Global Child Health and the Sustainable Development Goals – Tobias Alfvén's research group

The aim of the Global Child Health and the Sustainable Development Goals research group is to generate knowledge in order to improve health and equity for children of all ages and to improve the quality of care for children throughout the world.

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People holding a globe

About our research

Our vision is to enable the best possible health for all children, with a particular focus on children in poor and vulnerable environments. The group focuses on child health through an SDG lens and our research strives to be multidisciplinary and drive evidence-informed policy making. Key foci of our work are on identifying and addressing bottlenecks within the health system to make the most essential care available.

Research areas 

Child health has seen a lot of progress in the last thirty years, under-five mortality has decreased by more than half, many more children go to school and fewer children live in extreme poverty. However, 5 million children still die before their fifth birthday and the differences in risk between different countries can be as great as 50-fold. And survival is not enough, we must give children and adolescents the possibility to thrive on a healthy planet.

Our research projects are divided across seven research themes to cover the various areas of global child health:  

  • Case management and emergency care
  • Technology and innovation
  • Infectious diseases and outbreak control
  • Newborn care
  • Child development
  • Adolescent mental health and well-being
  • Multi-sectoral and policy research, including climate change
Tuberculosis and the Sustainable Development Goals research team
Centre for Tuberculosis Research research group Photo: Unknown KI

Tuberculosis and the Sustainable Development Goals research team

Tuberculosis and the Sustainable Development Goals is a research team in the Global Child Health and Sustainable Development Goals research group. The team is focusing on tuberculosis (TB), with a main focus on social interventions to improve access and mitigate the disease-poverty trap, linking SDG 3 with SDGs 1, 2 and 8 among others. The team is also studying innovative pathways for TB screening and diagnosis.

Global collaborations

Centre of Excellence for Sustainable Health
Photo: N/A

Centre of Excellence for Sustainable Health

The Centre of Excellence for Sustainable Health is a collaboration between Makerere University in Uganda and Karolinska Institutet that aims is to develop capacity and mobilise actions to drive the agenda for sustainable health.

HOLICARE
Holicare Photo: N/A

HOLICARE

Bridging the gap between technological excellence, available infrastructure, capacity and local uptake of technologies to tackle the challenge of diagnostic, treatment and prevention of respiratory tract infections.

News from the research group

Events

The research group in the media

Professor Johan Lundin's research in NewScientist
AI can spot parasites in stool samples to help diagnose infections Photo: N/A

Professor Johan Lundin's research in NewScientist

News article about group member Professor Johan Lundin och collagues research on how AI can spot parasites in stool samples to help diagnose infections.

Birger Forsberg guests podcast from Forum on Health Policy
Hälso- och sjukvårdspodden. Photo: N/A

Birger Forsberg guests podcast from Forum on Health Policy

With a background in social medicine, Birger Forsberg has seen the whole world in general and Region Stockholm in particular through the lens of public health. He has also had the privilege of leading the work on Region Stockholm's future planning, which makes for an interesting discussion when he guests Swedish podcast Hälso- och sjukvårdspodden, run by Forum for Health Polcy.

Newspaper Curie meets Giulia Gaudenzi
Assistant professor Giulia Gaudenzi is interviewed in Curie., front picture of Giulia with four colleagues in Uganda Photo: Private

Newspaper Curie meets Giulia Gaudenzi

Assistant professor Giulia Gaudenzi is interviewed by the newspaper Curie about her work on the development and understanding of point-of-care diagnostics in Uganda (in Swedish). 

We need to address the systems perspective to achieve sustainable global health
Portrait of Stefan Swartling Peterson. Photo Martin Stenmark. Photo: Martin Stenmark

We need to address the systems perspective to achieve sustainable global health

Stefan Swartling Peterson, Professor of Global Systems Transformation for Health is interviewed by Kristina Ström Olsson, board member of the Forum for Health Policy. Stefan highlights several issues for achieving sustainable health (in Swedish).

Tobias Alfvén answers questions in Swedish TV from parents about children and virus season
Tobias Alfvén in Swedish TV morning show answering questions about children and virus season with the text what do you do if your child refuses to eat? Photo: N/A

Tobias Alfvén answers questions in Swedish TV from parents about children and virus season

We are in the middle of the virus season, which is noticeable among parents with young children. After the holidays, illnesses can now increase again. 'It's winter, and there are a lot of sick children,' says Tobias Alfvén, pediatrician at Sachsska Children's and Youth Hospital.

