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Klingberg-Allvin, MarieORCID iD iconorcid.org/0000-0002-8947-2949
Publications (10 of 65) Show all publications
Klingberg-Allvin, M., Atuhairwe, S., Cleeve, A., Byamugisha, J. K., Larsson, E. C., Makenzius, M., . . . Gemzell-Danielsson, K. (2018). Co-creation to scale up provision of simplified high-quality comprehensive abortion care in East Central and Southern Africa. Global Health Action, 11(1), Article ID 1490106.
Open this publication in new window or tab >>Co-creation to scale up provision of simplified high-quality comprehensive abortion care in East Central and Southern Africa
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2018 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 11, no 1, article id 1490106Article in journal (Refereed) Published
Abstract [en]

Universal access to comprehensive abortion care (CAC) is a reproductive right and is essential to reduce preventable maternal mortality and morbidity. In East Africa, abortion rates are consistently high, and the vast majority of all abortions are unsafe, significantly contributing to unnecessary mortality and morbidity. The current debate article reflects and summarises key action points required to continue to speed the implementation of and expand access to CAC in the East, Central, and Southern African (ECSA) health community. To ensure universal access to quality CAC, a regional platform could facilitate the sharing of best practices and successful examples from the region, which would help to visualise opportunities. Such a platform could also identify innovative ways to secure women's access to quality care within legally restrictive environments and would provide information and capacity building through the sharing of recent scientific evidence, guidelines, and training programmes aimed at increasing women's access to CAC at the lowest effective level in the healthcare system. This type of infrastructure for exchanging information and developing co-creation could be crucial to advancing the Sustainable Development Goals 2030 agenda.

Keywords
Central, Eastern, Northern Africa, Unsafe abortions, maternal mortality
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-28137 (URN)10.1080/16549716.2018.1490106 (DOI)000437262000001 ()29972099 (PubMedID)
Available from: 2018-07-09 Created: 2018-07-09 Last updated: 2018-07-19Bibliographically approved
Makenzius, M., Faxelid, E., Gemzell-Danielsson, K., Odero, T. M., Klingberg-Allvin, M. & Oguttu, M. (2018). Contraceptive uptake in post abortion care-Secondary outcomes from a randomised controlled trial, Kisumu, Kenya.. PLoS ONE, 13(8), Article ID e0201214.
Open this publication in new window or tab >>Contraceptive uptake in post abortion care-Secondary outcomes from a randomised controlled trial, Kisumu, Kenya.
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2018 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 8, article id e0201214Article in journal (Refereed) Published
Abstract [en]

AIM: The aim was to explore contraceptive uptake, associated factors and satisfaction among post abortion-care (PAC) seeking women in Kenya. Due to unsafe abortions, almost 120 000 Kenyan women received PAC in 2012, and of these women, 70% did not use contraception before pregnancy.

METHODS: This study was nested in a larger randomised controlled trial, where 859 women sought PAC at two public hospitals in Kisumu, in June 2013-May 2016. The women were randomly assigned to a midwife or a physician for PAC, including contraceptive counselling, and followed up at 7-10 days and three months. Associated factors for contraceptive uptake were analysed with binary logistic regression, and contraceptive method choice, adherence and satisfaction level were examined by descriptive statistics, using IBM SPSS Statistics for Windows, Version 22.0.

RESULTS: Out of the 810 PAC-seeking women, 76% (n = 609) accepted the use of contraception. Age groups of 21-25 (OR: 2.35; p < 0.029) and 26-30 (OR: 2.22; p < 0.038), and previous experience of 1-2 gravidities (OR 1.939; p = 0.018) were independent factors associated with the up-take. Methods used: injections 39% (n = 236); pills 27% (n = 166); condoms 25% (n = 151); implant 7% (n = 45) and intrauterine device (IUD) 1% (n = 8). At 3-month follow-up of the women (470/609; 77%), 354 (75%) women still used contraception, and most (n = 332; 94%) were satisfied with the method. Reasons for discontinuation were side-effects (n = 44; 39%), partner refusal (n = 27; 24%), planned pregnancy (n = 27; 24%) and lack of resupplies (n = 15; 13%).

CONCLUSIONS: PAC-seeking women seem highly motivated to use contraceptives, yet a quarter decline the use, and at 3-month follow-up a further quarter among the users had discontinued. Implant, IUD and permanent method are rarely used. Strategies to improve contraceptive counselling, particularly to adolescent girls, and to increase access to a wide range of methods, as well as provider training and supervision may help to improve contraceptive acceptance and compliance among PAC-seeking women in Kisumu, Kenya.

