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Int J Equity Health ; 20(1): 215, 2021 09 26.
Article in English | MEDLINE | ID: covidwho-1496181


BACKGROUND: Lack of control over life situations is an important social determinant that may negatively affect parental and child health. This study took place in an area of Stockholm, Sweden with high indications of socioeconomic disadvantage, a large part of the population with foreign background, as well as higher levels of poor health than the county average. It investigated staff perceptions of pathways from situations of low control, potentially leading to health inequities, affecting families enrolled in an early childhood home visiting programme during the Covid-19 pandemic. METHODS: Semi-structured interviews were carried out with 23 child health care nurses and parental advisors working in a home visiting programme. The data was analysed using Reflexive Thematic Analysis. RESULTS: The analysis resulted in five pathways on two explanatory levels, affecting parents' health and parenting capacity and children's health and well-being, potentially damaging health and leading to health inequities. The first four pathways related to control at the personal explanatory level: Families facing instability and insecurity; Caring for children in crowded and poor housing conditions; Experiencing restricted access to resources; and Parenting with limited social support. The fifth pathway, Living in a segregated society, covered the collective experience of lack of control on community level. The Covid-19 pandemic was observed to negatively affect all pathways and thus potentially aggravate health inequities for this population. The pandemic has also limited the delivery of home visits to the families which creates further barriers in families' access to resources and increases isolation for parents with already limited social support. CONCLUSIONS: The diversity of pathways connected to health inequities presented in this study highlights the importance of considering this variety of influences when designing interventions for socioeconomically disadvantaged areas. The additional negative consequences of Covid-19 indicate the need for sustainable preventive early childhood interventions for families in such areas. The study also emphasizes the need for further research as well as policy action on possible long-term effects of changing behaviours during the Covid-19 period on child health and health equity. TRIAL REGISTRATION: The study was retrospectively registered (11 August 2016) in the ISRCTN registry ( ISRCTN11832097 ).

COVID-19 , Family , Health Status Disparities , Pandemics , Poverty Areas , COVID-19/epidemiology , House Calls , Humans , Observation , Qualitative Research , Sweden/epidemiology
Acta Paediatr ; 110(9): 2559-2566, 2021 09.
Article in English | MEDLINE | ID: covidwho-1223464


AIM: Routine immunisation programmes are at risk of disruption due to the COVID-19 pandemic. This study aimed to investigate the resilience of the Swedish national immunisation programme for children up to the age of five years during the early stages of the pandemic. METHODS: This was a cross-sectional, web-based survey of regional child health offices in Sweden between 10 September and 9 October 2020. It explored the organisation of child health services during the early stages of the pandemic, focusing on routine child immunisation. RESULTS: All 21 Swedish regional child health offices responded. They stated that child immunisation had been prioritised, communication with families had been intensified and there was greater flexibility at all organisational levels of child health services. In addition, the vaccine supply was sustained and child health centres remained open. However, there were periodic staff shortages, increased numbers of health visits cancelled by parents and most parent education groups were paused. CONCLUSION: The Swedish immunisation programme was resilient during the early COVID-19 pandemic, thanks to sustainable organisation co-ordinated by Sweden's network of regional child health offices.

COVID-19 , Child Health Services , Child , Child, Preschool , Cross-Sectional Studies , Humans , Immunization Programs , Pandemics/prevention & control , SARS-CoV-2 , Sweden/epidemiology