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Biomedical subjects

J Liljestrand

Publications and source records attributed to J Liljestrand.

At least 19 recordsLinked to original sources
PubMed2006

Human resources and access to maternal health care.

The lack of human resources is one of the main bottlenecks to achieving the Millennium Development Goals on maternal and child health. A coherent national policy, recognized across government, needs to be in place to overcome this especially in countries severely affected by HIV/AIDS. Such a policy should cover selection of pre-service students, the qualifications of trainers and training sites, supportive supervision, career path development, a package of carefully thought-out incentives for the retention of staff, strategies for interaction with communities, and an agreed-upon health staff HIV/AIDS policy. Without such coherent human resource planning, a large number of countries will fail to reduce maternal and newborn mortality.

Female↗
PubMed2004

Observations on reproductive health programs in the Baltic States.

Public attention in Sweden has been drawn to three neighboring states that recently joined the European Union: Estonia, Latvia, and Lithuania. At this historic moment, it seems instructive to look at how the rapidly reformed health sectors of these ex-Soviet republics are responding to the vision of reproductive health articulated in Cairo 10 years ago. Reproductive health and rights have improved in these states in spite of recent reforms often acting to oppose improvement. Reforms such as the introduction of family medicine need continued adjustment, especially regarding antenatal care. One special challenge is the retention of essential mid-level providers, such as midwives, as the mode of HIV transmission becomes increasingly sexual.

Baltic States↗
PubMed2001

Care for adolescent pregnancy and childbirth.

The rise in adolescent pregnancy in the 20th century has been influenced by declining age at menarche, increased schooling, delay of marriage, inadequate contraception and poverty. The main problems are preterm labor, hypertensive disease, anemia, more severe forms of malaria, obstructed labor in very young girls in some regions, poor maternal nutrition and poor breastfeeding. In many regions HIV infection is an important problem. The infants of adolescent mothers are more prone to low birth weight and increased neonatal mortality and morbidity. Antenatal care is often inadequate. The most important problem is the increased incidence of preterm labor and delivery, the youngest age groups running the highest risk. Technically, care of adolescents during labor need not differ from care of older women; most adolescents are not at increased risk during labor, although, they are more in need of empathic support. Generally, care of pregnant adolescents should be adjusted to their specific needs.

Adolescent↗
PubMed2001

Characteristics of antenatal care attenders in a rural population in Tamil Nadu, South India: a community-based cross-sectional study.

The objectives of the study were to identify factors associated with utilisation of antenatal care facilities in a rural population in South India. A community-based, cross-sectional questionnaire study of 30 randomly selected areas was used. A total of 1254 women (95%) had at least one antenatal care visit. The median number of visits was four. High utilisation of antenatal care facilities was associated with low parity and adverse obstetrical history, short distance to healthcare facilities and literacy. It was concluded that antenatal care coverage was high. Information about the above few aspects can be used to target women who are at risk of getting inadequate antenatal care.

Adolescent↗
PubMed2000

Candies in hell: women's experiences of violence in Nicaragua.

The aim of this study was to describe the characteristics of domestic violence against women in León, Nicaragua. A survey was carried out among a representative sample of 488 women between the ages of 15-49. The physical aggression sub-scale of the Conflict Tactics Scale was used to identify women suffering abuse. In-depth interviews with formerly battered women were performed and narratives from these interviews were analysed and compared with the survey data. Among ever-married women 52% reported having experienced physical partner abuse at some point in their lives. Median duration of abuse was 5 years. A considerable overlap was found between physical, emotional and sexual violence, with 21% of ever-married women reporting all three kinds of abuse. Thirty-one percent of abused women suffered physical violence during pregnancy. The latency period between the initiation of marriage or cohabitation and violence was short, with over 50% of the battered women reporting that the first act of violence act took place within the first 2 years of marriage. Significant, positive associations were found between partner abuse and problems among children, including physical abuse. Both the survey data and the narrative analysis pointed to extreme jealousy and control as constant features of the abusive relationship. Further, the data indicate that battered women frequently experience feelings of shame, isolation and entrapment which, together with a lack of family and community support, often contribute to women's difficulty in recognizing and disengaging from a violent relationship. These findings are consistent with theoretical conceptualisations of domestic violence developed in other countries, suggesting that, to a large degree, women's experiences of violence transcend specific cultural contexts.

