Background: Maternal common mental disorder (CMD), characterised by depression, anxiety and somatic symptoms of distress, is known to be an important health problem in low-and-middle-income countries, but had not been investigated in Malawi, Africa. In preliminary work, we adapted a CMD screening measure and showed that post-partum CMD was common and associated with child stunting. In the research presented here, we expanded the investigation of CMD in Malawi to include pregnant women and mothers of children with severe acute malnutrition (SAM). Using validated measures, we aimed to estimate the prevalence of antenatal CMD/depression and investigate its relationship to social support and intimate partner violence. Secondly, we sought to explore women’s lived experiences of the perinatal period. Finally, we investigated CMD amongst mothers of children admitted with SAM and other life-threatening illness and, in the former, we tested the hypothesis that maternal CMD would be associated with impaired child recovery. Method: In an antenatal clinic-based study, we validated and compared Chichewa and Chiyao versions of the Self Reporting Questionnaire (SRQ) and Edinburgh Postnatal Depression Scale (EPDS) using major depressive episode (MDE) as the criterion diagnosis. We adapted and validated the Multi-dimensional Scale of Perceived Social Support (MSPSS). We measured the prevalence of antenatal MDE and identified associated factors. We conducted focus group discussions with women and enquired about perinatal stressors and supports. We administered the SRQ to mothers of children with SAM during admission to a nutritional rehabilitation unit (NRU) and at 1-month post-discharge, and investigated whether CMD was a risk factor for lower child weight gain at follow-up. In a subsequent study, we compared levels of CMD symptoms between mothers of children admitted to a NRU, a high dependency unit and an oncology ward. Results: We found that the adapted EPDS and SRQ were both valid screening instruments for antenatal CMD/depression. The weighted prevalence of antenatal MDE was 10.7% (95% CI 6.9% - 14.5%). The adapted MSPSS showed adequate test characteristics and differentiated between sources of social support. MDE was associated with lack of support by a significant other; intimate partner violence moderated this association. We found that women in rural Malawi recognised depressive and anxious states in the perinatal period and identified lack of partner support as a key stressor. During admission with a severely malnourished child to a NRU, mothers had very high SRQ scores that greatly reduced post-discharge. There was no association between SRQ score and child weight gain at follow-up. We found no higher level of CMD symptoms amongst mothers of children admitted for treatment of SAM compared with those admitted to other wards. Conclusions: We demonstrated that measures of antenatal CMD and perceived social support can be adapted for use in Malawi. We found that maternal CMD is common and associated with lack of social support, intimate partner violence and child illness. We did not find evidence for a specific association between maternal CMD and child SAM but further prospective studies are required. Our findings suggest that treatment of CMD in mothers in Malawi will require attention to social support and partner behaviour.

Background Although Pressure ulcer is common in high and middle income countries it is rarely researched in low income countries. Evidence based interventions of pressure ulcer prevention are developed but the gap between the evidence and the clinical practice is wide. Aim Describe the nurses‟ knowledge about pressure ulcer prevention at a provincial hospital in Ghana. Design An empirical qualitative approached was used and semi-structured interviews were made with nurses at the Kwahu Governmental Hospital in Atibie, Ghana. A content analysis and a deductive content analysis were used to analyze the material. The evidence based interventions suggested by the North American Nurses Association (NANDA) was used as a theoretical framework. Result / Conclusion The themes Pressure ulcer prevention and Nurses‟ knowledge were found. Most of the evidence based interventions were mentioned by the participants. However, the participants explained massage as a preventive intervention although the evidence advice against massage. The participants did not mention any interventions considering documentation and nutrition. Further the nurses explained that they achieved their knowledge in school by practical demonstrations and examinations. The nurses‟ opinion was that their knowledge is enough to prevent pressure ulcers. / <p>Röda Korsets sjuksköterskeförening stipendium 2011</p>

