Claudia Hanson
Biographic Data
| ID | 6330385 |
|---|---|
| NAME | Claudia Hanson |
| GIVEN NAMES | Claudia |
| FAMILY NAME | Hanson |
| SIGNATURE | HANSON C |
| AFFILIATIONS | Karolinska Institutet |
| ORCID | 0000-0001-8066-7873 |
| VERIFIED | Yes |
| TOTAL WORKS | 51 |
| TOTAL CITATIONS | 6 |
| AUTHOR COUNT | 51 |
| EDITOR COUNT | 0 |
| FIRST PUBLICATION YEAR | 2008 |
| LATEST PUBLICATION YEAR | 2026 |
| H-INDEX | 2 |
(De)coding perinatal deaths
BACKGROUND: To reduce perinatal deaths, identification of their causes is paramount. 'The WHO application of ICD-10 to deaths during the perinatal period' (ICD-PM) was developed to improve the quality of perinatal death data. OBJECTIVES: To determine stillbirth and very early neonatal death rates across 16 hospitals in Benin, Malawi, Tanzania, and Uganda, examine causes of death and associated maternal conditions applying the ICD-PM, and assess h…
Implementation of a decision aid to promote shared decision-making on mode of birth in low-risk pregnant women
INTRODUCTION: Implementing shared decision-making (SDM) in maternity care remains challenging in low-income and middle-income countries (LMICs). Decision aids can support SDM, but evidence on their effectiveness in such settings is limited. We assessed the impact of a decision analysis tool (DAT) for pregnant women on mode of birth (MOB) within the QUALIty DECision-making project, a multisite, multicountry pragmatic trial to reduce unnecessary ca…
A missed opportunity
BACKGROUND: Cervical cancer causes morbidity and mortality among women worldwide, particularly in low- and middle-income countries (LMICs). Human Papillomavirus (HPV) vaccine is crucial for cervical cancer prevention, yet the vaccination rates remain suboptimal in Ethiopia. Studies identified cultural and religious factors as key barriers. While evidence suggests that faith leaders can effectively promote public health interventions, their potent…
“Implementing a policy is something else”. Governance of a complex health management information system and its digitalization in Tanzania
Health management information systems are crucial for a country’s health service planning and monitoring. Research findings indicate however that data produced within this system is often of low quality or not used for decision-making in low-resource settings like Tanzania. Policymaking and -implementation towards efficient data processes and use take place in an environment challenged by limited availability of human and other resources, low lev…
The prevalence of mental health-related multimorbidity during pregnancy
Multimorbidity during pregnancy, defined as the co-occurrence of two or more physical or psychological conditions, is an emerging global health concern associated with adverse birth outcomes. This systematic review addresses gaps in research by determining the global pooled prevalence of mental health-related multimorbidity amongst pregnant women and identifying key populations at higher risk of this type of multimorbidity. This study adhered to …
Partial pictures
Measurement of contact coverage of maternal and newborn health services may overestimate the benefits of the care that is provided, because the quality of care is not captured. It is therefore important to better understand the opportunities and challenges of capturing elements of care quality in routine health information systems (RHIS). This study explored healthcare workers’ (HCWs), health sector managers’ and policymakers’ perspectives on the…
Reframing labour companionship
Labour companionship positively shapes childbirth experiences, offering continuous emotional and practical support to birthing people. In Argentina, companionship is protected by law, though implementation challenges remain. Gender norms and expectations can act as barriers to quality care. Addressing a gap in companionship literature, this paper explores gender representations perceived by male and female companions and health care providers at …
Dietary diversity insufficiently explains differences in prevalence of anaemia in pregnancy across regions in Nigeria
The prevalence of anaemia in pregnancy differs across regions worldwide. Previous studies have reported associations between diet and anaemia. Dietary intake may be affected by regional factors like culture, food production and availability. However, in Nigeria, the association between dietary diversity and region in the context of anaemia prevalence among pregnant women is unclear. This study compared the prevalence of anaemia in pregnancy acros…
Mixed vulnerabilities
Identification of interacting vulnerabilities is essential to reduce maternal and perinatal mortality in sub-Saharan Africa (SSA). High parity (≥ 5 previous births) is an underemphasized biological vulnerability linked to poverty and affecting a sizeable proportion of SSA births. Despite increased risk, high parity women rarely use hospitals for childbirth. We assessed whether emergency referral during childbirth was associated with adverse event…
Is an improvement in anaemia and iron levels associated with the risk of early postpartum depression? A cohort study from Lagos, Nigeria
Improvement in anaemia severity during late pregnancy was non-significantly associated with lower risk for postpartum depression; no association between improvement in iron levels and postpartum depression. It is likely that an improvement in anaemia severity in early pregnancy will lessen the burden of postpartum depression; however, this study is limited by sample size to draw this conclusion
