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Maternal & Child & Clinical Care

The aims of the Maternal & Child and Clinical Care sub-group are to generate knowledge in order to improve health and equity for mothers and children and to improve the quality of care for patients throughout the world in collaboration with others.

We conduct research, build capacity and interact with society to support the development of stronger health systems. We also strive to improve information systems at community and health facility levels to generate evidence for health system planning and policy.

Our current projects include:


  • Identifying and addressing bottlenecks within the health system for effective coverage of health interventions
  • Designing and evaluating community, health facility and district health strategies for maternal, newborn care and child care
  • Childhood illness prevention and care
  • Point of care diagnostics for paediatric infectious diseases
  • Evaluation of pneumococcal vaccines
  • Evaluating and improving the quality of clinical care for critically ill patients
  • Improved metrics for maternal, newborn and child health

Group members

Tobias Alfvén

Tim Baker Post-doc
Ulrika Baker PhD student
Jesper Gantelius Post-doc
Claudia Hanson Project coordinator
Helena Hildenwall Senior researcher
Frida Kasteng PhD student
Dorkus Kiwanuka PhD student
Karin Källander Senior lecturer
Ann Lindstrand PhD student
Andreas Mårtensson Professor
Joan Nakayaga Lecturer
Stefan Peterson Professor
Reza Rasti PhD student
Peter Waiswa Lecturer

Research Projects

Global Critical Care/Anaesthesia

Tim Baker

Care of critically ill patients and Anaesthesia are under-prioritised areas of healthcare in low-resource settings. Critical care utilises a horizontal approach to healthcare – involving all patients, all specialties and all diseases. We are researching methods to identify critically ill patients using context appropriate tools based on patients’ vital signs, and treatment strategies to improve care and reduce mortality. Current projects include the development and implementation of the Vital Signs Directed Therapy, checklists in Obstetric and Paediatric Anaesthesia, quantification of the burden of critical illness, and development of guidelines for the management of patients with sepsis and other critical illness.

Ongoing collaborations include those with Muhimbili National Hospital, Muhimbili University of Health and Allied Sciences, Dar es Salaam Regional Medical Authorities, the Dept. of Anaesthesia, Intensive Care and Surgical Services at Karolinska University Hospital and the European Society for Intensive Care Medicine. The projects are run together with the Muhimbili-Karolinska Anaesthesia and Intensive Care Collaboration (MKAIC) and Life Support Foundation, an independent, medical organisation aiming to prevent deaths due to acute, life-threatening conditions in low-income countries. As well as research, we carry out training, exchanges and capacity building projects.

Funding: Kavli Fund, Laerdal Foundation, Olof Norlander Stipend, AAGBI, SFAI and SSMF.

Innovative Pediatric Infectious point of care diagnostics in low-income countries. (PI-POC)

Tobias Alfven

Translational research project together with SciLife laboratory to develop and evaluate new point of care (POC) diagnostics for infectious diseases, focusing on CNS infections in Uganda

TREND - Trial of Respiratory infections in children for ENhanced Diagnostics

Tobias Alfven

Translational research project together with SciLife laboratory to develop and evaluate new point of care (POC) diagnostics for infectious diseases, focusing on respiratory infections in Sweden.

Controlling Pneumococcal Disease in Low- and High-income Countries

Tobias Alfven

The studies aim to establish the consequences of preventing pneumonia using pneumococcal vaccines on child morbidity, serotype replacement and resistance patterns in both Uganda and Sweden

Neonatal Supraglottic Device Trial & NeoTap

Tobias Alfven

This trial represents a bold innovative idea where our consortium is in the forefront of international research. The idea: erratic neonatal resuscitation is still contributing to a high perinatal mortality worldwide and replacing the face-mask for initial respiratory support which is difficult-to-handle for non-doctors with the super-easy-to-handle second generation supraglottic device has the potential of saving millions of neonates. Our phase II trial is promising and we now want to conduct a high-quality phase III trial to provide the scientific support for a game-changing idea.

Innovations in the health system: Interventions for improved treatment of infectious disease in children in rural Uganda

Tobias Alfven

New project with three sub-themes; i) Quality of drug use in children, ii) Quality of care for common childhood illnesses managed in the private sector and iii) ICT tools (including POC) for better diagnostics and clinical decision support for pediatric respiratory illnesses

Integrated Community Case Management of pneumonia and malaria in Eastern Uganda

Tobias Alfven

Compare Performance of CHWs in integrated management of malaria and pneumonia versus malaria management alone & determine effect of integrated management on Prompt and appropriate pneumonia treatment and treatment outcomes

Universal versus conditional three-day follow-up visit for children with unclassified fever at the community level in Ethiopia

Tobias Alfven

Two-arm cluster randomized controlled non-inferiority trial, the safety of conditional follow-up of unclassified fever, i.e. non-severe fever with no malaria, pneumonia, diarrhea, or symptoms requiring referral, compared to universal follow-up after two days studied.