This research focuses on injuries from all mechanisms, with particular focus on road traffic injuries in urban Gambia. Data from trauma registries established in two major trauma hospitals were used to address three aims: 1) examine the general characteristics of injured individuals and their injuries, and identify factors associated with discharge status from the hospital emergency room; 2) identify differences in road-user, collision, vehicle, and driver factors, among individuals hospitalized with a road traffic injury; and 3) examine personal, crash, and injury factors associated with transfer status among road traffic injured (RTI) patients, and identify limitations of the current trauma systems that might be improved for more efficient use of resources. Data used for this dissertation were from trauma registries established in two major trauma hospitals in The Gambia: Edward Francis Small Teaching Hospital (EFSTH) and Serrekunda General Hospital (SGH). At intake, the treating physicians and nurses completed an accident and emergency ward survey form for injuries from all mechanisms. For admitted road traffic injured patients (admission more than 24 hours), the road traffic injured admission form is completed. Data about risk factors contributing to crashes and injuries were collected from the patients. At hospital discharge, treating physicians used a 19-item questionnaire to collect data on the discharge status and disability at discharge of road traffic injured patients. Using the trauma registry data from March 1, 2014 to March 31, 2016, we found the leading mechanism of injury was road traffic. For place of occurrence, injuries mostly occur at home and on the road. Assault was higher among young females (19 to 44 years) than males. Males have increased odds for admission and disability due to road traffic injuries. We also found that among admitted road traffic injured patients, injuries to pedestrians, bicyclists, and motorcyclists were higher than other road users. Crashes involved risk factors at person, crash, and environment levels. Head/skull injuries were common, and concussions/brain injuries were higher among pedestrians, bicyclists, and motorcyclists than vehicle occupants. Finally, our results also suggest that vehicle occupants, and professionals/skilled personnel had increased odds of being transferred than directly admitted RTI patients. Fractures/dislocations, and concussions/brain injuries were frequent among transfers. Intravenous fluid was the most frequent treatment administered to patients transferred to the definitive-care hospitals. This project shows that injuries, especially road traffic, create a large burden of injury in The Gambia and the many contributing factors. It also provides evidence that there are many opportunities to intervene at personal, crash, and environment levels. Additionally, creating trauma registries across the country as well as trauma response system will have a greater impact to reduce burden of road traffic crashes in The Gambia.

Bakgrund: Vid litteraturgenomgång kunde tre kunskapsområden relaterade till barns undernäring i ett globalt perspektiv identifieras. Omfattning och åtgärder är väl utforskade ämnen, medan det finns mindre forskning gällande hälso- och sjukvårdens roll och framförallt saknas sammanställd forskning om omvårdnaden av undernärda barn i låginkomstländer. Syfte: Studiens syfte var att belysa omvårdnaden av undernärda barn i ett globalt perspektiv. Metod: Arbetet genomfördes som empirisk studie med kvalitativ ansats. Analysen av data, bestående av texter från bloggar och reseberättelser skrivna av sjuksköterskor på fältuppdrag, genomfördes stegvis, inspirerat av metoden för berättelseanalys enligt Friberg (2006) samt med stöd av omvårdnadens fyra metabegrepp (Fawcett, 2005). Resultat: Analysen resulterade i 12 teman: det sårbara barnet, kulturell trygghet som hinder, lokalsamhället som resurs, fattigdom samhällsuppbyggnad och yttre hot, möten mot alla odds, det omänskliga valet, föräldrars frustration, sjuksköterskans existentiella tankar, den enkla lösningen, vikten av ett gott råd, sjuksköterskans upplevda utmaningar, att finna ett barn att vårda. Slutsats: Studien visar att sjuksköterskans förmåga att anpassa sig och sina omvårdnadshandlingar till de förutsättningar som den utmanande miljön och åtskillnaden i människosyn skapar är avgörande för hur resten av omvårdnaden blir. Klinisk betydelse: Genom att belysa problemen som kan uppstå då miljön skapar hinder för god omvårdnad kan förutsättningar skapas för att hitta lösningar och vägar runt dessa problem. / Background: In the literature review, three areas of knowledge related to child malnutrition in a global perspective were identified. Scope and actions are well researched topics, while there is less research on the health care role and above all lack of consolidated research on the care of malnourished children in low-income countries. Objective: The aim of the study was to illuminate the nursing care of malnourished children in a global perspective. Method: The work was conducted as an empirical study with qualitative approach. The analysis of data, consisting of texts from blogs and travel stories written by nurses on field mission, was carried out in stages, inspired by the method of narrative analysis as described by Friberg (2006) and with the support of four nursing meta-concepts (Fawcett, 2005). Results: The analysis resulted in 12 themes: the vulnerable child, cultural security barriers, the local community as a resource, poverty, community building and external threats, meetings against all odds, the inhuman choice, parental frustration, nurse's existential thoughts, the simple solution, the importance of good advice, nurses perceived challenges and finding a child to care for. Conclusion: The study shows that the nurse’s ability to adapt herself and her nursing actions to circumstances set by environmental challenges and differences in views on humanity are crucial for the nursing outcome. Clinical outcome: By highlighting problems raised from the environment conditions can be created to find solutions and ways around these problems.