Archive

Publications

All publications from group members

Staff and contact

Group leader

All members of the group

Research projects

Graphic design: Jerker Lokrantz

Case management and emergency care

An Pulse Oximeter standing on a table on papers. In the background books and images.
The EREMISS project aims to explore the potential for implementing emergency triage and treatment within primary health centres in rural Malawi. Photo: Private

EREMISS Project

Emergency case management, and subsequent referrals, have been highlighted as a key weakness of health systems in low-resource settings. The EREMISS project aims to explore the potential for implementing emergency triage and treatment within primary health centres in rural Malawi, and to describe both clinical progression across the referral pathway and care-seeking decisions.  We are collaborating with the Malawi College of Medicine and a local Malawian NGO, the Parent and Child Health Association.

The project is funded by the Swedish Research Council and the Einhorn Foundation (2018 – 2020).

Contact: Helena Hildenwall, Carina King

Project: SugarFact Trial

Hypoglycaemia is a common metabolic problem among severely sick children with high case fatality rates. The SUGARFACT project is a randomized control trial which seeks to assess risk factors for hypoglycaemia and the impact of changed blood glucose cut off for hypoglycaemia treatment among severely sick children admitted at the Zomba Central Hospital and Queen Elisabeth Central Hospital, Blantyre, Malawi.  Our team is collaborating with the Malawi College of Medicine. 

The project is funded by the Swedish Research Council and Region Stockholm.

Contact: Helena Hildenwall, Fatsani Ngwalangwa, Tim Baker, Gaetano Marrone

Publications and other links

Effect on mortality of increasing the cutoff blood glucose concentration for initiating hypoglycaemia treatment in severely sick children aged 1 month to 5 years in Malawi (SugarFACT): a pragmatic, randomised controlled trial.
Baker T, Ngwalangwa F, Masanjala H, Dube Q, Langton J, Marrone G, Hildenwall H
Lancet Glob Health 2020 12;8(12):e1546-e1554

Trial registration

Project: GlucELB Trial

Severely ill children with low blood glucose values in resource poor settings suffer a three to four-fold higher risk of mortality compared to children with normal blood glucose. The World Health Organization’s recommended treatment with 5ml/kg bolus dextrose followed by dextrose containing maintenance fluid has not been shown to decrease mortality among those with intermediary low blood glucose values. Thus, explanations for this excess mortality must be sought.

This three-arm randomized controlled trial will compare the incidence of post admission glycemic variability and electrolytes derangements between severely ill children with low and hypoglycemia receiving standard treatment versus 2 ml/kg intravenous dextrose bolus versus sublingual sugar.

The project is funded by the Swedish Research Council (2021 – 2024).

Contact: Helena Hildenwall, Carina King, Fatsani Ngwalangwa

 

Traction Project

Male involvement has been identified as important missing piece to improving maternal and child well being. The TRACTION projects aims to understand fathers’ roles and responsibilities in caring for their seek children. The project is embedded in a cluster randomized, community-based, controlled trial which aimed to assess non-inferiority, in terms of safety, of two different follow up recommendation conducted by Community Health Worker) for children with unclassified fever in Ethiopia.

The Traction project is funded through a collaboration with the President’s Malaria Initiative (Malaria Consortium) and USAID.

Contact: Tjede Funk, Karin Källander, Tobias Alfvén, Helle Mølsted Alvesson

 

Project: Community-Based Care for Improved Child Health: Distributional Impact and Sustainable Financing

This research aims to assess the extent to which community-based care for children in Uganda and Mozambique has led to a more equitable distribution of healthcare services in relation to need. In addition, we explore the cost and financial strategies associated with sustaining WHO’s iCCM strategy - Integrated Community Case Management of common childhood illnesses.

This project is based on the inSCALE trial conducted from 2010 – 2015. We are collaborating with the London School of Hygiene and Tropical Medicine, University College London and Malaria Consortium.

The project is funded by the Bill and Melinda Gates Foundation and a Karolinska KID grant (2015 – 2020).

Contact: Frida Kasteng, Karin Källander

 

Project: Trend Study

Differentiating viral pneumonia from bacteria pneumonia in children under-five is critical to effective treatment and survival. The overall aim of the TREND study is to improve the differential diagnosis of bacterial and viral aetiology in children with clinical community acquired pneumonia.