National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-28308 (URN)10.1371/journal.pone.0201214 (DOI)30096148 (PubMedID)
Available from: 2018-08-14 Created: 2018-08-14 Last updated: 2018-08-14Bibliographically approved
Abdillahi, H. A., Hassan, K. A., Kiruja, J., Osman, F., Egal, J. A., Klingberg-Allvin, M. & Erlandsson, K. (2017). A mixed-methods study of maternal near miss and death after emergency cesarean delivery at a referral hospital in Somaliland. International Journal of Gynecology & Obstetrics, 138(1), 119-124
Open this publication in new window or tab >>A mixed-methods study of maternal near miss and death after emergency cesarean delivery at a referral hospital in Somaliland
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2017 (English)In: International Journal of Gynecology & Obstetrics, ISSN 0020-7292, E-ISSN 1879-3479, Vol. 138, no 1, p. 119-124Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To explore maternal near miss and death after emergency cesarean delivery in Somaliland, including the impact of the prerequisite for family consent.

METHODS: A facility-based, mixed-methods study was conducted to assess all maternal near misses and deaths recorded at a referral hospital that provided services to women from all regions of Somaliland. The data sources comprised a quantitative prospective cross-sectional study using the WHO near-miss tool (performed from August 1 to December 31, 2015) and qualitative interviews with 17 healthcare providers working at the referral hospital who were in direct contact with the women in labor (performed from January 15 to March 15, 2015).

RESULTS: Of the 138 maternal near misses and deaths recorded, 50 (36%) were associated with emergency cesarean delivery. The most frequent maternal complication was severe pre-eclampsia (n=17; 34%), and the most frequent underlying causes were hypertensive disorders (n=31; 62%) and obstetric hemorrhage (n=15; 30%). Healthcare providers were often prevented from performing emergency cesarean delivery until the required consent had been received from the woman's extended family.

CONCLUSION: Maternity care in Somaliland must be improved, and the issue of legal authority for consent examined, to ensure both safe and timely provision of emergency cesarean delivery. This article is protected by copyright. All rights reserved.

Place, publisher, year, edition, pages
John Wiley & Sons, 2017
Keywords
Cesarean delivery, Consent, Maternal death, Near miss, Somaliland
National Category
Nursing
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-24701 (URN)10.1002/ijgo.12176 (DOI)000405092600021 ()28391614 (PubMedID)
Funder
Sida - Swedish International Development Cooperation Agency
Available from: 2017-04-11 Created: 2017-04-11 Last updated: 2017-10-23Bibliographically approved
Osman, F., Flacking, R., Schön, U.-K. & Klingberg-Allvin, M. (2017). A support program for Somali-born parents on children's behavioral problems. Pediatrics, 139(3)
Open this publication in new window or tab >>A support program for Somali-born parents on children's behavioral problems
2017 (English)In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 139, no 3Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: The objectives of this study were to evaluate a culturally tailored parenting support program (Ladnaan) for Somali-born parents and to determine its effectiveness on children’s emotional and behavioral problems.

METHODS: This randomized controlled trial included 120 Somali-born parents with children aged 11 to 16 years. The parents reported self-perceived stress in relation to parenting practices. The intervention consisted of culturally tailored societal information combined with the parenting program Connect. Parents received 12 weeks of intervention, 1 to 2 hours each week, in groups of 12 to 17 parents. Nine group leaders with a Somali background who received a standardized training program delivered the intervention. The primary outcome was a decrease in emotional and behavioral problems based on a Child Behavior Checklist. Parents were randomly allocated either to an intervention group or a wait-list control group. Covariance analyses were conducted according to intention-to-treat principles.

RESULTS: The results showed significant improvement in the children in the intervention group for behavioral problems after a 2-month follow-up. The largest effect sizes according to Cohen’s d were in aggressive behavior (95% confidence interval [CI], 1.06 to 3.07), social problems (95% CI, 0.64 to 1.70), and externalizing problems (95% CI, 0.96 to 3.53).

CONCLUSIONS: The large effect sizes in this study show that this 12-week culturally tailored parenting support program was associated with short-term improvements in children’s behavior. The study adds to the field of parenting interventions by demonstrating how to culturally tailor, engage, and retain parenting programs for immigrant parents.