Adolescent↗
PubMed2000

Strategies to reduce maternal mortality worldwide.

The challenge of reducing maternal mortality is increasingly being addressed by area-based efforts to improve access to care of obstetric emergencies. Improving coverage and quality of skilled attendance at birth is also being increasingly emphasized. Post-abortion care, better reproductive health services for adolescents, and improved family planning care are important ingredients in maternal mortality reduction. New developments in malaria, nutrition, violence and HIV/AIDS in relation to maternal health are highlighted, as well as measurement issues. Maternal mortality reduction is also being promoted today by using a human rights approach.

Female↗
PubMed1999

Fertility and infant mortality trends in Nicaragua 1964-1993. The role of women's education.

OBJECTIVES: To assess trends in fertility and infant mortality rates (IMR) in León, Nicaragua, and to examine the effect of women's education on these trends during 1964-1993, a period of rapid social change. DESIGN: Cross sectional survey, based on random cluster sampling. A retrospective questionnaire on reproductive events was used. SETTING: The municipality of León, which is the second largest city in Nicaragua, with a total population of 195,000 inhabitants. SUBJECTS: 10,867 women aged 15-49 years, corresponding to 176,281 person years of reproductive life. Their children contributed 22,899 person years under 12 months of age to the IMR analysis. MAIN OUTCOME MEASURES: Fertility rate (number of pregnancies per 1000 person years) for specific age groups and calendar periods, total fertility rate, and IMR. RESULTS: Fertility rates and IMR declined in parallel, especially during the 1980s. However, education specific fertility rates did not decline, but the proportion of educated young women increased from 20% to 46%. This had also an impact on the overall IMR decline, although IMR reduction mainly took place among infants of women without formal education, decreasing from 118 to 69 per 1000 during the observation period. CONCLUSIONS: In this demographic transition over three decades, fertility and IMR declined simultaneously. The decreasing trend in fertility was mainly explained by an increase in women's education, while the IMR decline seemed to be the result of health interventions, specially targeted to poorer groups of women and their infants. Thus, social differences in fertility rates remained unchanged, while equity in chances of child survival increased.

Adolescent↗
PubMed1999

Wife abuse among women of childbearing age in Nicaragua.

OBJECTIVES: This study measured the prevalence, frequency, and severity of physical wife abuse and its risk factors in León, Nicaragua. METHODS: A cross-sectional survey was conducted with a representative sample of 488 women 15 to 49 years of age. RESULTS: The lifetime prevalence of spousal violence was 52% among ever-married women (n = 360). Spousal violence was significantly positively associated with poverty, parity, urban residence, and history of violence in the husband's family. No significant associations were found between spousal violence and women's age, education, marital dependency, or occupation. CONCLUSIONS: Wife abuse constitutes a major public health problem in Nicaragua, requiring urgent measures for prevention and treatment for victims.

Adolescent↗
PubMed1998

Does antenatal care influence postpartum health behaviour? Evidence from a community based cross-sectional study in rural Tamil Nadu, South India.

OBJECTIVE: To study the association between attendance to antenatal care and postpartum health behaviour among women in rural Tamil Nadu, South India. DESIGN: Community based, cross-sectional questionnaire study of 30 randomly selected areas served by health subcentres. SETTING: Rural parts of Salem District, Tamil Nadu, South India. POPULATION: 1321 women who were delivered in the six months before the questionnaire-based interview. MAIN OUTCOME MEASURES: Feeding of colostrum, time of initiation of breastfeeding and maternal dietary habits during the first month postpartum. RESULTS: The median number of antenatal visits was four (range 0-51; lower quartile 3, upper quartile 7)., The fifth month of pregnancy was the median time for the initiation of antenatal care. Pregnant women 1. who had a large number of antenatal care visits, 2. who initiated antenatal care in the first trimester or 3. who reported having received information about breastfeeding were more likely to feed colostrum (odds ratio 1.48; 95% CI 1.06 to 2.07), (odds ratio 1.40; 95% CI 1.06 to 1.85), (odds ratio 1.66; 95% CI 1.29 to 2.14, respectively). Only women who reported having received information about breastfeeding were more likely to initiate early breastfeeding (odds ratio 1.81; 95% CI 1.34 to 2.43). Use of antenatal care facilities was not associated with maternal postpartum dietary habits. CONCLUSIONS: A large number of women attended antenatal care in the study area, but antenatal care had a limited effect on postpartum health behaviour. As antenatal care is considered an essential part of primary health care and takes up considerable resources, we recommend further research to explain the gap between the intentions of antenatal care and the actual outcome of such care.