The project will be conducted at Sachs Children’s and Youth hospital, Stockholm, in collaboration with SciLife Laboratory, Sahlgrenska University Laboratory, and Abo University Hospital.

The project was funded by ALF, Stiftelsen Frimurare Barnahuset.

Contact: Tobias Alfvén, Samuel Rhedin, Ingela Zenk, Malin Ryd-Rinder, Jesper Gantelius, Annika Eklundh

 

INSPIRING Project

Very little progress has been recorded in combating childhood pneumonia in Nigeria despite availability of proven interventions like pulse oximetry and oxygen therapy. The general objective of the INSPIRING Project is to reduce paediatric pneumonia deaths in two states in Nigeria, Lagos and Jigawa.

In Lagos we are determining the impact of an integrated training and mentorship approach to the introduction of pulse oximetry and enhanced sustainable oxygen systems on pneumonia case fatality rates in children aged 0-59 months. In Jigawa, we aim to determine the impact of a whole systems approach to capacity building and empowerment for improved childhood health, with a focus on pneumonia, on all causes of deaths in children aged 0-59 months.

We are collaborating with the State Primary Health Care Board Jigawa State Nigeria, University of Ibadan Nigeria, Johns Hopkins University, University College London, University of Melbourne, Save the Children and GSK.

The project is funded through GSK-Save the Children UK partnership (September 2018—December 2022).

Contact: Carina King, Ayobami Bakare

Publications and other links

Pediatric Pneumonia in Nigeria, 27 January 2020

Trial registration

Two hands showing pulse oximetry tool to help improve pneumonia diagnosis.
Photo: Isabeau Walker

Technology and Innovation

Project: NeoTap

Heart rate assessment is crucial in neonatal resuscitation, but pulse oximetry and electrocardiography are rarely accessible in low- to middle-income settings. These studies evaluated a free-of-charge smartphone application, NeoTap Life Support (NeoTapLS), recording heart rate with a screen-tapping method bypassing mental arithmetic calculations. The two studies were conducted at Sachs´Children and Youth Hospital, Sweden and in Kampala, Uganda through collaboration with Kawempe National Referral Hospital, Uganda and the University of Bergen, Norway (2014-2019).

Article I was funded by the Laerdal Global Health Foundation and Sachs' Children and Youth Hospital. Article II was funded by the Research Council of Norway (RCN), Norway, through the FRIMEDBIO program.

Contact: Susanna Myrnerts Höök, Nicolas Pejovic, Thorkild Tylleskär, Tobias Alfvén, Josaphat Byamugisha, Jolly Nankunda

Publications

Accurate and fast neonatal heart rate assessment with a smartphone-based application - a manikin study.
Myrnerts Höök S, Pejovic NJ, Marrone G, Tylleskär T, Alfvén T
Acta Paediatr 2018 Mar;():

Smartphone app for neonatal heart rate assessment: an observational study.
Myrnerts Höök S, Pejovic NJ, Cavallin F, Lubulwa C, Byamugisha J, Nankunda J, Tylleskär T, Alfven T
BMJ Paediatr Open 2020 ;4(1):e000688

 

Project: The paediatric infection – point of care (PI-POC)

The paediatric infection – point of care project researches novel methods for improving and strengthening the differential diagnosis of suspected childhood CNS infections in low-income health systems.

This project will develop a novel DNA-based assay for CNS infections, evaluate an advanced PCR-based multiplex tool for differential meningitis diagnosis and conduct protein profiling in CSF/blood of children with severe infection vs uncomplicated infection. In addition, we will study the carriage, serotype, molecular characteristics and virulence of N.meningitidis and explore pre-post PCV and HiB vaccine changes in aetiology. This study is conducted in Mbarara, Uganda, in collaboration with Epicentre Mbarara and SciLife.

The study is funded by the Swedish Research Council, Einhorn foundation and EIT health (2019–2021).

Contact: Giulia Gaudenzi, Tobias Alfvén, Reza Rasti

Publications and other links

Study protocol

Health care workers' perceptions of point-of-care testing in a low-income country-A qualitative study in Southwestern Uganda.
Rasti R, Nanjebe D, Karlström J, Muchunguzi C, Mwanga-Amumpaire J, Gantelius J, Mårtensson A, Rivas L, Galban F, Reuterswärd P, Andersson Svahn H, Alvesson HM, Boum Y, Alfvén T
PLoS One 2017 ;12(7):e0182005

A vertical flow paper-microarray assay with isothermal DNA amplification for detection of Neisseria meningitidis.
Rivas L, Reuterswärd P, Rasti R, Herrmann B, Mårtensson A, Alfvén T, Gantelius J, Andersson-Svahn H
Talanta 2018 Jun;183():192-200

 

Project: AIRR

Counting accurate respiratory rates is the main diagnostic criteria for paediatric pneumonia using WHO guidelines. However, this can be challenging, and is often not done, particularly at lower-level resource-limited health facilities.