National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-23732 (URN)10.1542/peds.2016-2764 (DOI)28235795 (PubMedID)
Available from: 2016-12-26 Created: 2016-12-26 Last updated: 2017-12-19Bibliographically approved
Cleeve, A., Faxelid, E., Nalwadda, G. & Klingberg-Allvin, M. (2017). Abortion as agentive action: reproductive agency among young women seeking post-abortion care in Uganda. Culture, Health and Sexuality, 19(11), 1286-1300
Open this publication in new window or tab >>Abortion as agentive action: reproductive agency among young women seeking post-abortion care in Uganda
2017 (English)In: Culture, Health and Sexuality, ISSN 1369-1058, E-ISSN 1464-5351, Vol. 19, no 11, p. 1286-1300Article in journal (Refereed) Published
Abstract [en]

Unsafe abortion in Africa continues to be a major contributor to the global maternal mortality which affects young women in particular. In Uganda, where abortion is legally restricted and stigmatised, unsafe abortion is a major public health issue. We explored reproductive agency in relation to unsafe abortion among young women seeking post-abortion care. Through in-depth interviews we found that reproductive agency was constrained by gender norms and power imbalances and strongly influenced by stigma. Lack of resources and the need for secrecy resulted in harmful abortion practices and delayed care-seeking. Women did not claim ownership of the abortion decision, but the underlying meaning in the narratives positioned abortion as an agentive action aiming to regain control over one's body and future. Women's experiences shaped contraceptive intentions and discourse, creating a window of opportunity that was often missed. This study provides unique insight into how young women negotiate and enact reproductive agency in Uganda. Health systems need to strengthen their efforts to meet young women's sexual and reproductive health needs and protect their rights. Enabling young women's agency through access to safe abortion and contraception is paramount.

Keywords
Gender norms, Uganda, reproductive agency, unsafe abortion, young women
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-24707 (URN)10.1080/13691058.2017.1310297 (DOI)000414216100008 ()28398161 (PubMedID)
Note

Open Access APC beslut 9/2017

Available from: 2017-04-13 Created: 2017-04-13 Last updated: 2017-11-16Bibliographically approved
Osman, F., Salari, R., Klingberg-Allvin, M., Schön, U.-K. & Flacking, R. (2017). Effects of a culturally tailored parenting support programme in Somali-born parents' mental health and sense of competence in parenting: a randomised controlled trial. BMJ Open, 7(12), Article ID e017600.
Open this publication in new window or tab >>Effects of a culturally tailored parenting support programme in Somali-born parents' mental health and sense of competence in parenting: a randomised controlled trial
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2017 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 12, article id e017600Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To evaluate the effectiveness of a culturally tailored parenting support programme on Somali-born parents' mental health and sense of competence in parenting.

DESIGN: Randomised controlled trial.

SETTING: A city in the middle of Sweden.

PARTICIPANTS: Somali-born parents (n=120) with children aged 11-16 years and self-perceived stress in their parenting were randomised to an intervention group (n=60) or a waiting-list control group (n=60).

INTERVENTION: Parents in the intervention group received culturally tailored societal information combined with the Connect parenting programme during 12 weeks for 1-2 hours per week. The intervention consisted of a standardised training programme delivered by nine group leaders of Somali background.

OUTCOME: The General Health Questionnaire 12 was used to measure parents' mental health and the Parenting Sense of Competence scale to measure parent satisfaction and efficacy in the parent role. Analysis was conducted using intention-to-treat principles.

RESULTS: The results indicated that parents in the intervention group showed significant improvement in mental health compared with the parents in the control group at a 2-month follow-up: B=3.62, 95% CI 2.01 to 5.18, p<0.001. Further, significant improvement was found for efficacy (B=-6.72, 95% CI -8.15 to -5.28, p<0.001) and satisfaction (B=-4.48, 95% CI -6.27 to -2.69, p<0.001) for parents in the intervention group. Parents' satisfaction mediated the intervention effect on parental mental health (β=-0.88, 95% CI -1.84 to -0.16, p=0.047).

CONCLUSION: The culturally tailored parenting support programme led to improved mental health of Somali-born parents and their sense of competence in parenting 2 months after the intervention. The study underlines the importance of acknowledging immigrant parents' need for societal information in parent support programmes and the importance of delivering these programmes in a culturally sensitive manner.

CLINICAL TRIAL REGISTRATION: NCT02114593.

