods: We used data of children aged 12-23 months from The Gambia 2019/2020 demographic and health survey (weighted n = 1355) with seen vaccination cards. We analyzed: the frequency of MOSVs; percentage point coverage reduction attributable to MOSVs for 18 vaccine doses and full basic vaccination; and MOSVs' contribution to urban-rural coverage inequity through Blinder-Oaxaca decomposition.

    Results: Sixty percent of children experienced MOSVs, in both urban and rural areas, but urban MOSVs were more seldom corrected (35.9 % vs 45.3 %). All eighteen vaccine doses assessed could have achieved between one to eleven percentage points higher coverage if MOSVs had been avoided, with full basic vaccination gaining even more. While MOSV correction did not impact overall urban-rural coverage inequity, it did exacerbate (explained coefficient = -0.1007; P = 0.002) inequities among children who experienced MOSVs, explaining 95 % of the observed difference.

    Conclusion: Our study highlights the prevalence and negative impact of MOSVs on overall vaccination coverage. Although MOSVs did not contribute significantly to the total urban-rural inequity in coverage, they have detrimental effects on vaccination coverage and urban-rural inequity among children who had experienced MOSVs. Addressing MOSVs, can enhance coverage and reduce the risk of under-vaccination, aligning with global initiatives.

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  • 32.
    Sowe, Alieu
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Expanded Program on Immunization, Ministry of Health, Banjul, Gambia.
    Namatovu, Fredinah
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Cham, Bai
    Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, Bakau, Gambia.
    Gustafsson, Per E
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    The frequency of missed opportunities for simultaneous vaccination and their impact on vaccination of children in The Gambia2023Ingår i: Population Medicine, E-ISSN 2654-1459, Vol. 5, s. 563-563Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background and Objective: The number of zero-dose and under-vaccinated children has passed 20 million following the COVID-19 pandemic. Reducing missed opportunities for vaccination is recommended as a key strategy for increasing coverage because it involves utilising existing vaccination sites. To generate actionable evidence for coverage and equality improvement targeting, this study aimed to estimate the frequencies of missed opportunities for simultaneous vaccination (MOSVs) and their correction by residential area and assess the impact of MOSVs on full vaccination and coverage of vaccine doses in The Gambia.

    Methods: Data of children with cards aged 12–23 months from The Gambia 2019/2020 demographic and health survey was used (weighted n = 1355). We measured the number of children who experienced at least 1 MOSV any time before the survey and the proportions of children who later 1) received all doses, 2) received some doses, and 3) never received any dose by residence. Finally, valid coverage with and without MOSVs was estimated for all eligible vaccine doses.

    Results: More than half of the children surveyed experienced at least one MOSV, and more than half of the MOSVs were later corrected. A quarter of the children who experienced MOSVs did not have them corrected. Rural and urban residents had similar experiences in the proportion of MOSVs, but children in urban areas had their MOSVs not corrected more frequently. Seventeen of eighteen vaccine doses in the national schedule would have coverage gains without MOSVs, with some gaining as much as nine percentage points in coverage.

    Conclusions: Missed opportunities for simultaneous vaccination are frequent, negatively affecting coverage and differentially impacting rural and urban areas, and should be targeted for vaccination improvement. Our study emphasizes the importance of MOSVs for vaccination coverage and the need to implement the WHO missed opportunities for vaccination strategy.

  • 33.
    Vikström, Lotta
    et al.
    Umeå universitet, Humanistiska fakulteten, Institutionen för idé- och samhällsstudier. Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR).
    Junkka, Johan
    Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR).
    Namatovu, Fredinah
    Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR). Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Häggström Lundevaller, Erling
    Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR).
    Karhina, Kateryna
    Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR). Umeå universitet, Humanistiska fakulteten, Institutionen för idé- och samhällsstudier.
    A longitudinal study of how disability affects mortality in Swedish Populations from the 1800s, 1900s and 2000s2021Rapport (Övrigt vetenskapligt)
    Abstract [en]

    BACKGROUND: Studies from across the world show that disability limits people’s health and social wellbeing in present-day populations. This disadvantage can lead to premature death, but there is dearth knowledge about the relationship between disability and mortality and changes over time.   

    OBJECTIVES: Unique access to longitudinal micro data on comprehensive Swedish populations enabled us to examine how disability affects premature death in men and women from the 1800s until 2010. 

    METHODS: Cox proportional regressions were used to estimate mortality hazards by disability status, gender and socio-economic indicators in three study populations from the 1800s, 1900s and 2000s. We followed all adults having disability from age 25 to compare their premature death risks (< age 43) relative to non-disabled groups.

    RESULTS: Irrespective of gender and century studied, the adjusted hazard ratios show that adults with disabilities had a significantly higher premature death risk relative to adults without disabilities, and it increased over time. In the 1800s, disability about doubled this risk (HR: 2.31, CI: 1.65–3.22) and it tripled from 1900–1959 (HR 3.01, CI 2.60– 3.48). At the turn of the 21th century, the mortality risk was almost ten-folded (HR 9.90, CI 8.03–10.5). 

    CONCLUSIONS: This study provides the first comprehensive estimates on how disability increased mortality in Swedish populations from the 1800s until the 2000s. Across three centuries, disability was associated with a profoundly higher relative death risk in adults aged 25–42. This risk grew when the general survival in Sweden improved and it was the highest in the 1990–2010 period. Fundamental societal changes and extensive welfare provisions promoting equality in gender, health and social wellbeing of all citizens have not come to include younger generations with disabilities. 