This study aims to develop an automated respiratory rate counter using artificial intelligence (AI) interpretation of existing videos from children with and without pneumonia in Malawi, Cambodia and Ethiopia.

Sponsored by the Swedish Research Council, the study is being conducted through partnership between Johns Hopkins University, Malaria Consortium, VTT Finland and Oulu University (Jan 2020-Dec 2022).

Contact: Carina King, Johan Lundin, Kevin Baker

Publication

Back to Basics in Paediatric Pneumonia-Defining a Breath and Setting Reference Standards to Innovate Respiratory Rate Counting.
Carina K, Kevin B, Rebecca N, Bassat Q, Shamim Ahmad Q, Eric D M
J Trop Pediatr 2021 01;67(1):

 

Project: Child Immunization App

Tracking childhood immunization among refugees is critical to achieve wider vaccine coverage and prevent outbreaks of vaccine preventable diseases. The Children Immunization App is aimed to test the impact of a low-cost app on child immunization visits among refugees at the Zaatari camp in Jordan. The project was completed in December 2019.

The study was funded through Grand Challenges Canada and implemented through collaboration with UNICEF, ECDC, UNHCR, and Jordan University of Science and Technology.

Contact: Ziad El-Khatib

People on the street in north Nigeria getting water
Children in the street in north Nigeria getting water. Photo: Kelly Elimian

Infectious diseases and outbreak control

Project: Cholera in Nigeria

The north-eastern region of Nigeria has several cholera hotspots, and ineffective implementation of multi-sectoral interventions in the region could make global cholera control out of reach. A major contributing factor to this challenge in this context is fragility. Given the complexity of disease control in such a fragile setting, this study aims to systematically examine the barriers and facilitators which influence the implementation of existing cholera interventions in Adamawa and Bauchi states, Nigeria. 

This study is conducted in collaboration with the Nigerian CDC, and is funded through a post-doctoral Forte fellowship (2020-2022).

Contact: Kelly Elimian

Publications

Understanding the factors enabling and blocking sustained implementation of cholera interventions in a fragile region of Nigeria: a multi-phase group model building study protocol [version 1; peer review: 1 approved with reservations]. Elimian K, King C, Diaconu K et al. F1000Research 2021, 10:85

 

Project: Measles in Vietnam

There have been some disturbing outbreaks of measles in Vietnam the last few years. Is everyone getting the vaccine and/or there people who choose not to vaccine their children? And since it’s a disease that easy transmits, it needs to be controlled, especially in the young infant to child population. In a controlled study we aim to evaluate and find risk factors for future outbreaks from the data sets that exist locally in Vietnam National Children’s Hospital and on a governmental level at MoH from outbreak 2014, 2019 and vaccination 2014, 2019 and 2020-date.

The project funded by in kind by KI researchers and locally by Vietnam National Children’s Hospital and MoH of Vietnam.

Contact: Linus Olson, Mattias Larsson, Nhung Hong, Dien Minh Tran

 

Project: Childhood infections in the DRC

Project summary: Despite gains in reducing deaths amongst children under-five, progress has been inequitable both between regions, and within countries. The DRC has one of the highest child mortality rates, but with large sub-national variation. Preventable infections and outbreaks still account for a large part of these deaths. This project aims to explore factors contributing to childhood infections and poor outcomes in the DRC.

This project involves a collaboration with UNICEF and the University of Kinshasa (2020 – 2026).

Contact: Mattias Schedwin, Carina King, Tobias Alfvén, Helena Hildenwall

 

Project: HIV-Chi

Children and adolescents with HIV on anti-retroviral treatment (ART) have about twice the rate of treatment failure compared to adults causing resistance that limits future therapeutic choices. This study aims to assess different support strategies, Enhanced Treatment Support (ETS) and Conventional Treatment Support (CTS), in relation to drug resistance and virological treatment failure. In a cross sectional pilot study the the rate and predictors of virological treatment failure will be assessed in relation to clinical and socioeconomic indicators among paediatric patients on treatment for more then 6 months.

