Papers by Geir Gunnlaugsson
Development Studies Research, 2018
There is increased emphasis on donor engagement in the world's poorest and most fragile states, b... more There is increased emphasis on donor engagement in the world's poorest and most fragile states, but aid modalities tend to differ depending on the recipient countries' governance. In fragile states, donors often bypass governments and collaborate with non-state development actors (NGOs) to prevent aid capture, improve effective delivery and increase effectiveness. Based on ethnographic fieldwork over 20 months in 2009-2012, the aim of this paper is to explore the role of NGOs in community-based primary healthcare vis-à-vis the Ministry of Health in Guinea-Bissau. Revitalization of Guinea-Bissau's formerly extensive community healthcare services was initiated in 2010. The Ministry of Health, in charge of its implementation, emphasized ownership, harmonization and alignment that created tension with NGOs. However, as a result of a military coup in 2012, donors bypassed the Ministry and gave NGOs a central role. Through the voices of stakeholders, this paper outlines donors' dilemmas in a situation of state fragility. They found NGO-ization reasonable to protect funds and secure implementation while some worried that it might counteract alignment, harmonization, ownership and sustainability. The paper argues that aid to the health sector in fragile states needs to be long-term and predictable.
International Journal of Environmental Research and Public Health
The COVID-19 pandemic affected the lives of children in a myriad of ways across the world. It exp... more The COVID-19 pandemic affected the lives of children in a myriad of ways across the world. It exposed and aggravated existing inequalities between children within countries and across continents and hampered education. In Guinea-Bissau, school closure was one of the first restrictions implemented to confront the emerging pandemic. The aim was to describe and analyse the experiences of adolescents of school closures in the capital Bissau, their concerns about their future and manifestations of inequality. Data were collected by semi-structured, open-ended interviews with 30 adolescents aged 15–17 years three months into the pandemic during an enforced state of emergency. A thematic analysis identified five themes: appreciation of education, feeling left behind, being stuck in confinement, suggestions for support, and a disrupted future. The results highlight global rather than local inequalities in the demographic, manifested by a lack of targeted educational support for public and p...
Archives of Disease in Childhood, Oct 15, 2015
After rapid economic growth, more than 90% of the Icelandic banking system collapsed within 2 wee... more After rapid economic growth, more than 90% of the Icelandic banking system collapsed within 2 weeks in October 2008. A severe economic crisis of historic proportion ensued from which Iceland is still recovering. To protect those most vulnerable, governmental response included policy measures aimed to address the needs of children, families, the elderly, those on social benefits and the unemployed. By the maintenance of free universal healthcare for pregnant women and children, child health has been preserved. Six years later, there is little notable impact of the crisis on key child health indicators. Yet, the proportion of children born small-for-gestational age increased from 2.0% to 3.4%. One important pillar for the outcome is the good coverage and easy access to universal healthcare, educational and social services with highly qualified professionals. Iceland has shown that, by protecting the most vulnerable and maintaining universal access to healthcare, children's health and well-being can be maintained during an economic crisis.
Research Square (Research Square), Mar 11, 2020
Objectives : To analyse the impact of austerity measures taken by European governments as a respo... more Objectives : To analyse the impact of austerity measures taken by European governments as a response to the 2008 economic and financial crisis on social determinants and child health (SDCH), and child health outcomes (CHO). Methods : A systematic literature review was carried out in Medline (Ovid), Embase, Web of Science, PsycInfo, and Sociological abstracts in the last 5 years from European countries. Studies aimed at analysing the Great Recession, governments' responses to the crisis, and its impact on SDCH were included. A narrative synthesis of the results was carried out. The risk of bias was assessed using the STROBE and EPICURE tools. Results : Fourteen studies were included, most of them with a low to intermediate risk of bias (average score 72.1%). Government responses to the crisis varied, although there was general agreement that Greece, Spain, Ireland and the United Kingdom applied higher levels of austerity. High austerity periods, compared to pre-austerity periods were associated with increased material deprivation, child poverty rates, and low birth weight. Increasing child poverty subsequent to austerity measures was associated with deterioration of child health. High austerity was also related to poorer access and quality of services provided to disabled children. An annual reduction of 1% on public health expenditure was associated to 0.5% reduction on Measles-Mumps-Rubella vaccination coverage in Italy. Conclusions : Countries that applied high level of austerity showed worse trends on SDCH and CHO. European governments must act urgently and reverse these austerity policy measures that are detrimental to family benefits and child protection.