Keywords
child protection, community child health, mental health, public health
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-26770 (URN)10.1136/bmjopen-2017-017600 (DOI)000423826700065 ()29222136 (PubMedID)
Note

Open Access APC beslut 26/2017

Available from: 2017-12-13 Created: 2017-12-13 Last updated: 2018-02-22Bibliographically approved
Erlandsson, K., Osman, F., Hatakka, M., Egal, J. A., Byrskog, U., Pedersen, C. & Klingberg-Allvin, M. (2017). Evaluation of an online master’s programme in Somaliland. A phenomenographic study on the experience of professional and personal development among midwifery faculty. Nurse Education in Practice, 25, 96-103
Open this publication in new window or tab >>Evaluation of an online master’s programme in Somaliland. A phenomenographic study on the experience of professional and personal development among midwifery faculty
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2017 (English)In: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 25, p. 96-103Article in journal (Refereed) Published
Abstract [en]

To record the variation of perceptions of midwifery faculty in terms of the possibilities and challenges related to the completion of their first online master's level programme in Sexual and Reproductive Health and Rights in Somaliland. The informants included in this phenomenongraphical focus group study were those well-educated professional women and men who completed the master's program. The informant perceived that this first online master's level programme provided tools for independent use of the Internet and independent searching for evidence-based information, enhanced professional development, was challenge-driven and evoked curiosity, challenged professional development, enhanced personal development and challenged context-bound career paths. Online education makes it possible for well-educated professional women to continue higher education. It furthermore increased the informants' confidence in their use of Internet, software and databases and in the use of evidence in both their teaching and their clinical practice. Programmes such as the one described in this paper could counter the difficulties ensuring best practice by having a critical mass of midwives who will be able to continually gather contemporary midwifery evidence and use it to ensure best practice. An increase of online education is suggested in South-central Somalia and in similar settings globally.

Place, publisher, year, edition, pages
Elsevier, 2017
Keywords
Online education, Net-based education, Midwifery education, Human rights
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-25050 (URN)10.1016/j.nepr.2017.05.007 (DOI)28575755 (PubMedID)2-s2.0-85019746618 (Scopus ID)
Note

Open Access APC beslut 15/2017

Available from: 2017-05-29 Created: 2017-05-29 Last updated: 2017-06-21Bibliographically approved
Kiruja, J., Osman, F., Egal, J. A., Essén, B., Klingberg-Allvin, M. & Erlandsson, K. (2017). Maternal near-miss and death incidences – Frequencies, causes and the referral chain in Somaliland: A pilot study using the WHO near-miss approach. Sexual & Reproductive HealthCare, 12, 30-36
Open this publication in new window or tab >>Maternal near-miss and death incidences – Frequencies, causes and the referral chain in Somaliland: A pilot study using the WHO near-miss approach
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2017 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 12, p. 30-36Article in journal (Refereed) Published
Abstract [en]

Background Somaliland is a self-declared country with a population of 3.5 million. Most of its population reside in rural areas. The objective of this pilot near-miss study was to monitor the frequency and causes of maternal near-miss and deaths and the referral chain for women to access Skilled Birth Attendants (SBA). Method: A facility-based study of all maternal near-miss and mortality cases over 5 months using the WHO near-miss tool in a main referral hospital. Reasons for bypassing the Antenatal Care facility (ANC) and late arrival to the referral hospital were investigated through verbal autopsy. Results: One hundred and thirty-eight (138) women with severe maternal complications were identified: 120 maternal near-miss, 18 maternal deaths. There were more near-miss cases on arrival (74.2%) compared with events that developed inside the hospital (25.8%). Likewise, there were more maternal deaths (77.8%) on arrival than was the case during hospitalization (22.2%). The most common mode of referral among maternal near-miss events was family referrals (66.7%). Of 18 maternal deaths, 15 were family referrals. Reasons for bypassing ANC were as follows: lack of confidence in the service provided; lack of financial resources; and lack of time to visit ANC. Reasons for late arrival to the referral hospital were as follows: lack of knowledge and transportation; and poor communication. Conclusion and clinical implication: To increase the utilization of ANC might indirectly lower the number of near-miss and death events. Collaboration between ANC staff and referral hospital staff and a more comprehensive near-miss project are proposed. © 2017 Elsevier B.V.