The aim is to in a semi randomized controlled way assess effect of peer support to children and adolescents with HIV in relation to adherence, virological treatment failure, physical development and quality of life. This project will generate information of great value for evidence based pediatric ARV treatment strategies in low-income settings and may have an impact on treatment guidelines for HIV globally.

The partner hospitals in study are Vietnam National Childrens Hospital in Hanoi, Children hospital 1 and 2 from HCMC, Childrens hospitals in Quan Nhin and Hai Phong. The project is in collaboration with Hanoi Medical University,Vietnam, who is the implementing organization, with funding from an ERC Carrier Grant (2015 – 2021).

Contact: Linus Olson, Mattias Larsson, Chuc Kim Nguyen, Toan Khanh Tran

 

CRE (Carbapenem-resistant Enterobacteriaceae) bacteria-
Photo: Privat

Project: Combating CREs in ICU

Antibiotic resistance is one of the major challenges facing the world. We will need to take multi-sectoral approaches to improving both our surveillance and understanding of the distribution of resistant bacteria and to improving stewardship. This is particularly important in intensive care settings, where antibiotic resistant pathogens lead to increased hospitalizations and mortality. This project uses a 9-step platform, including infection prevention and control, stewardship and genome sequencing, to combat multi-resistant bacteria in ICUs.

This project is conducted in Vietnam, and Laos, and is funded by STINT and an ERC Carrier Grant (2015 – 2021).

Contact: Linus Olson, Mattias Larsson

Publications

Article I: High prevalence of colonisation with carbapenem-resistant Enterobacteriaceae among patients admitted to Vietnamese hospitals: Risk factors and burden of disease.
Tran DM, Larsson M, Olson L, Hoang NTB, Le NK, Khu DTK, Nguyen HD, Vu TV, Trinh TH, Le TQ, Phan PTT, Nguyen BG, Pham NH, Mai BH, Nguyen TV, Nguyen PTK, Le ND, Huynh TM, Anh Thu LT, Thanh TC, Berglund B, Nilsson LE, Bornefall E, Song LH, Hanberger H
J Infect 2019 08;79(2):115-122

Article II: Multiple antibiotic resistance as a risk factor for mortality and prolonged hospital stay: A cohort study among neonatal intensive care patients with hospital-acquired infections caused by gram-negative bacteria in Vietnam.
Peters L, Olson L, Khu DTK, Linnros S, Le NK, Hanberger H, Hoang NTB, Tran DM, Larsson M
PLoS One 2019 ;14(5):e0215666

 

Project: Immune development in children and adolescents following infection with SARS-Cov-2

There is still a lack of information on antibody production against SARS-CoV-2 among children of different ages. Timing of antibody production has been difficult to assess among children due to the mild symptoms and the type of antibody response in children compared to adults has not been fully evaluated. Another recent finding is the presence of preexisting antibodies that may cross-react with SARS-CoV-2 in uninfected individuals that has shown to be more common in children than in adults, which in part could explain the difference in disease development and severity in children and adults.

In this study, we assess the prevalence of SARS-CoV2- antibodies in a cohort of children who travelled to the European Alps before national SARS-CoV-2 transmission was confirmed within Sweden. Both children who were PCR positive and negative in the first test are followed with repeat blood sampling to follow immune response over time.

Contact: Helena Hildenwall, Eric Herlenius, Selma Olsson-Åkefeldt, Olof Hertting

Publications and other links

Poster Session - Umeå Congress

 

Newborn baby
Photo: Linus Olson

Newborn care

Project: NeoSpirit

Globally, birth asphyxia is responsible for close to 1 million deaths per year, of which almost all (98%) take place in low and middle-income countries. An even greater number suffer brain injury. The main objective of neonatal resuscitation is to maintain a patent airway and provide effective positive pressure ventilation (PPV). However, neonatal resuscitation with face mask ventilation requires adequate operator skills, and endotracheal intubations are performed in the neonate only by skilled anaesthesiologists or neonatologists. Previously conducted studies both from our group and others indicate that a laryngeal mask airway under some circumstances should replace intubation as the first choice when face-mask ventilation fails. This RCT aims to answer that question.

The project builds on ‘Neonatal care in Vietnam’ and is a collaboration with PhuSan Hanoi Hospital, University of Padova and the University of Bergen, funded by the Swedish Research Council (2019 – 2020).