Nordicum-Mediterraneum, 2019
Flóttamannastofnun Sameinuðu þjóðanna (UNHCR) áætlar að á árinu 2017 hafi um 68,5 milljónir einst... more Flóttamannastofnun Sameinuðu þjóðanna (UNHCR) áætlar að á árinu 2017 hafi um 68,5 milljónir einstaklinga verið á flótta, þar af sé rúmlega helmingur börn (UNHCR, 2018). Umsækjandi um alþjóðlega vernd er hver sá sem hefur flúið heimaríki sitt og sótt um að fá viðurkennda stöðu flóttamanns og dvalarleyfi hjá stjórnvöldum annars ríkis (Rauði krossinn, e.d.). Mikil aukning hefur orðið á slíkum umsóknum á Íslandi undanfarið og er nokkur fjöldi barnafjölskyldna þar á meðal. Árið 2015 voru 79 börn á meðal umsækjenda um alþjóðlega vernd, 249 börn ári seinna (Útlendingastofnun, 2017) og 156 börn árið 2017 (Útlendingastofnun, 2018). Árið 2018 voru 166 börn meðal umsækjenda (Útlendingastofnun, 2019) en þessar tölur eiga við um börn sem leitað hafa alþjóðlegrar verndar í fylgd með foreldrum sínum eða forráðamönnum. Þann 1. janúar 2017 tóku gildi ný lög á Íslandi um útlendinga, nr. 80/2016, þar sem lögð er aukin áhersla á sjálfstæð réttindi barna miðað við fyrri lög um útlendinga nr. 96/2002. Helsta réttarfarsbótin er í 25. grein laganna en þar kemur fram að „barni sem getur myndað eigin skoðanir skal tryggður réttur til að tjá sig í máli sem það varðar og skal tekið tillit til skoðana þess í samræmi við aldur og þroska“ (Lög um útlendinga nr. 80/2016). Að auki er réttarstaða fylgdarlausra barna skýrð og komið er á rétti til fjölskyldusameiningar fyrir fylgdarlaus börn sem hafa fengið vernd. Tekið er fram að bestu hagsmunir barnsins skulu alltaf hafðir að leiðarljósi en ekki hafa verið sett upp viðmið um hvernig meta skuli hagsmuni barna. Mikilvægt er að huga að réttindum barna sem sækja um alþjóðlega vernd á Íslandi í fylgd foreldra og að rödd þeirra heyrist og að á þau sé hlustað. Markmið rannsóknarinnar er að lýsa og greina hvernig börn og foreldrar upplifa umsóknarferlið um alþjóðlega vernd hér á landi og áhrif þessarar reynslu á sálfélagslega vellíðan þeirra. Uppfyllir umsóknarferlið ákvæði um réttindi barna í samræmi við Barnasáttmála Sameinuðu þjóðanna? Ef ekki, að hvaða leyti er Barnasáttmálinn ekki uppfylltur? Fyrst er gerð grein fyrir stöðu barnafræða (e. childhood studies) og Barnasáttmála Sameinuðu þjóðanna með sérstöku tilliti til stöðu barna sem sækja um alþjóðlega vernd. Þá er aðferðafræðin kynnt og gerð grein fyrir niðurstöðum. Loks er staða barnanna skoðuð í alþjóðlegu samhengi og niðurstöður dregnar saman í lokaorðum.
The American Journal of Clinical Nutrition
International Journal of Educational Research
Acta Paediatrica
AimCritically review research methods used to elicit children and young people's views and ex... more AimCritically review research methods used to elicit children and young people's views and experiences in the first year of COVID‐19, using an ethical and child rights lens.MethodsA systematic search of peer‐reviewed literature on children and young people's perspectives and experiences of COVID‐19. LEGEND (Let Evidence Guide Every New Decision) tools were applied to assess the quality of included studies. The critical review methodology addressed four ethical parameters: (1) Duty of care; (2) Children and young people's consent; (3) Communication of findings; and (4) Reflexivity.ResultsTwo phases of searches identified 8131 studies; 27 studies were included for final analysis, representing 43,877 children and young people's views. Most studies were from high‐income countries. Three major themes emerged: (a) Whose voices are heard; (b) How are children and young people heard; and (c) How do researchers engage in reflexivity and ethical practice? Online surveys of chi...