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  • 34. Wagman, Jennifer A.
    et al.
    Gray, Ronald H.
    Nakyanjo, Neema
    McClendon, Katherine A.
    Bonnevie, Erika
    Namatovu, Fredinah
    Umeå universitet, Humanistiska fakulteten, Institutionen för idé- och samhällsstudier.
    Kigozi, Grace
    Kagaayi, Joseph
    Wawer, Maria J.
    Nalugoda, Fred
    Process evaluation of the SHARE intervention for preventing intimate partner violence and HIV infection in Rakai, Uganda2018Ingår i: Evaluation and Program Planning, ISSN 0149-7189, E-ISSN 1873-7870, Vol. 67, s. 129-137Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The Safe Homes And Respect for Everyone (SHARE) intervention introduced an intimate partner violence (IPV) prevention approach into Rakai Health Sciences Program, an established HIV research and service organization in Uganda. A trial found exposure to SHARE was associated with reductions in IPV and HIV incidence. This mixed methods process evaluation was conducted between August 2007 and December 2009, with people living in SHARE intervention clusters, to assess awareness about/participation in SHARE, motivators and barriers to involvement, and perceptions of how SHARE contributed to behavior change. Surveys were conducted with 1407 Rakai Community Cohort Study participants. Qualitative interviews were conducted with 20 key informants. Most (77%) were aware of SHARE, among whom 73% participated in intervention activities. Two-thirds of those who participated in SHARE felt it influenced behavior change related to IPV. While some felt confident to take part in new IPV-focused activities of a well-established program, others were suspicious of SHARE's motivations, implying awareness raising is critical. Many activities appealed to the majority (e.g., community drama) while interest in some activities was limited to men (e.g., film shows), suggesting multiple intervention components is ideal for wide-reaching programming. The SHARE model offers a promising, acceptable approach for integrating IPV prevention into HIV and other established health programs in sub-Saharan Africa.

  • 35. Wagman, Jennifer A
    et al.
    King, Elizabeth J
    Namatovu, Fredinah
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Kiwanuka, Deus
    Kairania, Robert
    Semanda, John Baptist
    Nalugoda, Fred
    Serwadda, David
    Wawer, Maria J
    Gray, Ronald
    Brahmbhatt, Heena
    Combined Intimate Partner Violence and HIV/AIDS Prevention in Rural Uganda: Design of the SHARE Intervention Strategy2016Ingår i: Health Care for Women International, ISSN 0739-9332, E-ISSN 1096-4665, Vol. 37, nr 3, s. 362-385Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Intimate partner violence (IPV) has a bidirectional relationship with HIV infection. Researchers from the Rakai Health Sciences Program (RHSP), an HIV research and services organization in rural Uganda, conducted a combination IPV and HIV prevention intervention called the Safe Homes and Respect for Everyone (SHARE) Project between 2005 and 2009. SHARE was associated with significant declines in physical and sexual IPV and overall HIV incidence, and its model could be adopted as a promising practice in other settings. In this article we describe how SHARE's IPV-prevention strategies were integrated into RHSP's existing HIV programming and provide recommendations for replication of the approach.

  • 36.
    Wagman, Jennifer A.
    et al.
    Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
    Namatovu, Fredinah
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Nalugoda, Fred
    Rakai Health Sciences Program, Uganda.
    Kiwanuka, Deus
    Center for Domestic Violence Prevention, Uganda.
    Nakigozi, Gertrude
    Rakai Health Sciences Program, Uganda.
    Gray, Ron
    Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
    Wawer, Maria J.
    Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
    Serwadda, David
    Makerere University, Uganda.
    A public health approach to intimate partner violence prevention in Uganda: The SHARE project2012Ingår i: Violence against Women, ISSN 1077-8012, E-ISSN 1552-8448, Vol. 18, nr 12, s. 1390-1412Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Research from Rakai, Uganda, suggests intimate partner violence (IPV) is common and attitudes condoning it are widespread. We used a public health approach to develop and implement an evidence-based IPV prevention intervention named the Safe Homes and Respect for Everyone (SHARE) Project. SHARE was designed on the Transtheoretical Model of behavior change and adapted IPV prevention strategies from Raising Voices and Stepping Stones. SHARE was implemented in four regions of Rakai. This article describes the design and implementation of SHARE, provides details on strategies and activities used, discusses challenges and lessons learned, and provides recommendations for other violence prevention programmers.

  • 37. Wagman, Jennifer A
    et al.
    Paul, Amy
    Namatovu, Fredinah
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Ssekubugu, Robert
    Nalugoda, Fred
    Ethical Challenges of Randomized Violence Intervention Trials: Examining the SHARE intervention in Rakai, Uganda2016Ingår i: Psychology of Violence, ISSN 2152-0828, E-ISSN 2152-081X, Vol. 6, nr 3, s. 442-451Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: We identify complexities encountered, including unanticipated crossover between trial arms and inadequate 'standard of care' violence services, during a cluster randomized trial (CRT) of a community-level intimate partner violence (IPV) and HIV prevention intervention in Uganda.

    METHODS: Concepts in public health ethics - beneficence, social value of research, fairness, standard of care, and researcher responsibilities for post-trial benefits - are used to critically reflect on lessons learned and guide discussion on practical and ethical challenges of violence intervention CRTs.

    RESULTS: Existing ethical guidelines provide incomplete guidance for responding to unexpected crossover in CRTs providing IPV services. We struggled to balance duty of care with upholding trial integrity, and identifying and providing appropriate standard of care. While we ultimately offered short-term IPV services to controls, we faced additional challenges related to sustaining services beyond the 'short-term' and post-trial.

    CONCLUSION: Studies evaluating community-level violence interventions, including those combined with HIV reduction strategies, are limited yet critical for developing evidence-based approaches for effectively preventing IPV. Although CRTs are a promising design, further guidance is needed to implement trials that avoid introducing tensions between validity of findings, researchers' responsibilities to protect participants, and equitable distribution of CRT benefits.

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