Contact: Tobias Alfven, Tina Dempsey, Linus Olson, Nicolas Pejovic, Susanna Myrnerts-Höök

 

Project: NeoObs

Prospective, multinational, multicentre, observational cohort study of neonatal sepsis in partner institutions. The cohort study was designed to evaluate health care utilization and current clinical practice and to assess risk factors for and outcomes of babies with neonatal sepsis (culture-negative and culture-positive). The aim of this project is to study neonatal sepsis cases across hospitals globally.

We are involved in the component occurring in Vietnam, working in partnership with St Georges University and Vietnam National Children’s Hospital in a global multi central study.

Contact: Linus Olson, Mattias Larsson, NeoObs international team

Publications and other links

Article I: Towards understanding global patterns of antimicrobial use and resistance in neonatal sepsis: insights from the NeoAMR network.
Li G, Bielicki JA, Ahmed ASMNU, Islam MS, Berezin EN, Gallacci CB, Guinsburg R et al.
Arch Dis Child 2020 01;105(1):26-31

Trial registration

 

Project: NeoSupra Trial

Birth asphyxia is the third leading cause of under-five child mortality. Worldwide, the most common neonatal resuscitation method is face-mask ventilation. We aimed to investigate whether the use of a cuffless laryngeal mask airway rather than face-masks could reduce mortality and morbidity in asphyxiated neonates during neonatal resuscitation. We conducted a randomised controlled trial in Uganda to test this.

This was a collaborative project with Kawempe National Referral Hospital, University of Bergen and Padova University, funded by the Research Council of Norway through the FRIMEDBIO program and the Centre for Intervention Science in Maternal and Child Health (CISMAC).

Contact: Susanna Myrnerts Höök, Nicolas Pejovic, Tobias Alfvén

Publications and other links

A Randomized Trial of Laryngeal Mask Airway in Neonatal Resuscitation.
Pejovic NJ, Myrnerts Höök S, Byamugisha J, Alfvén T, Lubulwa C, Cavallin F, Nankunda J, Ersdal H, Blennow M, Trevisanuto D, Tylleskär T
N Engl J Med 2020 11;383(22):2138-2147

Trial registration

 

Project: Clinical and experimental implementation of standardized hypothermic treatment for neonatal asphyxia

Recent results from independent randomized clinical trials provide strong evidence that mild hypothermia treatment of newborn infants at risk for hypoxic-ischemic encephalopathy (HIE) started within 6 hours after birth reduces the risk for neurologic sequele. The present cooling equipments in clinical use are relatively complex, expensive and dependent on continuous electric power and water supply. A cheap and effective cooling method is needed for global implementation especially in remote settings and during transportation to neonatal intensive care units. We will assess and optimise a novel cooling method using a so-called Phase Changing Material (PCM). This material requires no external power or specific maintenance to be effective. 

Contact: Linus Olson, Tobias Alfven, Hang Tran

Publications

Hypothermic treatment for neonatal asphyxia in low-resource settings using phase-changing material-An easy to use and low-cost method.
Tran HTT, Le HTT, Tran HTP, Khu DTK, Lagercrantz H, Tran DM, Winbladh B, Hellström-Westas L, Alfvén T, Olson L
Acta Paediatr 2021 01;110(1):85-93

 

Project: Informing change – neonatal resuscitation in Uganda

Asphyxia is a main cause of neonatal mortality. Improved neonatal resuscitation guidelines implies changing behavior. Behavioral change models are useful to understand barriers and enablers. According to the COM-B model, three interacting core components generates behaviour (B): capability (C), opportunity (O) and motivation (M). Many global initiatives focus on improving capability (knowledge and skills) and opportunity (by provision of items) – potentially risking not focusing on the major underlying reasons for appropriate behavior. To inform future actions, we are exploring midwives' perception on neonatal resuscitation at Mulago Hospital, Uganda.

This project is being funded by the Research Council of Norway (2018 – 2020).

Contact: Susanna Myrnerts Höök, Tobias Alfven

 

Project: Neonatal care in Vietnam

The project is the first 2 parts that eventually will become the NeoSpirit or similar studies, it’s the baseline for new innovative studies together with partners in Vietnam in Neonatalcare.The aim is to record the incidence, detailed management and outcome of birth asphyxia to better understand where intervention is necessary in order to reduce neonatal morbidity and mortality related to neonatal resuscitation. The objective is to add valuable information to the planning of a RCT planned to follow on this study at Phu San Hanoi Hospital.

