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Karlsson O. Scarring and selection effects on children surviving elevated rates of postneonatal mortality in sub-Saharan Africa. SSM Popul Health 2022; 19:101160. [PMID: 35846870 PMCID: PMC9283665 DOI: 10.1016/j.ssmph.2022.101160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 06/03/2022] [Accepted: 06/29/2022] [Indexed: 11/18/2022] Open
Abstract
Infants in sub-Saharan Africa face adversity: Infections and undernutrition are major causes of infant deaths and can cause physiological damage with long-lasting adverse scarring effects on the human development of the survivors, for example, in terms of health and education. However, selective mortality of more vulnerable children at very high levels of adversity in early life can leave the surviving population to appear on average healthier. This paper estimated the nonlinear effects of postneonatal mortality rate—a proxy for adversity, particularly infections and undernutrition—in a 50 km radius, occurring over the period of infancy, on the subsequent height-for-age and school attendance of the surviving children. The results indicated that an adverse environment in infancy negatively affected height-for-age at age 1–4 years: At relatively low levels of adversity (at the 10th percentile of postneonatal mortality rate), an additional postneonatal death per 100 person-years decreased height-for-age of the survivors by almost 2% of the mean deficit in height (relative to a common growth standard) when comparing siblings born into different levels of adversity. At high levels of adversity, no effect was found for height-for-age while a small positive association was observed for school attendance at age 7–16 years. The results indicated that selective mortality may have canceled out (or even dominated in the case of school attendance) observable scarring effects following high levels of postneonatal mortality rate in sub-Saharan Africa. Adversity in early life negatively affects human development in sub-Saharan Africa. The postneonatal mortality rate over infancy was used as a proxy for adversity. Elevated adversity in infancy negatively affected height-for-age at age 1–4 years. At high adversity, selective mortality may cancel out observable scarring effects.
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Affiliation(s)
- Omar Karlsson
- Takemi Program in International Health, Harvard T.H. Chan School of Public Health, Harvard University, 677 Huntington Avenue, Boston, MA, 02115, United States
- Department of Economic History, School of Economics and Management, Lund University, P.O. Box 7083, 220 07 Lund, Sweden
- Takemi Program in International Health, Harvard T.H. Chan School of Public Health, Harvard University, 677 Huntington Avenue, Boston, MA, 02115, United States.
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Mendes A, Whiteman A, Bullard K, Sharif S, Khurshid A, Alam MM, Salman M, Ford V, Blair T, Burns CC, Ehrhardt D, Jorba J, Hsu CH. Spatial analysis of genetic clusters and epidemiologic factors related to wild poliovirus type 1 persistence in Afghanistan and Pakistan. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000251. [PMID: 36962349 PMCID: PMC10021910 DOI: 10.1371/journal.pgph.0000251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 05/21/2022] [Indexed: 11/19/2022]
Abstract
Following the certification of the World Health Organization Region of Africa as free of serotype 1 wild poliovirus (WPV1) in 2020, Afghanistan and Pakistan represent the last remaining WPV1 reservoirs. As efforts continue in these countries to progress to eradication, there is an opportunity for a deeper understanding of the spatiotemporal characteristics and epidemiological risk factors associated with continual WPV1 circulation in the region. Using poliovirus surveillance data from 2017-2019, we used pairwise comparisons of VP1 nucleotide sequences to illustrate the spatiotemporal WPV1 dispersal to identify key sources and destinations of potentially infected, highly mobile populations. We then predicted the odds of WPV1 detection at the district level using a generalized linear model with structural indicators of health, security, environment, and population demographics. We identified evidence of widespread population mobility based on WPV1 dispersal within and between the countries, and evidence indicating five districts in Afghanistan (Arghandab, Batikot, Bermel, Muhamandara and Nawzad) and four districts in Pakistan (Charsada, Dera Ismail Khan, Killa Abdullah and Khyber) act as cross-border WPV1 circulation reservoirs. We found that the probability of detecting WPV1 in a district increases with each armed conflict event (OR = 1·024, +- 0·008), level of food insecurity (OR = 1·531, +-0·179), and mean degrees Celsius during the months of greatest precipitation (OR = 1·079, +- 0·019). Our results highlight the multidisciplinary complexities contributing to the continued transmission of WPV1 in Afghanistan and Pakistan. We discuss the implications of our results, stressing the value of coordination during this final chapter of the wild polio virus eradication initiative.