Background: Children with intellectual disabilities living in developing countries are vulnerable to participation restrictions. Few studies have been made regarding their own perspectives. Aim: To describe how children in a low income country aged 13-17 with an intellectual disability perceive their participation in everyday life activities. Method: This bachelor thesis was conducted as a descriptive study and had a quantitative approach. Participants were collected through a non-probability, goal-oriented consecutive sampling. Data were collected by using “Picture my Participation”, an instrument designed as a structured interview with quantitative questions. The data were analyzed with IBM SPSS Statistics 21. Tables and diagrams were made in Microsoft Excel 2013. Result: The activity that the children participated in most frequently was “Daily routines at home for personal care (dressing, choosing clothing, hair care, brushing teeth)”. The activity that most children prioritized as most important, and they were most involved in was “Organised leisure activities”. “Services and policies” and “Social environment” were the factors seen as “Facilitators” to participation, whereas “Family attitudes” was seen as a “Barrier” to participation. Conclusion: The children perceived their participation in the prioritized activities as high and experienced few barriers in the context of participation. / Bakgrund: Barn med intellektuella funktionsnedsättningar som lever i utvecklingsländer är sårbara för delaktighetsinskränkningar. Få studier har gjorts som rör deras perspektiv. Syfte: Att beskriva hur barn i ett låginkomstland mellan 13-17 år med en intellektuell funktionsnedsättning upplever sin delaktighet i dagliga aktiviteter. Metod: Kandidatuppsatsen genomfördes som en deskriptiv studie med en kvantitativ ansats. Deltagare samlades in genom ett icke-slumpmässigt-, målinriktat konsekutivt urval. Data samlades in med “Picture my Participation”, ett instrument designat som en strukturerad intervju med kvantitativa frågor. Data analyserades i IBM SPSS Statistics 21. Tabeller samt diagram gjordes i Microsoft Excel 2013. Resultat: Aktiviteten som barnen deltog mest frekvent i var “Daily routines at home for personal care (dressing, choosing clothing, hair care, brushing teeth)”. Aktiviteten som flest barn prioriterade som viktigast, och var mest involverade i var “Organised leisure activities”. “Services and policies” och “Social environment” var faktorer som sågs som “Facilitators” till delaktighet, medan “Family attitudes” sågs som en “Barrier” till delaktighet. Slutsats: Barnen upplevde en hög delaktighet i de prioriterade aktiviteterna och upplevde få barriärer i relation till delaktighet.

Background: Insertion of a peripheral intravenous catheter (PVC) is a common procedure performed by nurses. The practical skill is a complex act, which not only requires theoretical and practical knowledge, but also nursing care adjusted to each patient's history and needs. Aim: The aim was to explore the procedure of inserting a peripheral intravenous catheter at a local hospital in Tanzania with focus on nursing care and patient safety. Method: The study was performed as a non-participating observational study and was preceded by a pilot study performed in Sweden. Eight observations were made, which were analysed with a qualitative content analysis. Result: The categories “Execution” and “Respecting patients” with associated sub-categories constituted the results. “Execution” describes how the procedure is performed, while “Respecting patients,” explains the performed nursing care during the practical skill. Conclusion: The Model of Practical Skill Performance was used for interpreting and discussing the result. The model clarified that some components were not fulfilled and the performance can therefore not be considered as well proceeded. One can discuss whether it depends on lack of knowledge, resources and/or culture. Keywords: Peripheral intravenous catheter, nursing care, patient safety, Tanzania, low-income country. / Bakgrund: Insättning av perifer venkateter (PVK) är en vanligt förekommande uppgift för sjuksköterskor. Denna praktiska färdighet kan anses vara komplex, då den inte bara kräver teoretisk och praktisk kunskap, utan också omvårdnad anpassad efter varje patients behov och tidigare erfarenheter. Syfte: Syftet var att undersöka tillvägagångssättet vid insättning av perifer venkateter på ett lokalt sjukhus i Tanzania, med fokus på omvårdnad och patientsäkerhet. Metod: Studien utfördes som en icke-deltagande observationsstudie och föregicks av en pilotstudie utförd i Sverige. Åtta observationer genomfördes som sedan analyserades med kvalitativ innehållsanalys. Resultat: Kategorierna “Utförande” och “Respektera patienter” med tillhörande underkategorier utgjorde resultatet. ”Utförande” beskriver tillvägagångssättet vid insättnig av PVK, samt förberedelser och slutförande. “Respektera patienter” beskriver den givna omvårdnaden under det det praktiska utförandet. Konklusion: Modellen för praktisk färdighetsutövande användes för att tolka och diskutera resultatet. Modellen klargjorde att några komponenter inte uppfylldes och utförandet kan därmed inte anses som väl utfört. Det kan diskuteras om detta beror på bristande kunskap, resurser och/eller kultur. Nyckelord: Perifer venkateter, omvårdnad, patientsäkerhet, Tanzania, låginkomstland.