Breast Feeding↗
PubMed1998

Saving more neonates in hospital: an intervention towards a sustainable reduction in neonatal mortality in a Nicaraguan hospital.

A process of change was initiated in a Nicaraguan regional hospital in order to achieve a sustainable reduction of early neonatal mortality. A series of organizational, educational and hygienic measures was introduced, involving all staff in antenatal care, delivery care and neonatal care. Neonatal mortality decreased from 56/1000 live births in 1985 to 11/1000 in 1993. A commission of maternal and child health, a weekly perinatal audit, the active involvement of all staff and dedicated work of key individuals, as well as national policy decisions, are considered important determinants of the process. Keeping neonatal mortality in focus through continuous analysis of care routines, and through external exchange of ideas is important in order to sustain improvements and to decrease further the mortality.

Adult↗
PubMed1997

Reproductive pattern, perinatal mortality, and sex preference in rural Tamil Nadu, south India: community based, cross sectional study.

OBJECTIVES: To study reproductive pattern and perinatal mortality in rural Tamil Nadu, South India. DESIGN: Community based, cross sectional questionnaire study of 30 randomly selected areas served by health subcentres. SETTING: Rural parts of Salem District, Tamil Nadu, South India. SUBJECTS: 1321 women and their offspring delivered in the 6 months before the interview. MAIN OUTCOME MEASURES: Number of pregnancies, pregnancy outcome, spacing of pregnancies, sex of offspring, perinatal and neonatal mortality rates. RESULTS: 41% of the women (535) were primiparous; 7 women (0.5%) were grand multiparous (> 6 births). The women had a mean age of 22 years and a mean of 2.3 pregnancies and 1.8 live children. The sex ratio at birth of the index children was 107 boys per 100 girls. The stillbirth rate was 13.5/1000 births, the neonatal mortality rate was 35.3/1000, and the perinatal mortality rate was 42.0/1000. Girls had an excess neonatal mortality (rate ratio 3.42%; 95% confidence interval 1.68 to 6.98; this was most pronounced among girls born to multiparous women with no living sons (rate ratio 15.48 (2.04 to 177.73) v 1.87 (0.63 to 5.58) in multiparous women with at least one son alive). CONCLUSIONS: In this rural part of Tamil Nadu, women had a controlled reproductive pattern. The excess neonatal mortality among girls constitutes about one third of the perinatal mortality rate. It seems to be linked to a preference for sons and should therefore be addressed through a holistic societal approach rather than through specific healthcare measures.

Abortion, Spontaneous↗
PubMed1997

Gender and social differences in adolescent sexuality and reproduction in Nicaragua.

PURPOSE: The aim of this research was to study gender and social differences in adolescent sexuality and reproduction, as reflected in age at first intercourse and age at first pregnancy, as a basis for future interventions in the municipality of León, Nicaragua. METHODS: In a community-based cross-sectional study including 7789 households, all women aged 15-49 years (n = 10,867) were interviewed about socioeconomic, sexual, and reproductive issues. A random subsample of men (n = 388) and women (n = 413) aged 15-49 years was interviewed in more detail about sexual patterns and reproduction. RESULTS: The median age at first intercourse for women and men was 17.8 and 16.2 years, respectively. Women's average latency period to end of first pregnancy was 22 months. There was a significant tendency to start active sexual life later among today's girls aged 15-20 years, compared to the groups 21-27, 28-35, and 36-49 years old. A similar trend was found in age at first pregnancy. These secular trends were not found among men. Age at first pregnancy for current adolescents was lower among those having less formal education. CONCLUSIONS: The short latency period between first sexual intercourse and end of first pregnancy, probably reflecting lack of access to counseling and contraception, is worrying in light of the growing sexually transmitted disease/human immunodeficiency virus threat. The secular trend of later start of reproduction, however, is a positive sign which partly may be an effect of increasing education in the Nicaraguan society.

Adolescent↗
PubMed1997

Female and male sterilization and refertilization in Sweden.