Inequalities in use of hospitals for childbirth among rural women in sub-Saharan Africa
INTRODUCTION: Rising facility births in sub-Saharan Africa (SSA) mask inequalities in higher-level emergency care-typically in hospitals. Limited research has addressed hospital use in women at risk of or with complications, such as high parity, linked to poverty and rurality, for whom hospital care is essential. We aimed to address this gap, by comparatively assessing hospital use in rural SSA by wealth and parity. METHODS: Countries in SSA with…
Data for whom? Experiences and perceptions of a perinatal eRegistry in two hospitals in Mtwara region, Tanzania
INTRODUCTION: Digital data systems have the potential to improve data quality and provide individual-level information to understand gaps in the quality of care. This study explored experiences and perceptions of a perinatal eRegistry in two hospitals in Mtwara region, Tanzania. Drawing from realist evaluation and systems thinking, we go beyond a descriptive account of stakeholders' experiences and provide insight into key structural drivers and …
Knowledge gaps related to HIV and condom use for preventing pregnancy
We found significant knowledge gaps on HIV and condom use for preventing pregnancy among migrants in Sweden. Comprehensive sexual health education in language schools, along with information to newly arrived migrants from diverse regional backgrounds and targeted sexual health services to younger individuals, women, and those who lack sexual health education, are needed to address these information gaps and provide crucial SRHR education and info…
High Child Mortality and Interventions Coverage in the City of Dar es Salaam, Tanzania
The 'urban penalty' in health refers to the loss of a presumed survival advantage due to adverse consequences of urban life. This study investigated the levels and trends in neonatal, post-neonatal and under-5 mortality rate and key determinants of child survival using data from Tanzania Demographic and Health Surveys (TDHS) (2004/05, 2010 and 2015/16), AIDS Indicator Survey (AIS), Malaria Indicator survey (MIS) and health facility data in Tanzan…
Neonatal and perinatal mortality in the urban continuum
INTRODUCTION: Recent studies suggest that the urban advantage of lower neonatal mortality in urban compared with rural areas may be reversing, but methodological challenges include misclassification of neonatal deaths and stillbirths, and oversimplification of the variation in urban environments. We address these challenges and assess the association between urban residence and neonatal/perinatal mortality in Tanzania. METHODS: The Tanzania Demog…
Understanding maternity care providers’ use of data in Southern Tanzania
INTRODUCTION: Health information management system data is collected for national planning and evaluation but is rarely used for healthcare improvements at subnational or facility-level in low-and-middle-income countries. Research suggests that perceived data quality and lack of feedback are contributing factors. We aimed to understand maternity care providers' perceptions of data and how they use it, with a view to co-design interventions to imp…
Midwifery care providers’ childbirth and immediate newborn care competencies
Evidence-based quality care is essential for reducing sub-Saharan Africa’s high burden of maternal and newborn mortality and morbidity. Provision of quality care results from interaction between several components of the health system including competent midwifery care providers and the working environment. We assessed midwifery care providers’ ability to provide quality intrapartum and newborn care and selected aspects of the working environment…
Feasibility, usability and acceptability of a novel digital hybrid-system for reporting of routine maternal health information in Southern Tanzania
Health information systems are important for health planning and progress monitoring. Still, data from health facilities are often of limited quality in Low-and-Middle-Income Countries. Quality deficits are partially rooted in the fact that paper-based documentation is still the norm at facility level, leading to mistakes in summarizing and manual copying. Digitization of data at facility level would allow automatization of these procedural steps…
Implementing the Quali-DEC project in Argentina, Burkina Faso, Thailand and Viet Nam
The project ‘Quality Decision-making by women and providers’ (QUALI-DEC) combines four non-clinical interventions to promote informed decision-making surrounding mode of birth, improve women’s birth experiences, and reduce caesarean sections among low-risk women. QUALI-DEC is currently being implemented in 32 healthcare facilities across Argentina, Burkina Faso, Thailand, and Viet Nam. In this paper, we detail implementation processes and the pla…
Knowledge of the abortion law and key legal issues of sexual and reproductive health and rights among recently arrived migrants in Sweden
We found a substantial lack of knowledge among migrants of reproductive age in Sweden regarding important laws and policies of SRHR, particularly the right to abortion. SRHR-related programmes and comprehensive sexual health education for recently arrived migrants could include components to increase knowledge of legal and safe abortions and other laws concerning SRHR