BMJ Paediatrics Open
BackgroundWorldwide, governments have implemented restrictions on movement and gatherings to cont... more BackgroundWorldwide, governments have implemented restrictions on movement and gatherings to contain the COVID-19 pandemic. In the spirit of the Convention on the Rights of the Child, children have a right to express their opinion on matters of concern to them. The study aimed to describe and analyse how adolescents in the capital Bissau understood the unfolding COVID-19 pandemic and their lived experiences during the first 3 months of the pandemic.MethodsCollaborators identified participants in five urban areas in Bissau in June 2020. Semistructured, open-ended interviews were conducted with 30 adolescents aged 15–17 years, attending private and public schools or out-of-school. The interviews were conducted in Kriol, recorded, transcribed, translated and analysed.ResultsAll the participants were heavily affected by the confinement measures during a state of emergency. Almost all believed in the realness of coronavirus while there were some doubts about its arrival in the country. T...
BMJ Paediatrics Open, 2021
BackgroundCOVID-19 is mainly a disease of adults but can affect vulnerable children indirectly th... more BackgroundCOVID-19 is mainly a disease of adults but can affect vulnerable children indirectly through social containment measures. The study aimed to explore the impact of the pandemic on the lives of Quranic schoolboys, almudos, who beg on behalf of their teachers, chernos, in Guinea-Bissau.MethodsData were collected in July 2020 during a state of emergency. Data rest on semistructured interviews with 14 almudos and observations. The almudos, aged 12–16 years, were identified in the capital Bissau and the regional centre Gabú.ResultsFour interconnected themes were found. The first, hardship, was brought by the COVID-19 pandemic and caused by lockdown and police threats, resulting in a decrease in alms and hunger. The second, circumvention of calamity, included preventive measures the boys undertook and concerns with crowdedness impeding social distancing. Relations with others is the third theme. These had changed with sharply reduced contacts with neighbours and other providers o...
BJS Open, 2020
Background International guidelines in 2008 recommended orchidopexy for undescended testis at 6–1... more Background International guidelines in 2008 recommended orchidopexy for undescended testis at 6–12 months of age to reduce the risk of testicular cancer and infertility. Using administrative data from England, Finland, Ontario (Canada), Scotland and Sweden (with data from Victoria (Australia) and Iceland in supplementary analyses), the aim of this study was to investigate compliance with these guidelines and identify potential socioeconomic inequities in the timing of surgery before 1 and 3 years. Methods All boys born in 2003–2011 with a diagnosis code of undescended testis and procedure codes indicating orchidopexy before their fifth birthday were identified from administrative health records. Trends in the proportion of orchidopexies performed before 1 and 3 years of age were investigated, as were socioeconomic inequities in adherence to the guidelines. Results Across all jurisdictions, the proportion of orchidopexies occurring before the first birthday increased over the study p...
Final Oral/Poster Number, Nov 1, 2019
Aims Contemporary pathological processes leading to cardiovascular disease (CVD) are known to beg... more Aims Contemporary pathological processes leading to cardiovascular disease (CVD) are known to begin in childhood and young people (CYP), and this can be increased in a number of disease states. It is well established that mental health disorders in adults are strongly linked to CVD with increased associated mortality. Less is known about the associations between CVD risk and mental health disorders in CYP; and it is unclear whether CYP with mental health disorders have higher rates of conventional, detectable CVD risk factors (such as dyslipidaemia), or contemporary pathological processes (such as arterial stiffening). Furthermore, this important question has never been systematically reviewed. We hypothesized that CYP with emotional mental health disorders (depression or anxiety) would have higher rates of CVD risk. Methods We performed a systematic review of the literature using PRISMA guidelines. PubMed, PsychINFO, Web of Science and Embase were searched from inception to May 2019. Searches identified papers studying associations between CVD risk (contemporary CVD risk markers such as blood pressure, lipids, insulin resistance, central adiposity; established measures of arterial stiffening; or later disease outcomes) and common emotional mental health disorders (depression or anxiety) in CYP. Studies examining obesity and mental health disorders alone were excluded. Results Results will be presented in narrative format, separated by individual risks and mental health disorder.