In Sweden, approximately 1,500 men and 7,000 women are sterilized yearly. The frequency varies considerably between regions. The reasons for these differences are not fully known. More women than men are sterilized in Sweden, but a higher proportion of sterilized men undergo refertilization. The object of the study was to analyze counselling routines prior to sterilization, presterilization waiting time, the number of refertilizations performed, the attitudes of the operating departments towards refertilization, and the possible relation between frequency of refertilization and incidence of sterilization. A questionnaire was mailed to all units performing refertilizations and/or sterilizations of mean and women in Sweden (n = 161). The response was 93%. Counselling routines and waiting times before sterilization varied, which influenced the operation's availability. The frequency of refertilizations varied considerably between counties from 0.5 to 5.4 per 100,000 inhabitants. There was no correlation between frequency of sterilizations and refertilizations. The rate of refertilization appears to be determined mostly by the local attitudes of the health authority. The Swedish sterilization law has had a heterogeneous impact in the country.

Adult↗
PubMed1997

Which babies die during the first week? A case control study in a Nicaraguan hospital.

In a hospital-based case control study (108 and 285 infants) on risk factors for early neonatal death in Nicaragua, an analysis was performed on the possible association with characteristics of the mother and her environment, her reproductive history and contact with antenatal services as well as characteristics of the child. Antenatal medical supervision was associated with a lower risk for neonatal death, even when adjusting for parents' literacy. This association disappeared if birth weight or gestational age was entered into the analysis. There was an interaction between mortality and the mother's versus the father's literacy, showing the highest risk if the mother was illiterate and the father was literate (odds ratio, OR 7.0, CI 2.6-19.3), while illiteracy of both parents was associated to a lower risk (OR 4.2, CI 1.0-18.3). The strong association between maternal literacy and early neonatal death is striking. Is maternal empowerment the important factor?

Asphyxia Neonatorum↗
PubMed1996

Contraceptive patterns among women and men in León, Nicaragua.

The aim was to study the contraceptive patterns among men and women in León, Nicaragua. A questionnaire about sexual, contraceptive, reproductive and socioeconomic issues was directed to 7,789 households including 22% of all women of the municipality aged 15-49 years (n = 10,867). A subsample of 388 men and 413 women aged 15-49 years was drawn at random. Refusals were less than 2%. Private interviews revealed that among fertile women who had been sexually active within the last three months, non-pregnant and wishing to avoid pregnancy, 77% were contracepting. Female sterilization was the most common contraceptive method (39%), followed by intrauterine device (16%). Even though around 60% of women at some time had tried oral contraceptives, only 13% of contraceptors used them currently. The rhythm and interruption methods together constituted only 4%. Condom use was low and mainly occasional. Contraceptive use in sexually active women aged 15-44 years was lower among those having lower education, living in rural areas, and living under poverty conditions. The predominance of female sterilization and the occasional condom use-mainly reported by men-reflects a situation of relative male control over contraception and reproduction. This probably originates from "machista" values where men having many children with different women are considered strong. There was also a significantly higher use of contraceptives among the better-off women and men compared with the extremely poor. The situation of many poor women, in a country with limited contraceptive services, is worrying considering that abortion is illegal and the threat of HIV epidemic is growing. The situation for adolescents is particularly problematic with low experience in contraceptive use.

Adolescent↗
PubMed1996

Induced abortions and childbirths: trends in Estonia, Latvia, Lithuania, Russia, Belarussia and the Ukraine during 1970 to 1994.

BACKGROUND: To analyse trends in childbirth, induced abortions and maternal morbidity from 1970 to 1994 in Estonia, Latvia, Lithuania, Russia, Belarussia and the Ukraine. METHODS: Official health statistics from the six countries were compiled and analysed. RESULTS: High abortion rates (up to 142 per 1000 women of fertile ages and years) were seen in all countries analysed, but since 1980 a continuing decrease is noted for Estonia, Latvia and Kalimingrad with a lowest rate of 50 abortions/1000 women/year in Latvia in 1994. Teenage abortions and childbirths are increasing. Maternal mortality, including complications of abortions, is still a reality in all the countries studied. CONCLUSION: The high abortion frequencies in all countries studied here indicate that national abortion prevention programs are needed. Such programs should focus on education, both of medical professionals, teenagers, fertile women and males. Concomitantly, the availability of cheap and modern contraceptives must increase, especially to defined risk groups.

Abortion, Induced↗