Background: Malnutrition is a major problem in Bangladesh. One third of the population in Bangladesh is malnourished, but figures for older persons specifically are scant. Aims: This thesis describes the nutritional status of individuals aged 60+ years, living in a rural community in Bangladesh, with particular focus on the impact of demographic, health and social factors on nutritional status. A main aim is to examine the magnitude of malnutrition in this population. Second, the thesis focuses on the impact of demographic, health and social factors on nutritional status. Third, this thesis also aims to investigate the influence of nutritional status on functional abilities. Methods: A cross-sectional study of people aged 60+ years was conducted in Matlab, a rural area in Bangladesh during 2003-2004. Data were obtained through home interviews, clinical examination and cognitive tests. Nutritional status was assessed using a modified form of the Mini Nutritional Assessment. Physical function was measured by self-reported and performance-based instruments. Cognitive function was assessed using general and specific cognitive tasks. A total of 850 individuals were randomly selected for the purpose of the study, of which 625 participated in the home interviews and 473 underwent clinical examinations and cognitive tests. Information on complete nutritional status was available for 457 individuals. Results: About 26% of older people living in a rural community in Bangladesh were malnourished and 62% were at risk of malnutrition (Studies I-IV). Self-reported health problems (Study I), physician’s diagnoses (Study II), food expenditure (Study I), literacy (Studies I, II), personal income (Study II), female gender (Studies I, II) and financial support (Study II) were significantly associated with nutritional status. Health indicators accounted for the largest variations in nutritional status compared to demographic and socio-economic indicators (Studies I, II). Nutritional status was directly associated with self-reported and performance-based physical functions (Study III), as well as general and specific cognitive functions (Study IV). Conclusion: In low income countries, nutritional status of older persons needs to be addressed both from a health and a socio-economic perspective. Good nutritional status is essential for older persons to be functionally active, both physically and cognitively.

<p>This thesis was successfully defended on January 15, 2014 at McMaster University.</p> / <p>Understanding why policies change is an important pursuit for researchers and policy-makers alike. Research evidence is one of many possible factors that encourage or constrain policy change, as is the role of ‘networks’ of policy actors. Despite extensive empirical literature on each of evidence-informed health policy and policy networks, the two have rarely been studied together, particularly in low-income country policy environments. This thesis explores both of these variables in a broader structural context of institutions, interests and ideas. Concepts and approaches from social network analysis are applied to three distinct research questions and chapters with the objective to: 1) develop and test a conceptual framework for the integration of networks, institutions, interests and ideas as major variables explaining policy change; 2) test the relationship between policy network structure (closure and heterogeneity) on the use of research evidence and innovation across the three cases; and 3) model the factors that influence the formation of an evidence exchange relationship between policy actors, and the effect of those exchanges on actor-level use of research evidence. Taken together, the findings of this dissertation present persuasive support for adopting a network lens to study evidence-informed health policy and policy change.</p> / Doctor of Philosophy (PhD)