M&E for global impact – what can we learn from the AIDS epidemic

Tobias Alfven

What can we learn from Monitoring and Evaluation of the AIDS epidemic for effective monitoring of the Sustainable Development goals?


Helena Hildenwall, Tim Baker

Queen Elisabeth central hospital, BlantyreSugar Requirements in Febrile African Children Trial. While antibiotics and anti-malarial drugs constitute the definitive treatment for paediatric infections, the role of supportive therapies, such as maintaining normal blood sugar and electrolyte balances, has been given limited attention. Hypoglycaemia is common in children admitted with fever and outcomes are poor. One in four children have “low-normal” blood glucose levels of 2.5-5.0mmol/l. These children also have a greater risk of death.

We will conduct studies in Malawi to investigate the causes of the low levels of blood glucose and the reasons for increased mortality. We will conduct intervention studies that aim to reduce mortality rates. We aim to strengthen the evidence base for management of children with febrile illness and to challenge the current global definition of hypoglycaemia.

Collaborations: University of Malawi, College of Medicine; Dept. of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi; Dept. of Paediatrics, Karolinska University Hospital, Huddinge, Stockholm; Dept. of Anaesthesia, Intensive Care & Surgical Services, Karolinska University Hospital, Stockholm.

Funding: Vetenskapsrådet, Stockholms Läns Landsting.


Stefan Peterson

The Community and District Empowerment for Scale-up focuses on health service management strategies to allow the improvement in the coverage and quality of interventions for common childhood illnesses.

New approaches are urgently needed to resolve the many difficulties of scaling up lifesaving interventions to prevent deaths due to pneumonia and diarrhea, which together account for more than a third of child mortality. Previous studies have demonstrated that the obstacles are essentially due to four factors: the lack of supportive policies, failure to prioritize those interventions that are most likely to prevent deaths, problems with the essential commodities for vaccination services and treatment of illnesses, and the absence of community-based health promotions activities and care.

CODES aims to develop and evaluate the effect of a focused approach to scaling up high impact intervention to accelerate mortality reduction from pneumonia and diarrhoea. Uganda, which has one of the highest child mortality rates in Africa and a highly decentralized health system, will be the case study for this approach. The CODES project aims to demonstrate that a management strategy based on three pillars will lead to improvements both regarding coverage and quality of key interventions to prevent children from dying of diarrhea and pneumonia. The three pillars of improvements are:

  • Improved targeting of interventions to match disease burden, and better allocation of resources;
  • Regular review and improvement of district health team performance, and use of evidence-based management tools and focal funding to overcome management bottlenecks;
  • Community oversight and inputs.

The method Diagnose-Intervene-Verify-Adjust will be used to identify and respond to health system and demand-side bottlenecks that arise at the district level in order to strengthen the district health system, support capacity development and empower communities. The core partners are: U.S. Fund for UNICEF, UNICEF Uganda Office, Karolinska Institutet, Makerere University and Ministry of Health of Uganda.

Funding: Bill & Melinda Gates foundation


Karin Källander

The Integrated Community Case Management of Common Childhood Diseases: Mozambique and Uganda project looks at the limitations surrounding scale up of community case management, a proven method of delivering lifesaving treatment to children. Community-based agents (CBAs) can deliver lifesaving treatment to children. However, scale-up can be problematic in terms of low motivation, attrition and poor performance of CBAs. The Innovations at Scale for Community Access and Lasting Effects (inSCALE) project will identify and document limitations to national scale up of Integrated Community Case Management (ICCM) in terms of its geographical distribution and quality.

The aim of the project is to demonstrate that coverage of government-led integrated community case management programmes can be increased to cover up to 33 percent of the districts, primarily resulting in more children with diarrhoea, pneumonia and malaria accessing appropriate care.

Funding: Bill & Melinda Gates Foundation.


Community-based care for improved child health in low-income countries: Distributional impact and sustainable financing

Frida Kasteng

Integrated community case management (iCCM) of common childhood illnesses (malaria, pneumonia, diarrhoea) was endorsed by the WHO and UNICEF in 2012 as an equity-focused strategy to improve access to appropriate treatment of illness in children and is currently introduced in a number of countries in sub-Saharan Africa, provided by lay Community Health Workers (CHWs).

The aim of the research is to assess the extent to which community-based care for children in Uganda and Mozambique has led to more equitable distribution of healthcare services in relation to need and explore the cost and financial strategies associated with sustaining iCCM, considering that an important reason for failure of CHW programmes in the past has been the underestimation of resources and support needed to maintain high-quality services at the community level.