Keywords
Maternal death, Maternal near-miss, Referral chain, Somaliland
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-24581 (URN)10.1016/j.srhc.2017.02.003 (DOI)000401884100006 ()28477929 (PubMedID)2-s2.0-85013803837 (Scopus ID)
Available from: 2017-03-13 Created: 2017-03-13 Last updated: 2017-06-15Bibliographically approved
Paul, M., Essén, B., Sariola, S., Iyengar, S., Soni, S. & Klingberg-Allvin, M. (2017). Negotiating collective and individual agency: a qualitative study of young women's reproductive health in rural India. Qualitative Health Research, 27(3), 311-324
Open this publication in new window or tab >>Negotiating collective and individual agency: a qualitative study of young women's reproductive health in rural India
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2017 (English)In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 27, no 3, p. 311-324Article in journal (Refereed) Published
Abstract [en]

The societal changes in India and the available variety of reproductive health services call for evidence to inform health systems how to satisfy young women's reproductive health needs. Inspired by Foucault's power idiom and Bandura's agency framework, we explore young women's opportunities to practice reproductive agency in the context of collective social expectations. We carried out in-depth interviews with 19 young women in rural Rajasthan. Our findings highlight how changes in notions of agency across generations enable young women's reproductive intentions and desires, and call for effective means of reproductive control. However, the taboo around sex without the intention to reproduce made contraceptive use unfeasible. Instead, abortions were the preferred method for reproductive control. In conclusion, safe abortion is key, along with the need to address the taboo around sex to enable use of "modern" contraception. This approach could prevent unintended pregnancies and expand young women's agency.

Keywords
reproductive decision making, contraception, abortion, agency, rural India, reproductive health policy, qualitative in-depth interviews
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-19954 (URN)10.1177/1049732315613038 (DOI)000394093500002 ()26531879 (PubMedID)
Available from: 2015-11-06 Created: 2015-11-06 Last updated: 2017-12-01Bibliographically approved
Makenzius, M., Oguttu, M., Klingberg-Allvin, M., Gemzell-Danielsson, K., Odero, T. M. & Faxelid, E. (2017). Post-abortion care with misoprostol - equally effective, safe and accepted when administered by midwives compared to physicians: a randomised controlled equivalence trial in a low-resource setting in Kenya. BMJ Open, 7(10), Article ID e016157.
Open this publication in new window or tab >>Post-abortion care with misoprostol - equally effective, safe and accepted when administered by midwives compared to physicians: a randomised controlled equivalence trial in a low-resource setting in Kenya
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2017 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 10, article id e016157Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To assess the effectiveness of midwives administering misoprostol to women with incomplete abortion seeking post-abortion care (PAC), compared with physicians.

DESIGN: A multicentre randomised controlled equivalence trial. The study was not masked.

SETTINGS: Gynaecological departments in two hospitals in a low-resource setting, Kenya.

POPULATION: Women (n=1094) with incomplete abortion in the first trimester, seeking PAC between 1 June 2013 to 31 May 2016. Participants were randomly assigned to receive treatment from midwives or physicians. 409 and 401 women in the midwife and physician groups, respectively, were included in the per-protocol analysis.

INTERVENTIONS: 600 µg misoprostol orally, and contraceptive counselling by a physician or midwife.

MAIN OUTCOME MEASURES: Complete abortion not needing surgical intervention within 7-10 days. The main outcome was analysed on the per-protocol population with a generalised estimating equation model. The predefined equivalence range was -4% to 4%. Secondary outcomes were analysed descriptively.

RESULTS: The proportion of complete abortion was 94.8% (768/810): 390 (95.4%) in the midwife group and 378 (94.3%) in the physician group. The proportion of incomplete abortion was 5.2% (42/810), similarly distributed between midwives and physicians. The model-based risk difference for midwives versus physicians was 1.0% (-4.1 to 2.2). Most women felt safe (97%; 779/799), and 93% (748/801) perceived the treatment as expected/easier than expected. After contraceptive counselling the uptake of a contraceptive method after 7-10 days occurred in 76% (613/810). No serious adverse events were recorded.

CONCLUSIONS: Treatment of incomplete abortion with misoprostol provided by midwives is equally effective, safe and accepted by women as when administered by physicians in a low-resource setting. Systematically provided contraceptive counselling in PAC is effective to mitigate unmet need for contraception.

TRIAL REGISTRATION NUMBER: NCT01865136; Results.

Keywords
Community Gynaecology, Health Policy, Maternal Medicine, Reproductive Medicine
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-26432 (URN)10.1136/bmjopen-2017-016157 (DOI)000422617500060 ()29018067 (PubMedID)2-s2.0-85031304432 (Scopus ID)
Available from: 2017-10-18 Created: 2017-10-18 Last updated: 2018-02-02Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0002-8947-2949

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