The project is funded by the Swedish Research Council (2020).

Contact: Tobias Alfvén, Tina Dempsey, Linus Olson, Nicolas Pejovic, Susanna Myrnerts-Höök, Anh Nguyen, Phuong Pham, Hien Vu, Lien Huong Nguyen, Thu Huong Nguyen, Xuan Anh Bui

Child pushing another child in a wheelchair in Uganda
Children with cerebral palsy in rural Uganda receiving wheelchair donations, as a part of a collaboration of the CURIE project and the charity Walkabout foundation. Photo: Carin Andrews

Child development

CURIE-Cerebral palsy in Uganda: Epidemiology, risk factors and intervention project

Cerebral palsy (CP) is the most common childhood-onset motor disorder and most children with CP live in low- and middle-income countries with little access to services and support systems.

This project aims to understand the epidemiology and life situation for children with cerebral palsy in Uganda. We will explore prevalence, risk factors, premature mortality, functional impairments, participation in community and family life and access to therapies and specialized health services. We have also developed and will implement a multi-component community based intervention programme for children with cerebral palsy in Uganda, the Akwenda CP-programme.

This programme will contain 5 components: i) caregiver-led training workshops ii) therapist led practical group sessions iii) provision of technical assistive devices iv) goal-directed training v) community communication and advocacy. The CURIE project is a collaboration between Karolinska Institutet and Makerere University. The Akwenda-CP programme was developed by international experts, local therapists, caregivers of children with CP and the NGO Malamulele Onward in South Africa.

The research is funded by the Swedish Research Council, the Promobilia foundation, Frimurare Barnhuset, Sällskapet Barnavård, Folke Bernadotte Stiftelsen, and Sunnerdahl Handikappfond.

Contact: Carin Andrews

Publications

Prevalence of cerebral palsy in Uganda: a population-based study.
Kakooza-Mwesige A, Andrews C, Peterson S, Wabwire Mangen F, Eliasson AC, Forssberg H
Lancet Glob Health 2017 12;5(12):e1275-e1282

Excessive premature mortality among children with cerebral palsy in rural Uganda: A longitudinal, population-based study.
Namaganda LH, Almeida R, Kajungu D, Wabwire-Mangen F, Peterson S, Andrews C, Eliasson AC, Kakooza-Mwesige A, Forssberg H
PLoS One 2020 ;15(12):e0243948

Impairments, functional limitations, and access to services and education for children with cerebral palsy in Uganda: a population-based study.
Andrews C, Kakooza-Mwesige A, Almeida R, Swartling Peterson S, Wabwire-Mangen F, Eliasson AC, Forssberg H
Dev Med Child Neurol 2020 04;62(4):454-462

 

NHINZE child health project

Children with developmental delay and disability are often excluded from current development efforts, even though they have an increased need for health care, early childhood developmental services and educational services compared to their peers. The NHINZE Child Health Project utilizes a three-stage design to establish the prevalence of functional difficulties, developmental delay and neurodevelopmental disorder in the region of Iganga/Mayuge in Eastern Uganda.

The project further aims to validate the predictive value of the screening questions in the UNICEF/Washington Group on disability statistics’ module on child functioning to screen for neurodevelopmental disorders among children two to nine years of age in a rural Ugandan setting. In addition, Ugandan norms for some previously unused international assessments will be established, including setting thresholds for referral for further examinations and interventions.

The project is funded by the Swedish Research Council, Forskar-AT, Frimurare Barnhuset, and Sällskapet Barnavård.

Contact: Anna-Theresia Ekman, Tobias Alfven, Angelina Mwesige-Kakooza, Hans Forssberg

 

Project: Understanding childhood disability through large household survey data

Prevalence estimates of developmental delay and disabilities and neurodevelopmental disorders are important for local and national public health planning as well as for improved knowledge of underlying conditions. However, current global prevalence estimates are largely speculative and estimates from low-income countries are scarce.

Utilizing standardized household survey data can increase knowledge on children living with functional difficulties and symptoms reflecting neurodevelopmental disorders. For an individual child, better public health planning can translate into inclusion in early intervention programs and in established or emerging early childhood education programs. Both can lead to decreased suffering, better life-time prognosis and reduced stigma. Results can also feed into other ongoing early education and intervention initiatives.

