Johanne Sundby

Maternal mortality in the rural Gambia, a qualitative study on access to emergency obstetric care

BackgroundMaternal mortality is the vital indicator with the greatest disparity between developed and developing countries. The challenging nature of measuring maternal mortality has made it necessary to perform an action-oriented means of gathering information on where, how and why deaths are occurring; what kinds of action are needed and have been taken. A maternal death review is an in-depth investigation of the causes and circumstances surrounding maternal deaths. The objectives of the present study were to describe the socio-cultural and health service factors associated with maternal deaths in rural Gambia.MethodsWe reviewed the cases of 42 maternal deaths of women who actually tried to reach or have reached health care services. A verbal autopsy technique was applied for 32 of the cases. Key people who had witnessed any stage during the process leading to death were interviewed. Health care staff who participated in the provision of care to the deceased was also interviewed. All interviews were tape recorded and analyzed by using a grounded theory approach. The standard WHO definition of maternal deaths was used.ResultsThe length of time in delay within each phase of the model was estimated from the moment the woman, her family or health care providers realized that there was a complication until the decision to seeking or implementing care was made. The following items evolved as important: underestimation of the severity of the complication, bad experience with the health care system, delay in reaching an appropriate medical facility, lack of transportation, prolonged transportation, seeking care at more than one medical facility and delay in receiving prompt and appropriate care after reaching the hospital.ConclusionWomen do seek access to care for obstetric emergencies, but because of a variety of problems encountered, appropriate care is often delayed. Disorganized health care with lack of prompt response to emergencies is a major factor contributing to a continued high mortality rate.

Self‐reported skin morbidity in Oslo. Associations with sociodemographic factors among adults in a cross‐sectional study

Background  Previous studies on prevalence of skin diseases in the population have been based on clinical examination of a sample of the population. A questionnaire on self‐reported skin complaints has recently been developed and validated for use in population surveys, but has not been used until now.

Perinatal complications among ethnic Somalis in Norway

Background. The majority of ethnic Somali women in Norway have undergone an elaborate form of circumcision (infibulation). The aim of this study was to examine the risk of perinatal complications among ethnic Somalis and to discuss its relation to circumcision.

Infertility in the Gambia: traditional and modern health care.

In order to understand the problems of unwanted infertility in a country--the Gambia--where the desire for children and the fertility is very high, a population-based survey was undertaken. All infertile women in 24 randomly selected enumeration areas were assessed. The study included a review of the problems faced and coping mechanisms employed by infertility clients and types of health care available for infertile couples in the different types and levels of the formal and traditional health system. Half of the infertile couples failed to seek formal health care, and they have to reach a certain level of care in order to properly managed. Alternative care is often sought. Child fostering is also a frequent solution to childlessness. In-depth interviews revealed that traditional care like healers and spiritual leaders are frequently consulted long before formal health care. This delay could be a problem in those cases where infertility is caused by infections.

Qualitative study of perinatal care experiences among Somali women and local health care professionals in Norway

OBJECTIVE To explore how perinatal care practice may influence labor outcomes among circumcised women. STUDY DESIGN In-depth interviews were conducted with 23 Somali immigrants and 36 Norwegian health care professionals about their experiences from antenatal care, delivery and the management of circumcision. RESULTS Circumcision was not recognized as an important delivery issue among Norwegian health care professionals and generally the topic was not addressed antenatally. The Somalis feared lack of experience and sub-optimal treatment at delivery. All of the women expressed a strong fear of cesarean section. Health care professionals were uncertain about delivery procedures for infibulated women and occasionally cesarean sections were performed in place of defibulation. CONCLUSION We hypothesize that neglect of circumcision may lead to adverse birth outcomes including unnecessary cesarean sections, prolonged second stage of labor and low Apgar scores. We suggest that infibulated women need a carefully planned delivery, correctly performed defibulation and adequate pain relief.

Striving to promote male involvement in maternal health care in rural and urban settings in Malawi - a qualitative study

BackgroundUnderstanding the strategies that health care providers employ in order to invite men to participate in maternal health care is very vital especially in todays dynamic cultural environment. Effective utilization of such strategies is dependent on uncovering the salient issues that facilitate male participation in maternal health care. This paper examines and describes the strategies that were used by different health care facilities to invite husbands to participate in maternal health care in rural and urban settings of southern Malawi.MethodsThe data was collected through in-depth interviews from sixteen of the twenty health care providers from five different health facilities in rural and urban settings of Malawi. The health facilities comprised two health centres, one district hospital, one mission hospital, one private hospital and one central hospital. A semi-structured interview guide was used to collect data from health care providers with the aim of understanding strategies they used to invite men to participate in maternal health care.ResultsFour main strategies were used to invite men to participate in maternal health care. The strategies were; health care provider initiative, partner notification, couple initiative and community mobilization. The health care provider initiative and partner notification were at health facility level, while the couple initiative was at family level and community mobilization was at village (community) level. The community mobilization had three sub-themes namely; male peer initiative, use of incentives and community sensitization. The sustainability of each strategy to significantly influence behaviour change for male participation in maternal health care is discussed.ConclusionStrategies to invite men to participate in maternal health care were at health facility, family and community levels. The couple strategy was most appropriate but was mostly used by educated and city residents. The male peer strategy was effective and sustainable at community level. There is need for creation of awareness in men so that they sustain their participation in maternal health care activities of their female partners even in the absence of incentives, coercion or invitation.