Peter Waiswa

The Uganda Newborn Study focuses on improving newborn mortality in Uganda by developing an integrated maternal-newborn care package that links community and facility care and evaluating its effects for policy information and scale-up. It is now well established that many low income countries will not achieve MDG 4 to reduce under-five mortality by two thirds unless neonatal mortality is well addressed. With evidence that integrating community health workers (CHWs) in health systems can lead to improved morbidity and mortality, many countries in Sub-Saharan Africa are scaling-up such programs. However, one of the challenges is how to integrate these CHWs in existing health system programs. The aim is to adapt, develop and cost an integrated maternal-newborn care package that links community and facility care, and will evaluate its effect on maternal and neonatal practices in order to inform policy and scale-up in Uganda.

UNEST is a community randomized controlled trial in Iganga/Mayuge Health Demographic Surveillance Site in eastern Uganda. Trained CHWs make 2 pregnancy and 3 postnatal visits in the first week after birth. In addition, basic health facility strengthening is done to make supply-side care better. Preliminary evaluations show marked improvements in key care practices such as birth preparedness, supervised deliveries, and neonatal care practices. In addition, the project has already had policy impact by contributing to the design of the country-wide community health work strategy. Furthermore, it has been used as a platform for funding of two new large scale projects: MANEST or maternal and newborn study in Uganda to be funded by DFID and WHO, and EQUIP or Expanded Quality Improvement Using Information Power to improve maternal and newborn health in Uganda and Tanzania.


Claudia Hanson

The Helping Mothers Survive - Bleeding After Birth project aims to evaluate the impact of a short training session on maternal morbidity and mortality from post-partum hemorrhage. Post-partum hemorrhage remains a leading cause of maternal morbidity and mortality in sub-Saharan Africa. It is estimated that up to 10% of mothers experience post-partum hemorrhage - a blood loss of > 500 ml. Around 30% of maternal deaths - 90,000 women every year - are because of severe bleeding, almost all of them in low and middle income countries.

The Active Management of the Third Stage of Labor (AMTSL), a very simple measure, can prevent severe post-partum bleeding. The most important intervention in AMSTL is the application of a uterotonic within one minute after the baby is born. To evaluate the impact of a 1-day training in AMTSL, complemented by in-service simulator practice over a period of six weeks, on maternal morbidity and mortality due to post-partum hemorrhage. The cluster randomized, facility-based intervention trial will be done in 20 health districts in both Tanzania and Kenya, where half of the included districts will be assigned to the intervention arm.

A most interesting aspect of this study is the use of the near-miss application to measure maternal mortality: using maternal morbidity defined as near miss', or 'a woman who nearly died by survived a complication that occurred during pregnancy, childbirth, or within 42 days or termination of pregnancy'.

Funding: Laerdal Foundation.

Information sheet with more detailed methods

EQUIP Expansion

Claudia Hanson, Stefan Peterson

Two studies will build on the original Expanded Quality Management Using Information Power (EQUIP) intervention to improve maternal and newborn mortality. One study aims to document community-oriented approaches to improve recognition and use of appropriate care-seeking for newborn and/or maternal complications in five countries, and the other will pilot the scale-up of the EQUIP approach. These two studies build on the EQUIP intervention to improve maternal and newborn mortality.

  • TRAction aims to achieve the systematic documentation of community-oriented approaches to improve recognition and use of appropriate care-seeking for newborn and/or maternal complications in five countries, including the EQUIP target countries of Uganda and Tanzania. The TRAction project provides resources for an improved understanding of what the EQUIP project was able to achieve in the community. Using qualitative research we aim to understand and document changes in the identification of potentially life-threatening complications, as well as timely and appropriate care-seeking in intervention and comparison districts. Funding: USAID
  • QUADS: The Quality Improvement for Maternal and Newborn Health at District-level Scale in Mtwara Region, Tanzania, will pilot the scale-up of the EQUIP approach within Mtwara region. EQUIP was implemented only in one intervention district in both Uganda and Tanzania. The QUADS project aims to assess whether the resource intensive mentoring and coaching of quality improvement teams can be integrated into the district and regional support functions; how can quality improvement be integrated into pre-existing district health systems? We aim to produce a model that can be streamlined and integrated into existing structures within the Tanzania health system, eliminating the resource-intensive external facilitation, which characterizes most quality improvement initiatives, and which limit their scale-up. The project will be evaluated using a realist evaluation throughout the intervention, based on internal monitoring, improved health management information system data on coverage and outcomes, among others.

Funding: CIHR and IDRC



We are organising the course: Maternal and Child Health in a global perspective within the MSc Global Health

Translational research project together with SciLife laboratory to develop and evaluate new point of care (POC) diagnostics for infectious diseases, focusing on CNS infections in Uganda