The project is funded through RALF-funding and Forskar-AT.

Contact: Anna-Theresia Ekman, Helena Frielingsdorf, Tobias Alfvén.

 

Project: Neonatal complications and neurodevelopment

Project summary: This project aims to establish the prevalence of brain impairment and associated factors among young infants in Eastern Uganda. Further it will assess knowledge, perceptions and experiences of mothers of babies with infants with brain impairment and health facility readiness to care for high risk newborn babies. This project is being conducted at the Iganga Health and Demographic Surveillance site, Uganda and is funded SIDA.

Contact: Helena Hildenwall, Gertrude Namazzi

Publications

Neurodevelopmental outcomes of preterm babies during infancy in Eastern Uganda: a prospective cohort study.
Namazzi G, Tumwine JK, Hildenwall H, Ndeezi G, Mubiri P, Hanson C, Kakooza-Mwesige A, Waiswa P
Glob Health Action 2020 12;13(1):1820714

Caring for children with neurodevelopmental disability: Experiences from caretakers and health workers in rural eastern Uganda.
Namazzi G, Hanson C, Nalwadda C, Tetui M, Nampijja M, Waiswa P, Tumwine JK, Hildenwall H
PLoS One 2020 ;15(7):e0236488

Multi-sectoral and policy research

Project: Impact of non-health determinants on child health

In order to achieve Sustainable Development Goal 3.2, to eliminate preventable child deaths by 2030, it is clear that multi-sectoral action is needed. This project aims to determine the impact of non-health sector factors on child health in the Millennium Development Goal era, using Cambodia and Uganda as case studies.

There are many data gaps regarding the Sustainable Development Goals and the Cambodian Sustainable Development Goals. We have compiled data from various sources on the Cambodian Sustainable Development Goals as well as the general budget expenses for the Royal Government of Cambodia, free to use here:

This project is funded though the Swedish Research Council, Forskar AT and Formas (2019 – 2022).

Contact: Daniel Helldén

Publication

Climate change and child health: a scoping review and an expanded conceptual framework.
Helldén D, Andersson C, Nilsson M, Ebi KL, Friberg P, Alfvén T
Lancet Planet Health 2021 03;5(3):e164-e175

Placing children and adolescents at the centre of the Sustainable Development Goals will deliver for current and future generations.
Alfvén T, Dahlstrand J, Humphreys D, Helldén D, Hammarstrand S, Hollander AC, Målqvist M, Nejat S, Jørgensen PS, Friberg P, Tomson G
Glob Health Action 2019 ;12(1):1670015

Project: The politics of prevention

There are several effective approaches to minimise the risks of non-communicable diseases, however, these are not consistently implemented as policy. This project aims to understand barriers and facilitators of implementing evidence-based, cost-effective policies to prevent tobacco smoking, harmful use of alcohol, poor diet and insufficient physical exercise. This will be done through reviewing implementation of ‘Best Buy’ policies, engaging stakeholders and modelling impact.

The project is funded by the Swedish Research Council, SLS and the Fulbright Commission.

Contact: Hampus Holmer

Young people smiling holding up their hands with paint on them
Photo: Patrick Buck

Adolescent mental health and well-being

Project: Political Economy of Adolescent Mental Health and Wellbeing

Globally, adolescent mental health and wellbeing constitute an enormous, neglected problem. According to the World Health Organization, mental health conditions including depression and anxiety represent 16% of the global burden of disease among 10-19-year-olds. Despite the magnitude of problem, the issue has received limited attention and resources.

Karolinska Institutet, in collaboration with Johns Hopkins University, is undertaking a program of research and action that consists of global and national scientific studies, consultations and knowledge translation activities. The program aims at increasing knowledge of the political economy of adolescent mental health to reduce fragmentation, mobilize resources and facilitate multisectoral action for improved adolescent mental health and wellbeing. The studies will be based on data from document and literature reviews, key-informant interviews with experts and other key stakeholders, focus group discussions with adolescent advocates, and observations. A crucial component of the research is the involvement of adolescents and local investigators.

This project is funded through Carl Bennet AB (2021-2025).

Contact: Mariam Claeson, Stefan Peterson, Olivia Biermann

Keywords:
Child Health Epidemiology Health Care Service and Management, Health Policy and Services and Health Economy Infectious Medicine Pediatrics Show all
Content reviewer:
Tobias Alfvén
Miriam Mosesson
25-11-2024