BMJ Paediatrics Open, 2017
Laeknabladid
Introduction: Parenting styles that include abuse can harm the development of the child's bra... more Introduction: Parenting styles that include abuse can harm the development of the child's brain with a long or short-term impact on his/her health and behaviour. The scope and diversity of abuse are important determinants, and neglect is one of its most serious manifestations. The aim of the study is to examine the prevalence and diversity of emotional abuse and neglect reported by adult Icelanders in their childhood, and how such experience had influenced their evaluation of their upbringing. Materials and methods: Icelanders 18 years and older were randomly selected from the national population register. They were invited to express their perception of their upbringing, and answer questions regarding their experience of 8 specific forms of emotional abuse in childhood, and neglect. Results: Of 966 interviewees, 663 (69%) had experienced one or more of the 8 forms of emotional abuse. Those younger than 30 years were 2.9 times more likely to have such an experience compared to t...
East African Medical Journal, 2001
Children
The COVID-19 pandemic underscores the importance of a child rights-based approach to policymaking... more The COVID-19 pandemic underscores the importance of a child rights-based approach to policymaking and crisis management. Anchored in the United Nations Convention on the Rights of the Child, the 3P framework—provision, protection, and participation—forms the foundation for health professionals advocating for children’s rights. Expanding it with two additional domains—preparation and power—into a 5P framework has the potential to enhance child rights-based policies in times of crisis and future pandemics. The study aimed to (1) gather perspectives from child health-and-rights specialists on how children’s rights were highlighted during the early phase of the pandemic in their respective settings; and (2) evaluate the usefulness of the 5P framework in assessing children’s visibility and rights. A qualitative survey was distributed among child health-and-rights professionals; a total of 68 responses were analysed in Atlas.ti 9 from a multi-disciplinary group of policymakers and front-l...
Vaccines
Background: Routine childhood vaccination coverage rates fell in many countries during the COVID-... more Background: Routine childhood vaccination coverage rates fell in many countries during the COVID-19 pandemic, but the impact of inequity on coverage is unknown. Methods: We synthesised evidence on inequities in routine childhood vaccination coverage (PROSPERO, CRD 42021257431). Studies reporting empirical data on routine vaccination coverage in children 0–18 years old during the COVID-19 pandemic by equity stratifiers were systematically reviewed. Nine electronic databases were searched between 1 January 2020 and 18 January 2022. The risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Tool for Cohort Studies. Overall, 91 of 1453 studies were selected for full paper review, and thirteen met the inclusion criteria. Results: The narrative synthesis found moderate evidence for inequity in reducing the vaccination coverage of children during COVID-19 lockdowns and moderately strong evidence for an increase in inequity compared with pre-pandemic months (before March 20...
Final Oral/Poster Number, Nov 1, 2019
was to simulate a range of policy-relevant calorie-reduction interventions to measure the impact ... more was to simulate a range of policy-relevant calorie-reduction interventions to measure the impact on obesity and inequalities. Methods The predicted probability of obesity at age 11 was estimated using marginal structural models adjusted for total calorie consumption, as calculated from three-day diet diaries at age 7 years, and other baseline and intermediate confounding using data from Avon Longitudinal Study of Parents and Children (n=10,680). Socioeconomic inequalities were indicated using maternal social class and assessed using odds ratios for absolute and relative inequalities. Complete case and multiple imputation analyses were conducted to manage survey attrition and missing data. A series of probabilities were estimated by manipulating the mediator to simulate daily caloriereduction interventions, including targeted and informed scenarios. Results Using imputed data and adjusting for inequalities and confounding, 18.3% of children were living with obesity at 11 years. Maternal social class at baseline and total daily calories at 7 years significantly predicted obesity at 11 years. A simulation to reduce intake down to recommended levels, a 6% reduction in daily calories, universally applied but with random variation, reduced overall obesity prevalence by 0.8% with the greatest decrease observed among the lowest social class, meaning this intervention would reduce inequalities. Targeted interventions by income led to variations in reductions by social group. Informed interventions for children with overweight or obesity, or for children who ate excess calories daily, both at age 7 reduced obesity prevalence at age 11 by 0.9% and 1.5% respectively. Conclusions A universal decrease in total daily calories to the recommended daily limit would reduce childhood obesity and inequalities but disproportionate uptake targeted across SES would have little impact on the overall effect. Informed interventions to reduce caloric intake among children who ate excess calories daily, or with overweight or obese at age 7, would be effective at reducing obesity and inequalities.
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Papers by Geir Gunnlaugsson