Impact of the Covid-19 pandemic on access to and utilisation of services for sexual and reproductive health
INTRODUCTION: The COVID-19 pandemic has negatively impacted health systems globally and widened preexisting disparities. We conducted a scoping review on the impact of the COVID-19 pandemic on women and girls' access to and utilisation of sexual and reproductive health (SRH) services for contraception, abortion, gender-based and intimate partner violence (GBV/IPV) and sexually transmitted infections (STIs). METHODS: We systematically searched pee…
A growing disadvantage of being born in an urban area? Analysing urban–rural disparities in neonatal mortality in 21 African countries with a focus on Tanzania
INTRODUCTION: Neonatal mortality rate (NMR) has been declining in sub-Saharan African (SSA) countries, where historically rural areas had higher NMR compared with urban. The 2015-2016 Demographic and Health Survey (DHS) in Tanzania showed an exacerbation of an existing pattern with significantly higher NMR in urban areas. The objective of this study is to understand this disparity in SSA countries and examine the specific factors potentially unde…
Caesarean section or vaginal delivery for low-risk pregnancy? Helping women make an informed choice in low- and middle-income countries
Women’s fear and uncertainty about vaginal delivery and lack of empowerment in decision-making generate decision conflict and is one of the main determinants of high caesarean section rates in low- and middle-income countries (LMICs). This study aims to develop a decision analysis tool (DAT) to help pregnant women make an informed choice about the planned mode of delivery and to evaluate its acceptability in Vietnam, Thailand, Argentina, and Burk…
Operationalising effective coverage measurement of facility based childbirth in Gombe State; a comparison of data sources
Estimating effective coverage of childbirth care requires linking population based data sources to health facility data. For effective coverage to gain widespread adoption there is a need to focus on the feasibility of constructing these measures using data typically available to decision makers in low resource settings. We estimated effective coverage of childbirth care in Gombe State, northeast Nigeria, using two different combinations of facil…
No increase in use of hospitals for childbirth in Tanzania over 25 years
Improving childbirth care in rural settings in sub-Saharan Africa is essential to attain the commitment expressed in the Sustainable Development Goals to leave no one behind. In Tanzania, the period between 1991 and 2016 was characterized by health system expansion prioritizing primary health care and a rise in rural facility births from 45% to 54%. Facilities however are not all the same, with advanced management of childbirth complications gene…
Assessing scalability of an intervention
Public health interventions should be designed with scale in mind, and researchers and implementers must plan for scale-up at an early stage. Yet, there is limited awareness among researchers of the critical value of considering scalability and relatively limited empirical evidence on assessing scalability, despite emerging methodological guidance. We aimed to integrate scalability considerations in the design of a study to evaluate a multi-compo…
How people-centred health systems can reach the grassroots
BACKGROUND: Quality improvement (QI) methods engage stakeholders in identifying problems, creating strategies called change ideas to address those problems, testing those change ideas and scaling them up where successful. These methods have rarely been used at the community level in low-income country settings. Here we share experiences from rural Tanzania and Uganda, where QI was applied as part of the Expanded Quality Management Using Informati…
Harnessing the health systems strengthening potential of quality improvement using realist evaluation
Quality improvement (QI) is a problem-solving approach in which stakeholders identify context-specific problems and create and implement strategies to address these. It is an approach that is increasingly used to support health system strengthening, which is widely promoted in Sub-Saharan Africa. However, few QI initiatives are sustained and implementation is poorly understood. Here, we propose realist evaluation to fill this gap, sharing an exam…
HIV control in low-income countries in sub-Saharan Africa
HIV control efforts in sub-Saharan Africa meet with difficulties. Incidence and prevalence remains high, and little behaviour change seems to have taken place. The focus on HIV control has shifted to anti-retroviral therapy (ART), although this is unlikely either to be cost-effective or the reduce the incidence of HIV. There is reason to change the current approach. Three questions arise: Is there a need to adjust the view on the determinants of …
Differences in essential newborn care at birth between private and public health facilities in eastern Uganda
BACKGROUND: In Uganda and elsewhere, the private sector provides an increasing and significant proportion of maternal and child health services. However, little is known whether private care results in better quality services and improved outcomes compared to the public sector, especially regarding care at the time of birth. OBJECTIVE: To describe the characteristics of care-seekers and assess newborn care practices and services received at publi…