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Affiliation(s)
- Amalia Mendes
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- DRT Strategies Inc., Arlington, Virginia, United States of America
| | - Ari Whiteman
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Peraton, Atlanta, Georgia, United States of America
| | - Kelley Bullard
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- IHRC Inc., Atlanta, Georgia, United States of America
| | - Salmaan Sharif
- Department of Virology, National Institute of Health, Islamabad, Pakistan
| | - Adnan Khurshid
- Department of Virology, National Institute of Health, Islamabad, Pakistan
| | | | - Muhammad Salman
- Department of Virology, National Institute of Health, Islamabad, Pakistan
| | - Vanessa Ford
- Department of Pediatrics, Emory University, Atlanta, Georgia, United States of America
| | - Taisha Blair
- Department of Pediatrics, Emory University, Atlanta, Georgia, United States of America
| | - Cara C. Burns
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Derek Ehrhardt
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jaume Jorba
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Christopher H. Hsu
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Assessing innovative approaches for global health capacity building in fragile settings in the MENA region: development of the evaluation of capacity building (eCAP) program. Confl Health 2022; 16:31. [PMID: 35658917 PMCID: PMC9163880 DOI: 10.1186/s13031-022-00462-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 05/25/2022] [Indexed: 01/14/2023] Open
Abstract
Background Given the magnitude and frequency of conflicts in the MENA region along with their devastating impact on health responses and outcomes, there exists a strong need to invest in contextualized, innovative, and accessible capacity building approaches to enhance leadership and skills in global health. The MENA region suffers from limited (1) continued educational and career progression opportunities, (2) gender balance, and (3) skill-mix among its health workforce, which require significant attention. Main text The Global Health Institute at the American University of Beirut incepted the Academy division to develop and implement various global health capacity building (GHCB) initiatives to address those challenges in fragile settings across low-and middle-income countries in the MENA region. These initiatives play a strategic role in this context, especially given their focus on being accessible through employing innovative learning modalities. However, there exists a dearth of evidence-based knowledge on best practices and recommendations to optimize the design, implementation, and evaluation of GHCB in fragile settings in the MENA region. The present paper describes the development of the evaluation of capacity building program (eCAP), implemented under the Academy division, to assess the effectiveness of its initiatives. eCAP is composed of 3 phases: (1) a situational assessment, followed by (2) production of multiple case studies, and finally (3) a meta-assessment leading to model development. The goal of eCAP is not only to inform the Academy’s operations, but also to synthesize produced knowledge into the formation of an evidence-based, scalable, and replicable model for GHCB in fragile settings. Conclusion eCAP is an important initiative for researchers, educators, and practitioners interested in GHCB in fragile settings. Several lessons can be learned from the outcomes it has yielded so far in its first two phases of implementation, ranging from the situational assessment to the production of evaluation case studies, which are expanded on in the manuscript along with pertinent challenges.
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Bürgin D, Anagnostopoulos D, Vitiello B, Sukale T, Schmid M, Fegert JM. Impact of war and forced displacement on children's mental health-multilevel, needs-oriented, and trauma-informed approaches. Eur Child Adolesc Psychiatry 2022; 31:845-853. [PMID: 35286450 PMCID: PMC9209349 DOI: 10.1007/s00787-022-01974-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The infliction of war and military aggression upon children must be considered a violation of their basic human rights and can have a persistent impact on their physical and mental health and well-being, with long-term consequences for their development. Given the recent events in Ukraine with millions on the flight, this scoping policy editorial aims to help guide mental health support for young victims of war through an overview of the direct and indirect burden of war on child mental health. We highlight multilevel, need-oriented, and trauma-informed approaches to regaining and sustaining outer and inner security after exposure to the trauma of war. The impact of war on children is tremendous and pervasive, with multiple implications, including immediate stress-responses, increased risk for specific mental disorders, distress from forced separation from parents, and fear for personal and family's safety. Thus, the experiences that children have to endure during and as consequence of war are in harsh contrast to their developmental needs and their right to grow up in a physically and emotionally safe and predictable environment. Mental health and psychosocial interventions for war-affected children should be multileveled, specifically targeted towards the child's needs, trauma-informed, and strength- and resilience-oriented. Immediate supportive interventions should focus on providing basic physical and emotional resources and care to children to help them regain both external safety and inner security. Screening and assessment of the child's mental health burden and resources are indicated to inform targeted interventions. A growing body of research demonstrates the efficacy and effectiveness of evidence-based interventions, from lower-threshold and short-term group-based interventions to individualized evidence-based psychotherapy. Obviously, supporting children also entails enabling and supporting parents in the care for their children, as well as providing post-migration infrastructures and social environments that foster mental health. Health systems in Europe should undertake a concerted effort to meet the increased mental health needs of refugee children directly exposed and traumatized by the recent war in Ukraine as well as to those indirectly affected by these events. The current crisis necessitates political action and collective engagement, together with guidelines by mental health professionals on how to reduce harm in children either directly or indirectly exposed to war and its consequences.
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Affiliation(s)
- David Bürgin
- Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital