Lars-Åke Persson

Lars-Åke Persson
London School of Hygiene and Tropical Medicine | LSHTM · Department of Disease Control

MD PhD, Professor

About

342
Publications
53,679
Reads
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15,013
Citations
Citations since 2017
64 Research Items
5316 Citations
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20172018201920202021202220230200400600800
20172018201920202021202220230200400600800
20172018201920202021202220230200400600800
Additional affiliations
March 2003 - present
Uppsala University
Position
  • Professor
January 1999 - March 2003
International Centre for Diarrhoeal Disease Research, Bangladesh
Position
  • Division Director

Publications

Publications (342)
Preprint
Full-text available
Background Universal coverage of evidence-based interventions for perinatal health could prevent most deaths, particularly if entire communities were engaged in the implementation. Social innovations may provide creative solutions to healthcare challenges, but their implementation relies on engaging communities and health system actors. This proof-...
Article
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Objective A routine health information system (RHIS) enables decision making in the healthcare system. We aimed to analyse data quality at the district and regional level and explore factors and perceptions affecting the quality and use of routine data. Design This was a mixed-methods study. We used the WHO toolkit for analysing data quality and i...
Article
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Background We aimed to identify the 2001–2013 incidence trend, and characteristics associated with adolescent pregnancies reported by 20–24-year-old women. Methods A retrospective analysis of the Cuatro Santos Northern Nicaragua Health and Demographic Surveillance 2004–2014 data on women aged 15–19 and 20–24. To calculate adolescent birth and preg...
Preprint
Full-text available
Background In earlier studies, we could show that rural Ethiopian maternal health services were distributed pro-rich, while child immunization coverage was equitably distributed. Hence, this study aimed at exploring rural Ethiopian mothers’ and primary healthcare workers’ perceptions of inequities and their causes in the provision and utilization o...
Article
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Background Community health workers and volunteers are vital for the achievement of Universal Health Coverage also in low-income countries. Ethiopia introduced community volunteers called women’s development group leaders in 2011. These women have responsibilities in multiple sectors, including promoting health and healthcare seeking. Objective We...
Article
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Background We have shown that Ethiopian primary healthcare providers refer only half of the severely sick children who, according to guidelines, should get an urgent referral. Frequently parents of referred ill children don’t bring their children to the next level. We aimed to describe the referral of severely ill Ethiopian children based on primar...
Article
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Background: Millions of individuals worldwide, particularly in Bangladesh, are exposed to arsenic, mainly through drinking water from tube wells. Arsenic is a reproductive toxicant, but there is limited knowledge of whether it influences pubertal development. Objectives: We evaluated the association between prenatal arsenic exposure and age at mena...
Article
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Objective The health system context influences the implementation of evidence-based practices and quality of healthcare services. Ethiopia aims at reaching universal health coverage but faces low primary care utilisation and substandard quality of care. We assessed the health extension workers’ perceived context and the preparedness of health posts...
Article
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Context and objective Ethiopia’s primary care has a weak referral system for sick children. We aimed to identify health post and child factors associated with referrals of sick children 0–59 months of age and evaluate the healthcare providers’ adherence to referral guidelines. Design A cross-sectional facility-based survey. Setting This study inc...
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Introduction: Ethiopian Health Extension Workers provide facility-based and outreach services, including home visits to manage sick children, aiming to increase equity in service coverage. Little is known about the scope of the outreach services and caregivers' and health workers' perceptions of these services. We aimed at exploring mothers' and h...
Article
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Many routine health information systems (RHIS) show persistent gaps between recording and reporting data and their effective use in solving problems. Strengthening RHIS has become a global priority to track and address national health goals. In Ethiopia, the Ministry of Health and Bill & Melinda Gates Foundation introduced the Operational Research...
Article
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Background Due to low care utilization, a complex intervention was done for two years to optimize the Ethiopian Health Extension Program. Improved quality of the integrated community case management services was an intermediate outcome of this intervention through community education and mobilization, capacity building of health workers, and streng...
Preprint
Full-text available
Background: We have earlier shown that the utilization of Ethiopian maternal health services was distributed pro-rich, while child immunization was equitably distributed. Hence, this study aimed at exploring rural Ethiopian women’s and primary health care workers’ perceptions of inequities and their causes in the provision and utilization of matern...
Article
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Objective We assessed whether geographic distance and difference in altitude between home to health facility and household socioeconomic status were associated with utilisation of maternal and child health services in rural Ethiopia. Design Household and health facility surveys were conducted from December 2018 to February 2019. Setting Forty-six...
Article
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Background: Ethiopia is investing in the routine Health Management Information System. Improved routine data are needed for decision-making in the health sector. Objective: To analyse the quality of the routine Health Management Information System data and triangulate with other sources, such as the Demographic and Health Surveys. Methods: We analy...
Article
Full-text available
Background Women’s development group leaders are volunteer community health workers in Ethiopia who, among other duties, promote health and prevention of diseases. They link and extend essential health services from health posts to households. Objective To assess the characteristics, knowledge, and practice of women’s development group leaders in...
Article
Full-text available
Background A routine health information system is one of the essential components of a health system. Interventions to improve routine health information system data quality and use for decision-making in low- and middle-income countries differ in design, methods, and scope. There have been limited efforts to synthesise the knowledge across the cur...
Article
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Background: Care-seeking for sick children at the Ethiopian primary health care level is low. This problem may partly be due to unfavorable community perceptions of the quality of care provided. There is, however, limited knowledge on the quality of the clinical assessment and management provided by the health extension workers at the health posts...
Article
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Introduction: Ethiopia successfully reduced mortality in children below 5 years of age during the past few decades, but the utilisation of child health services was still low. Optimising the Health Extension Programme was a 2-year intervention in 26 districts, focusing on community engagement, capacity strengthening of primary care workers and rei...
Article
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An intervention called 'Optimising the Health Extension Program', aiming to increase care-seeking for childhood illnesses in four regions of Ethiopia, was implemented between 2016 and 2018, and it included community engagement, capacity building, and district ownership and accountability. A pragmatic trial comparing 26 districts that received the i...
Article
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Background: Quality of care depends on system, facility, provider, and client-level factors. We aimed at examining structural and process quality of services for sick children and its association with client satisfaction at health facilities in Ethiopia. Methods: Data from the Ethiopia Service Provision Assessment Plus (SPA+) survey 2014 were us...
Article
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Aim Ethiopia has implemented the integrated Community Case Management to reduce mortality in childhood diseases. We analysed prevention, care‐seeking, and treatment of suspected pneumonia from household to health facility in Ethiopia. Methods Analyses were based on a survey in four regions that included modules covering 5714 households, 169 health...
Article
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Background: By expanding primary health care services, Ethiopia has reduced under-five mor4tality. Utilisation of these services is still low, and concerted efforts are needed for continued improvements in newborn and child survival. "Optimizing the Health Extension Program" is a complex intervention based on a logic framework developed from an an...
Article
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Aim: This study aimed at assessing the referral of sick young infants and children from the community, health posts, and health centres to higher levels. Methods: A cross-sectional survey was conducted in four of the largest Ethiopian regions from December 2016 to February 2017. Referral practices were assessed at each level in 46 districts of t...
Article
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AIM: This study aimed at assessing the referral of sick young infants and children from the community, health posts, and health centres to higher levels. METHODS: A cross-sectional survey was conducted in four of the largest Ethiopian regions from December 2016 to February 2017. Referral practices were assessed at each level in 46 districts of the...
Article
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We identified clusters of multiple dimensions of poverty according to the capability approach theory by applying data mining approaches to the Cuatro Santos Health and Demographic Surveillance database, Nicaragua. Four municipalities in northern Nicaragua constitute the Cuatro Santos area, with 25,893 inhabitants in 5,966 households (2014). A local...
Article
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Background: Despite the pro-poor health policies in Ethiopia, the utilization of maternal, neonatal, and child health services remains a challenge for the country. Health equity became central in the post-2015 Sustainable Development Goals globally and is a priority for Ethiopia. The aim of this study was to assess equity in utilization of a range...
Article
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Background: Maternal and child health (MCH) care utilization often vary with geographic location. We analyzed the geographic distribution and determinants of utilization of four or more antenatal care visits, health facility delivery, child immunization, and care utilization for common childhood illnesses across four Ethiopian regions. Methods:...
Article
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Background: In order to further identify the needed interventions for continued poverty reduction in our study area Cuatro Santos, northern Nicaragua, we aimed to elucidate what predicts poverty, measured by the Unsatisfied Basic Need index. This analysis was done by using decision tree methodology applied to the Cuatro Santos health and demograph...
Article
In South Asia, maternal and child undernutrition is common with consequences for short- and long-term health. In the MINIMat trial (Maternal and Infant Nutrition Interventions in Matlab) in Bangladesh 4436 pregnant women were allocated to early or later start of food supplements and different micronutrient alternatives. Children of mothers who rece...
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The Guest Editors for the PLOS Medicine Special Issue on Maternal and Child Health & Nutrition discuss the published research in the context of global priorities for women's and children's health.
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Introduction Preterm birth is the major cause of under-five mortality. Population-based data on determinants and proportions of children born preterm are limited, especially from low-income countries. This study aimed at assessing time trends and social, reproductive and environmental determinants of preterm births based on a population-based pregn...
Article
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Introduction WHO has set a goal to reduce the prevalence of stunted child growth by 40% by the year 2025. To reach this goal, it is imperative to establish the relative importance of risk factors for stunting to deliver appropriate interventions. Currently, most interventions take place in late infancy and early childhood. This study aimed to ident...
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Aim: This paper aimed to analyse the association between small for size at birth, stunting, recovery from stunting, and pubertal development in a rural Bangladeshi cohort. Methods: The participants were 994 girls and 987 boys whose mothers participated in the Maternal and Infant Nutrition Interventions in Matlab trial. The birth cohort was follo...
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Aim The Ethiopian primary care of sick children is provided within the integrated Community Case Management of childhood illnesses by Health Extension Workers (HEW). There is limited knowledge whether this cadre correctly assess and classify common diseases. The aim was to study their ability to correctly classify common childhood illnesses. Metho...
Article
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Inadequate micronutrient intakes are relatively common in low‐ and middle‐income countries (LMICs), especially among pregnant women, who have increased micronutrient requirements. This can lead to an increase in adverse pregnancy and birth outcomes. This review presents the conclusions of a task force that set out to assess the prevalence of inadeq...
Preprint
Full-text available
We aimed to describe multiple dimensions of poverty according to the capability approach theory by applying data mining approaches to the Cuatro Santos Health and Demographic Surveillance databases, Nicaragua. Four municipalities in northern Nicaragua constitute the Cuatro Santos area, with 25,893 inhabitants in 5,966 households (2014). A local pro...
Article
Full-text available
Background: Access to food is a basic necessity, and food insecurity may impair the individual's well-being and health. Self-rated health measurements have frequently been used to assess population health. Little is known, however, as to whether food security is associated with self-rated health in low- and middle-income settings. This study aims...
Article
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Despite its clear biological benefits, many infants globally do not receive exclusive breastfeeding. In a Guest Editorial, Lars Åke Persson discusses what is needed to make breastfeeding the social norm.
Article
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Background Little is know about whether the effects of community engagement interventions for child survival in low-income and middle-income settings are sustained. Seasonal variation and secular trend may blur the data. Neonatal mortality was reduced in a cluster-randomised trial in Vietnam where laywomen facilitated groups composed of local stake...
Article
Full-text available
Introduction Nutrition interventions may have favourable as well as unfavourable effects. The Maternal and Infant Nutrition Interventions in Matlab (MINIMat), with early prenatal food and micronutrient supplementation, reduced infant mortality and were reported to be very cost-effective. However, the multiple micronutrients (MMS) supplement was ass...
Data
Incremental cost-effectiveness ratios (ICERs) for cost per DALY averted for the different MINIMat prenatal food and micronutrient supplementation arms, disability weight 0.024. (DOCX)
Chapter
Over the past 25 years of the Millennium Development Goal (MDG) era, the global figure of mortality in children under the age of 5 has dropped from 90 to 43 per 1,000 live births. The progress has been slower in terms of improvement in neonatal survival, reduction of stillbirths, and improvement in nutritional status of children. A wide range of co...
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In a Perspective, Lars Åke Persson discusses the need to focus on quality of care to improve maternal, newborn, and child healthcare.
Article
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Epidemiological studies have suggested a negative association between early life arsenic exposure and fetal size at birth, and subsequently with child morbidity and growth. However, our understanding of the relationship between arsenic exposure and morbidity and growth is limited. This paper aims to systematically review original human studies with...
Article
Full-text available
Background: Micronutrient deficiencies are common among women in low-income and middle-income countries. Data from randomised trials suggest that maternal multiple micronutrient supplementation decreases the risk of low birthweight and potentially improves other infant health outcomes. However, heterogeneity across studies suggests influence from e...
Article
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This paper presents an initiative to revive the previous Somali–Swedish Research Cooperation, which started in 1981 and was cut short by the civil war in Somalia. A programme focusing on research capacity building in the health sector is currently underway through the work of an alliance of three partner groups: six new Somali universities, five Sw...
Article
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Aim: A previous maternal and infant nutrition intervention in rural Matlab, Bangladesh, showed that prenatal nutrient supplements improved child survival, but had no effect on size at birth. This secondary analysis examined if prenatal multiple micronutrient supplements (MMS), on their own or combined with an early invitation to receive prenatal f...
Article
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Background Perinatal audit and the three-delays model are increasingly being employed to analyse barriers to perinatal health, at both community and facility level. Using these approaches, our aim was to assess factors that could contribute to perinatal mortality and potentially avoidable deaths at Rwandan hospitals. Methods Perinatal audits were c...
Article
Full-text available
Analysing child mortality may enhance our perspective on global achievements in child survival. We used data from surveillance sites in Bangladesh, Nicaragua and Vietnam and Demographic Health Surveys in Rwanda to explore the development of neonatal and under‐five mortality. The mortality curves showed dramatic reductions over time, but child morta...
Article
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Background: In a post-war frontier area in north-western Nicaragua that was severely hit by Hurricane Mitch in 1998, local stakeholders embarked on and facilitated multi-dimensional development initiatives to break the cycles of poverty. Objective: The aim of this paper is to describe the process of priority-setting, and the strategies, guiding pri...
Article
Full-text available
This paper presents an initiative to revive the previous Somali-Swedish Research Cooperation, which started in 1981 and was cut short by the civil war in Somalia. A programme focusing on research capacity building in the health sector is currently underway through the work of an alliance of three partner groups: six new Somali universities, five Sw...
Article
Full-text available
Background Fetal nutritional insults may alter the later metabolic phenotype. We hypothesized that early timing of prenatal food supplementation and multiple micronutrient supplementation (MMS) would favourably influence childhood metabolic phenotype. Methods : Pregnant women recruited 1 January to 31 December 2002 in Matlab, Bangladesh, were rand...
Article
Full-text available
Aim It is unknown whether maternal malnutrition reduces the effect of counselling on exclusive breastfeeding. This study evaluated the effect of breastfeeding counselling on the duration of exclusive breastfeeding, and whether the timing of prenatal food and different micronutrient supplements further prolonged this duration. Methods Pregnant wome...