Beyond too little, too late and too much, too soon
Community based maternal and newborn care economic analysis
Despite health systems improvements in Tanzania, gaps in the continuum of care for maternal, newborn and child health persist. Recent improvements have largely benefited those over one month of age, leading to a greater proportion of under-five mortality in newborns. Community health workers providing home-based counselling have been championed as uniquely qualified to reach the poorest. We provide financial and economic costs of a volunteer home…
Delaying first birth
Delayers of first birth have very high unmet needs for modern contraceptives and they should be routinely and separately categorised and measured within nationally-representative surveys such as Demographic and Health Survey and Multiple Indicator Cluster surveys. Acknowledging their unique needs could help catalyse a programmatic response
Ready to deliver maternal and newborn care? Health providers’ perceptions of their work context in rural Mozambique
BACKGROUND: Deficiencies in the provision of evidence-based obstetric care are common in low-income countries, including Mozambique. Constraints relate to lack of human and financial resources and weak health systems, however limited resources alone do not explain the variance. Understanding the healthcare context ahead of implementing new interventions can inform the choice of strategies to achieve a successful implementation. The Context Assess…
The Effect of Seasonal Floods on Health
There is limited knowledge on the effect of seasonal flooding on health over time. We quantified the short- and long-term effects of floods on selected health indicators at public healthcare facilities in 11 districts in Cambodia, a flood-prone setting. Counts of inpatient discharge diagnoses and outpatient consultations for diarrhea, acute respiratory infections, skin infections, injuries, noncommunicable diseases and vector-borne diseases were …
Hand hygiene in hospitals
Retrospectively registered with Clinical Trials Registry- India ( CTRI/2018/04/013014 )
How people-centred health systems can reach the grassroots
BACKGROUND: Quality improvement (QI) methods engage stakeholders in identifying problems, creating strategies called change ideas to address those problems, testing those change ideas and scaling them up where successful. These methods have rarely been used at the community level in low-income country settings. Here we share experiences from rural Tanzania and Uganda, where QI was applied as part of the Expanded Quality Management Using Informati…
“Every Newborn-BIRTH” protocol
BACKGROUND: - Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study aims to validate selected newborn and maternal indicators for routine tracking of coverage and quality of facility-based care for use at district, national and global levels. METHODS: EN-BIRTH is an observational study including >20 000 facility births in three countries (Tanzania, Bangladesh and Nepal) to validate selected indicators. Direct clinical observation will …
Evaluation of the Safe Care, Saving Lives (SCSL) quality improvement collaborative for neonatal health in Telangana and Andhra Pradesh, India
BACKGROUND: The collaborative quality improvement approach proposed by the Institute for Healthcare Improvement has the potential to improve coverage of evidence-based maternal and newborn health practices. The Safe Care, Saving Lives initiative supported the implementation of 20 evidence-based maternal and newborn care practices, targeting labour wards and neonatal care units in 85 public and private hospitals in Telangana and Andhra Pradesh, In…
Assessing scalability of an intervention
Public health interventions should be designed with scale in mind, and researchers and implementers must plan for scale-up at an early stage. Yet, there is limited awareness among researchers of the critical value of considering scalability and relatively limited empirical evidence on assessing scalability, despite emerging methodological guidance. We aimed to integrate scalability considerations in the design of a study to evaluate a multi-compo…
Postneonatal under-5 mortality in peri-urban and rural Eastern Uganda, 2005–2015
INTRODUCTION: Community and individual sociodemographic characteristics play an important role in child survival. However, a question remains how urbanisation and demographic changes in sub-Saharan Africa affect community-level determinants for child survival. METHODS: Longitudinal data from the Iganga/Mayuge Health and Demographic Surveillance Site was used to obtain postneonatal under-5 mortality rates between March 2005 and February 2015 in pe…
Health system redesign for equity in maternal and newborn health must be codesigned, country led, adapted to context and fit for purpose
No Abstract available. Comment
Staying afloat
INTRODUCTION: Resilient health systems have the capacity to continue providing health services to meet the community's diverse health needs following floods. This capacity is related to how the community manages its own health needs and the community and health system's joined capacities for resilience. Yet little is known about how community participation influences health systems resilience. The purpose of this study was to understand how commu…
“We do what we can do to save a woman” health workers’ perceptions of health facility readiness for management of postpartum haemorrhage
