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Publisher's version (útgefin grein) ; The monitoring of relevant health indicators is important in the examination of work that aims to improve health, not only globally, as for example, through the Millennium Development Goals 2000–2015, but also at the national, regional and/or sectoral, level. During the period 2000–2011, the Icelandic International Development Agency (ICEIDA) supported the strengthening of the primary healthcare system in the Monkey Bay area of Mangochi District, Malawi. Based on data collected through several evaluative approaches and the use of commonly used health indicators, we explore the overall performance and constraints of the services provided by ICEIDA during project implementation. Structural and diverse process indicators provided evidence that access to governmental services improved during the project period. The population expressed satisfaction with the ongoing improvement of the healthcare services they felt were of good value and quality. During the MDG era, Malawi succeeded in decreasing the under-5 mortality rate by 2/3 (MDG4 target), and maternal mortality by 66% by implementing evidence based interventions similar to those ICEIDA supported in the Monkey Bay area. Albeit small, ICEIDA's support was a relevant, effective, and efficient approach to strengthen primary healthcare services in the Monkey Bay area, resulting in tangible and sustainable benefits for the Monkey Bay communities, that may also be applicable in other settings. ; Peer Reviewed

Publisher's version (útgefin grein). ; Aim: This review examined and summarised the research published on child abuse in Iceland, which was mainly in the country's native language, to make the findings more accessible to English speakers. It specifically focused on child rearing and the physical, emotional and sexual abuse, neglect and intrafamilial conflicts suffered by children at the hands of their parents and other carers. Method: The review drew on published research, books and reports and compared the findings with Nordic research and global estimates of child abuse. Results: Qualitative and quantitative research revealed that the prevalence of different forms of child abuse, child neglect and intra-familial conflicts in Iceland was similar to, or higher than, global and Nordic estimates. Younger respondents reported less physical abuse than older respondents, but higher levels of emotional abuse. Legislation, greater awareness, public debates and research on child abuse in Iceland have contributed to the growing recognition of the negative consequences of child abuse and strengthened support for prevention strategies. Conclusion: Icelandic children have reportedly experienced diverse forms of child abuse and neglect from their parents and other carers. Diverse initiatives have been put in place that underline the urgent need to tackle such behaviour. ; Peer Reviewed

BACKGROUND: COVID-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. METHODS: Data 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. RESULTS: Four 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 of alms. The parents had more frequent telephone contact with their sons, and encouraged them to continue their studies. At the same time, the chernos and almudos passed more time together, and they dedicated more time than earlier to the studies and prayers. The fourth theme has to do with the boys' concerns about their long-term aspirations—to complete their studies and become respected chernos, for which begging was seen as an integral part. CONCLUSION: The almudos suffered from decreased alms, resulting in hunger. COVID-19 was only an additional burden to the boys, who are used to facing challenges while begging to complete their religious education. According to the Convention on the Rights of the Child, children have a right to develop their capabilities in line with their future aspirations. Governments and child rights organisations need to address the specific needs of almudos in respectful collaboration with them, their parents, the chernos and their communities.

Publisher's version (útgefin grein) ; 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. ; This paper is based on findings from the PhD thesis of the first author. We would like to thank the various actors that financed the PhD research: The Doctoral Grants of The University of Iceland Research Fund that funded the research for three years; the Faculty of Sociology, Anthropology and Folkloristics at the University of Iceland for a one-year teacher's stipend; and the Nordic Africa Institute for a travel scholarship to visit Guinea-Bissau, as well as two months PhD scholarships at the Institute and for use of its excellent library. We would also like to thank all donor representatives, international and national NGO workers, Ministry of Health officials and local health professionals that accepted to participate in this study. ; Peer Reviewed

