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  • 1. Ahlberg, Beth Maina
    et al.
    Krantz, Ingela
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Lindmark, Gunilla
    Warsame, Marian
    'It's only a tradition': making sense of eradication interventions and the persistence of female 'circumcision' within a Swedish context2004In: Critical Social Policy, ISSN 0261-0183, E-ISSN 1461-703X, Vol. 24, no 1, p. 50-78Article in journal (Refereed)
    Abstract [en]

    This paper questions why female circumcision (FC) persists despite eradication interventions and the migration of people to non-practising countries and discusses the reasoning of Somali immigrants on female circumcision. It is based on interviews with diverse groups and individuals in the Somali community, mostly refugees in Sweden. Paradoxes implying denial and avoidance emerged. Female circumcision was described, as just 'a tradition' that has little to do with Islam. The fear of bringing up an uncircumcised daughter in the liberal sexual morality of Sweden was mentioned as a dilemma. Circumcised women said the health care they received during pregnancy and childbirth was poor while the law failed to take account of the experiences of the Somali people. We conclude that rather than eradication, interventions seem to have silenced and stigmatized the practice due to their failure to take account of its meanings, organization and contexts, including the diasporic dynamics within which immigrants negotiate identities.

  • 2.
    Krantz, Ingela
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences. Department of Medical Ethics, Lund University, Sweden; Skaraborg Institute for Research and Development, Skövde, Sweden.
    Eriksson, Bo
    Lundquist-Persson, Cristina
    Ahlberg, Beth Maina
    Nilstun, Tore
    Screening for postpartum depression with the Edinburgh Postnatal Depression Scale (EPDS): an ethical analysis2008In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 36, no 2, p. 211-216Article in journal (Refereed)
    Abstract [en]

    Aims: To assess the Edinburgh Postnatal Depression Scale (EPDS), a self-administered questionnaire created to screen for symptoms of postpartum depression in the community, from an epidemiological and ethical perspective. Screening, as the practice of investigating apparently healthy individuals to detect unrecognised disease or its precursors, has interpretation problems and is complicated by deliberations on probabilities for something to occur, on which the scientific community is unanimous.

    Methods: Our ethical analysis is made using a framework with two different dimensions, the ethical principles autonomy and beneficence and the affected persons. To balance the ethical costs and the ethical benefits of EPDS an analogy with the assessment of pharmaceutics is used.

    Results: In this article we argue that routine EPDS screening of Swedish postpartum women would lead to considerable ethical problems due to the weak scientific foundation of the screening instrument. Despite a multitude of published studies, the side-effects in terms of misclassifications have not been considered carefully. The EPDS does not function very well as a routine screening instrument. The dualism created is too reductive and fails to recognize the plurality of difference that exists in the social word.

    Conclusions: Public health authorities should not advocate screening of unproved value. Screening is not just a medical issue but also an ethical one.

  • 3.
    Nordin, Per
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Nyale, E
    Mtweve, S
    Maina Ahlberg, B
    Feldmeier, H
    Krantz, Ingela
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Determining the prevalence of schistosomiasis haematobium in population-groups from northern Tanzania based on the discordance between egg counts and haematuriaManuscript (preprint) (Other academic)
  • 4.
    Nordin, Per
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. The Skaraborg Institute for Research and Development, Skövde, Sweden.
    Nyale, Edwin
    Department of Clinical Laboratory, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
    Kalambo, Clement
    Department of Radiology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
    Ahlberg, Beth Maina
    The Skaraborg Institute for Research and Development, Skövde, Sweden; Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Feldmeier, Hermann
    Institute of Microbiology, Infectious Diseases and Immunology, Charité University Medicine, Berlin, Germany.
    Krantz, Ingela
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. The Skaraborg Institute for Research and Development, Skövde, Sweden.
    Determining the prevalence of urogenital schistosomiasis based on the discordance between egg counts and haematuria in populations from northern Tanzania2023In: Frontiers in Tropical Diseases, E-ISSN 2673-7515, Vol. 4, article id 1100139Article in journal (Refereed)
    Abstract [en]

    Objectives: The presence of schistosomal eggs in the urine is a sufficient but not necessary condition for an individual to be diagnosed with urogenital schistosomiasis. The absence of eggs does not prove that a person is disease-free. Thus, when examining populations using egg occurrence, there is a real risk of underestimating the prevalence. The aim is to develop an easy to use model for improved prevalence estimates of urogenital schistosomiasis.

    Design and methods: Urine samples were taken from 161 schoolchildren and 124 adults on three different days for each individual. The probands were recruited from two areas in northern Tanzania with varying prevalence of urogenital schistosomiasis. The presence of eggs by microscopy and haematuria by dipstick were recorded for each sample and the measurements combined using the discordance of the outcomes.

    Result: As a consequence of applying the developed model, a substantial increase in the prevalence estimate was noted for groups displaying a low egg occurrence.

    Conclusion: By using the biological relationship that exists between the presence of eggs and blood in urine of an infected individual, we provide a way of adjusting the prevalence estimates of urogenital schistosomiasis, using the observed prevalence of haematuria, in the absence of competing causes.

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  • 5.
    Nordin, Per
    et al.
    The Skaraborg Institute for Research and Development, Skövde, Sweden.
    Poggensee, Gabriele
    Nigerian Field Epidemiology and Laboratory Training Program, Abuja, Nigeria.
    Mtweve, Sabina
    Department of Community Health, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
    Krantz, Ingela
    The Skaraborg Institute for Research and Development, Skövde, Sweden.
    From a weighing scale to a pole: a comparison of two different dosage strategies in mass treatment of Schistosomiasis haematobium2014In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, article id 25351Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Clinical schistosomiasis in endemic countries is treated with a single dose of praziquantel per 40 mg/kg body weight. Treating according to weight, in resource-poor settings when thousands of doses are to be administered in mass treatment campaigns, is considered problematic. A calibrated dose-pole based on height was developed and is now used in mass treatment campaigns for determining the doses for schoolchildren. The dose-pole will generate dose errors since every child population contains individuals that are either short or tall for weight. The aim of this study is to explore whether the WHO praziquantel pole is a satisfactory dose instrument for mass treatment of S. haematobium.

    METHODS: In 1996 and 2002, 1,694 children were surveyed in the Kilimanjaro Region, Tanzania. We compared doses given by weight to doses given by height using descriptive statistics and regression.

    CONCLUSIONS AND INTERPRETATION: The WHO dose-pole for praziquantel is based on height of the patient; however, children with the same height will differ in weight. Our study shows that children with the same weight could qualify for up to four different dose levels based on their height. The largest variation of doses based on the WHO dose-pole will be found in children below 20 kg of bodyweight. Using bodyweight and tablet halves as the smallest tablet division unit to determine the doses of praziquantel, one only has to identify every 6th kilogram of bodyweight; the doses will then vary a lot less than when using the WHO dose-pole.

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  • 6.
    Wall, Stig
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Emmelin, Maria
    Department of Social Medicine and Global Health, Lund University, Lund, Sweden..
    Krantz, Ingela
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Nilsson, Maria
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Norström, Fredrik
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Schröders, Julia
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Stewart Williams, Jennifer
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Östergren, Per-Olof
    Department of Social Medicine and Global Health, Lund University, Lund, Sweden.
    Global Health Action at 15 – revisiting its rationale2021In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 14, no 1, article id 1965863Article in journal (Refereed)
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