Psychosocial determinants of sexual activity and condom use intention among youth in Addis Ababa, Ethiopia.

Determinants of sexual activity and intentions for condom use were examined guided by the Attitude, Social influences, and Self-efficacy (ASE) model as a theoretical framework. A total of 561 in and out-of-school youth (15–24 years) in Addis Ababa completed a self-administered questionnaire. A third of them reported sexual intercourse in the past and half of the sexually active used condoms during recent intercourse. Being out-of-school, male, aged 20–24 years, alcohol use and khat (amphetamine-like substance) consumption predicted the likelihood of engagement in sexual activity. Of these variables, however, male sex was more associated with reported condom use during recent sexual intercourse. Self-efficacy, skills, and barriers predicted 23% of the variance in intentions to use condoms. Self-efficacy was also associated with past condom use. Psychosocial constructs predicted more variations in condom use intention for males than for females. In general, self-efficacy was found to be the strongest predictor of the constructs, whereas attitude and social influences were the weakest. The study implies that HIV/AIDS prevention programmes for young people in Ethiopia need to emphasize building assertive communication skills in sexual negotiations and condom use. Minimizing the gender gap in sexual relationships forms the cornerstone for such educational strategies.

Early menopause, association with tobacco smoking, coffee consumption and other lifestyle factors: a cross-sectional study.

BackgroundEarly onset of menopause is a risk factor for several health problems. The objective was primarily to investigate the association between early menopause and current, past active and passive smoking. A second aim was to investigate the association between coffee and alcohol consumption and early menopause.MethodsThe present population-based cross-sectional study included a sub-sample of 2123 postmenopausal women born in 1940–41 who participated in the Oslo Health Study. Early menopause was defined as menopause occurring at an age of less than 45 years. We applied logistic regression analyses (crude and adjusted odds ratio (OR)) to examine the association between early menopause and selected lifestyle factors.ResultsCurrent smoking was significantly associated with early menopause (adj. OR, 1.59; 95% CI, 1.11–2.28). Stopping smoking more than 10 years before menopause considerably reduced the risk of early menopause (adj. OR, 0.13; 95% CI, 0.05–0.33). Total exposure to smoking (the product of number of cigarettes per day and time as a smoker) was positively related to early menopause and, at the highest doses, nearly doubled the odds (adj. OR, 1.93; 95% CI, 1.12–3.30). These data suggest a possible dose-response relationship between total exposure to smoking and early menopause, but no dose-response relationship was detected for the other variables examined. We found no significant association of coffee or alcohol consumption with early menopause. Of the lifestyle factors tested, high educational level (adj. OR, 0.50; 95% CI, 0.34–0.72) and high social participation (adj. OR, 0.60, 95% CI, 0.39–0.98) were negatively associated with early menopause.ConclusionThis cross-sectional study shows an association between current smoking and early menopause. The data also suggest that the earlier a woman stops smoking the more protected she is from early menopause. Early menopause was not significantly associated with passive smoking, or alcohol or coffee consumption.

Female genital cutting in Kilimanjaro, Tanzania: changing attitudes?

OBJECTIVES To study the prevalence, type, social correlates and attitudes towards female genital cutting (FGC) among urban women in Kilimanjaro, Tanzania; and to examine the association between FGC and gynaecological problems, reproductive tract infections (RTIs) and HIV.

Infertility in the Gambia: frequency and health care seeking

In order to understand the problems of undesired infertility in the Gambia, where the desire for children and fertility is very high, a population based estimate of the frequency of sub-/infertility was undertaken. A survey was used in a representative random sample of the population. The study included an assessment of health care available for infertile couples in the different types and levels of the formal and traditional health system. Primary sterility was found to be fairly uncommon (3%), and secondary infertility to be more frequent (6%). Half of the infertile couples failed to seek formal health care, and they had to reach a certain level of care in order to be properly managed. As investigations are very basic and treatment possibilities scarce, many forms of alternative care are often sought. In addressing reproductive health in developing countries, a systematic primary health care approach to infertility in rural areas with limited resources should be developed.