Iceland came under the jurisdiction of the Norwegian King in 1262 to later become a colony of Denmark for about 500 years. Already in the second half of the 18th century, the Danish king initiated actions that aimed to improve the precarious situation of the Icelandic population. After independence in 1944, Iceland enjoyed the highest per capita support of the Marchall Plan (European Recovery Program) following World War II. Thereafter Iceland received aid and loans from the World Bank according to which Iceland was a developing country until 1974. In 1981, the Icelandic International Development Agency (Iceida) was established, substituting the office for Iceland´s Assistance to the Developing Countries, and since 2013 it is a formal member of the Development Assistance Committee (DAC) of the OECD. Iceida and now Ministry of Foreign Affairs has in recent years been engaged in bilateral collaboration with mostly three countries, one of which is Malawi. The aim of the chapter is to describe and analyze the transformation of Iceland from a net receiver of foreign aid to a donor country, with particular attention given to its involvement in Mangochi District in Malawi in Southern-Africa. From early engagement within the fishing sector at the shores of Lake Malawi in the early 1990s, the focus of the collaboration in the area moved to health services, water-and-sanitation, primary education, and social sector initiatives, later expanded to district-wide support. On the basis of achieved results along the years of collaboration, it is concluded Iceland can constructively contribute to international development in the new Global Agenda 2030 era if due attention is given to the needs of poor people. Finally, it is argued that in addition to multilateral assistance, Iceland on the basis of its history and economic strength can play an important role with partner countries in a bilateral collaboration that addresses sector-wide issues of importance in the daily lives of poor people, as currently is the case in Malawi.

Publisher's version (útgefin grein) ; Objective To assess whether the level of austerity implemented by national governments was associated with adverse trends in perinatal outcomes and the social determinants of children's health (SDCH) in rich countries Design Longitudinal ecological study of country-level time trends in perinatal outcomes and SDCH and from 2005 to 2015. Setting and participants 16 European countries using available data from the International Monetary Fund, the Organisation for Economic Co-operation and Development and Eurostat. Main outcome measures Trends in perinatal outcomes (low birth weight (LBW); infant mortality) and the SDCH: child poverty rates; severe material deprivation in families with primary education; preschool investment in three time periods: 2005-2007, 2008-2010 and 2012-2015. Outcomes were compared according to the cyclically adjusted primary balance (CAPB, differences between 2013 and 2009) as a measure of austerity, stratified in tertiles. Generalised estimating equation models of repeated measures were used to assess time trend differences in three periods. Results Countries with higher levels of austerity had worse outcomes, mainly at the last study period. Material deprivation increased during the period 2012-2015 in those countries with higher CAPB (interaction CAPB-period 2012-2015, B: 5.62: p<0.001), as did LBW (interaction CAPB-period 2012-2015, B: 0.25; p=0.004). Conclusions Countries that implemented more severe austerity measures have experienced increasing LBW, and for families with primary education also increasing material deprivation, worsening the negative impact of economic crisis. Reversing austerity policies that impact children is likely to improve child health outcomes. ; Funding DT-R is funded by the MRC on a Clinician Scientist Fellowship (MR/ P008577/1). The study was not externally financed. ; Peer Reviewed

BACKGROUND: Worldwide, 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. METHODS: Collaborators 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. RESULTS: All 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. The consequences were staying at home, enforced with increased police violence. At the same time, other violence on the streets or between neighbours had decreased. A few participants said they liked staying at home because they appreciated spending more time with their families. Most participants claimed that they and their family members tried to follow preventive measures. Almost all participants voiced concerns about the worsening financial situation at home, leading to food scarcity. Nearly all the adolescents were tired of the lockdown and worried about the pandemic's implications on their future opportunities. CONCLUSIONS: Study participants, here adolescents in Bissau, have a clear notion of their existence and the current situation's potential negative impact on their future. Their voices need to be heard and acted on, which may soften the lockdown's negative impact on adolescents in Guinea-Bissau, as elsewhere.

BACKGROUND: To analyse the impact of austerity measures taken by European governments as a response to the 2008 economic and financial crisis on social determinants on 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, demonstrating the importance that economic policy may have for equity in child health and development. European governments must act urgently and reverse these austerity policy measures that are detrimental to family benefits and child protection.

Publisher's version (útgefin grein) ; Background: To analyse the impact of austerity measures taken by European governments as a response to the 2008 economic and financial crisis on social determinants on 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, demonstrating the importance that economic policy may have for equity in child health and development. European governments must act urgently and reverse these austerity policy measures that are detrimental to family benefits and child protection. ; No funding was received for this article. Open access funding provided by Stockholm University. ; Peer Reviewed