<p>In community health promotion intersectoral collaboration is essential. Important actors are the governmental health system, the civil society and Non-Governmental organisations (NGOs). The aim of this qualitative thesis was to examine what kind of cooperation existed in a rural community in Mozambique and to describe the actor’s experiences of collaboration and how it can be improved. This was done by conducting interviews. The result of the study showed that different ways of cooperation existed, intersectoral as well as side by side and intrasectoral. The extent of intersectoral collaboration was fairly loose, such as networks, alliances or partnership. All the informants were positive to collaboration, they had experienced that people had been helped and their knowledge in health issues was improved as an effect of joint efforts. The experience among the actors was that the collaboration had improved and that they had become closer together over the years. Problems to cooperation that were mentioned concerned dropouts and financial issues. The informants were unanimous that it was necessary to broaden the collaboration. They were concerned over the sustainability in the different projects as well as the sustainability in cooperation itself.</p> / <p>Para a promoção da saúde em comunidade a colaboração intersetorial é essencial. O sistema público de saúde, a sociedade civil e as organisações não governamentais (ONGs) são importantes agentes. O objetivo desta tese qualitativa foi examinar qual tipo de cooperação existiu em uma comunidade rural em Moçambique e descrever as experiências de colaboração dos agentes e como ela pode ser melhorada. Isto foi feito através de entrevistas. O resultado do estudo mostrou que existiram diferentes modos de colaboração: intersetorial assim como intrasetorial de forma paralela. O nível da colaboração intersetorial foi relativamente informal assim como redes de contato, alianças e parcerias. Todos os entrevistados foram positivos a colaborar e experienciaram que as pessoas tinham sido auxiliadas e que seus conhecimentos acerca de assuntos de saúde foi melhorado como resultado da união de esforços. A experiência entre os agentes foi de que a colaboração foi melhorada e que eles se tornaram mais próximos através dos anos. Problemas acerca de colaboração que foram mencionados foram devidos a desistências e questões financeiras. Os entrevistados foram unânimes sobre a necessidade de aumento do nível de colaboração. Eles estavam preocupados sobre a sustentabilidade de diferentes projetos assim como a sustentabilidade da cooperação em sí própria.</p>

In community health promotion intersectoral collaboration is essential. Important actors are the governmental health system, the civil society and Non-Governmental organisations (NGOs). The aim of this qualitative thesis was to examine what kind of cooperation existed in a rural community in Mozambique and to describe the actor’s experiences of collaboration and how it can be improved. This was done by conducting interviews. The result of the study showed that different ways of cooperation existed, intersectoral as well as side by side and intrasectoral. The extent of intersectoral collaboration was fairly loose, such as networks, alliances or partnership. All the informants were positive to collaboration, they had experienced that people had been helped and their knowledge in health issues was improved as an effect of joint efforts. The experience among the actors was that the collaboration had improved and that they had become closer together over the years. Problems to cooperation that were mentioned concerned dropouts and financial issues. The informants were unanimous that it was necessary to broaden the collaboration. They were concerned over the sustainability in the different projects as well as the sustainability in cooperation itself. / Para a promoção da saúde em comunidade a colaboração intersetorial é essencial. O sistema público de saúde, a sociedade civil e as organisações não governamentais (ONGs) são importantes agentes. O objetivo desta tese qualitativa foi examinar qual tipo de cooperação existiu em uma comunidade rural em Moçambique e descrever as experiências de colaboração dos agentes e como ela pode ser melhorada. Isto foi feito através de entrevistas. O resultado do estudo mostrou que existiram diferentes modos de colaboração: intersetorial assim como intrasetorial de forma paralela. O nível da colaboração intersetorial foi relativamente informal assim como redes de contato, alianças e parcerias. Todos os entrevistados foram positivos a colaborar e experienciaram que as pessoas tinham sido auxiliadas e que seus conhecimentos acerca de assuntos de saúde foi melhorado como resultado da união de esforços. A experiência entre os agentes foi de que a colaboração foi melhorada e que eles se tornaram mais próximos através dos anos. Problemas acerca de colaboração que foram mencionados foram devidos a desistências e questões financeiras. Os entrevistados foram unânimes sobre a necessidade de aumento do nível de colaboração. Eles estavam preocupados sobre a sustentabilidade de diferentes projetos assim como a sustentabilidade da cooperação em sí própria.