Background: In many low-resource settings, in-service training is a common strategy to improve the performance of health workers and ultimately reduce the persistent burden of maternal mortality and morbidities. An evaluation of the Helping Mothers Survive Bleeding After Birth (HMS BAB) training as a single-component intervention in Tanzania found some positive albeit limited effect on clinical management and reduction of postpartum haemorrhage (…
Neurodevelopmental outcomes of preterm babies during infancy in Eastern Uganda
BACKGROUND: Complications due to prematurity are a threat to child survival and full developmental potential particularly in low-income settings. OBJECTIVE: The aim of the study was to determine the neurodevelopmental outcomes among preterm infants and identify any modifiable factors associated with neurodevelopmental disability (NDD). METHODS: We recruited 454 babies (242 preterms with birth weight <2.5 kg, and 212 term babies) in a cohort study…
Fetal heart rate monitoring practices at a public hospital in Northern Uganda – what health workers document, do and say
When compared to national and international guidelines, FHR monitoring is sub-optimal in the studied setting. Approximately one in four women was not monitored during the first stage of labor. Barriers to appropriate FHR monitoring included shortage of staff and devices, institutional challenges and mother's negative attitudes. These barriers need to be addressed in order to reduce neonatal mortality
Harnessing the health systems strengthening potential of quality improvement using realist evaluation
Quality improvement (QI) is a problem-solving approach in which stakeholders identify context-specific problems and create and implement strategies to address these. It is an approach that is increasingly used to support health system strengthening, which is widely promoted in Sub-Saharan Africa. However, few QI initiatives are sustained and implementation is poorly understood. Here, we propose realist evaluation to fill this gap, sharing an exam…
Mismatched ambition, execution and outcomes
BACKGROUND: Since 2015, Tanzania has been implementing the Maternal Death Surveillance and Response (MDSR) system. The system employs interactions of health providers and managers to identify, notify and review maternal deaths and recommend strategies for preventing further deaths. We aimed to analyse perceptions and experiences of health providers and managers in implementing the MDSR system. METHODS: An exploratory qualitative study was carried…
Essential Emergency and Critical Care
BACKGROUND: Globally, critical illness results in millions of deaths every year. Although many of these deaths are potentially preventable, the basic, life-saving care of critically ill patients are often overlooked in health systems. Essential Emergency and Critical Care (EECC) has been devised as the care that should be provided to all critically ill patients in all hospitals in the world. EECC includes the effective care of low cost and low co…
National health governance, science and the media
The COVID-19 pandemic is an unprecedented global crisis in which governments had to act in a situation of rapid change and substantial uncertainty. The governments of Germany, Sweden and the UK have taken different paths allowing learning for future pandemic preparedness. To help inform discussions on preparedness, inspired by resilience frameworks, this paper reviews governance structures, and the role of science and the media in the COVID-19 re…
Abortion-related near-miss morbidity and mortality in 43 health facilities with differences in readiness to provide abortion care in Uganda
INTRODUCTION: With a view to inform policy for improved postabortion care, we describe abortion-related near-miss and mortality by sociodemographic risk factors and management options by pregnancy trimester in Uganda. METHODS: This secondary data analysis used an adapted WHO near-miss methodology to collect cross-sectional maternal near-miss and abortion complications data at 43 health facilities in Central and Eastern Uganda in 2016-2017. We com…
Inequity in uptake of hospital-based childbirth care in rural Tanzania
Proportions of facility births are increasing throughout sub-Saharan Africa, but obstetric services vary within the health system. In Tanzania, advanced management of childbirth complications (comprehensive emergency obstetric care) is offered in hospitals, while in frontline, primary health care (PHC) facilities (health centres and dispensaries) mostly only routine childbirth care is available. With over half (54%) of rural births in facilities,…
Impact of the Covid-19 pandemic on access to and utilisation of services for sexual and reproductive health
INTRODUCTION: The COVID-19 pandemic has negatively impacted health systems globally and widened preexisting disparities. We conducted a scoping review on the impact of the COVID-19 pandemic on women and girls' access to and utilisation of sexual and reproductive health (SRH) services for contraception, abortion, gender-based and intimate partner violence (GBV/IPV) and sexually transmitted infections (STIs). METHODS: We systematically searched pee…
Medicine (43 works) · Global Maternal and Child Health (37 works) · Environmental health (26 works) · Health care (23 works) · Nursing (23 works) · Tanzania (20 works) · Economic growth (19 works) · Pregnancy (17 works) · Population (16 works) · Public health (15 works)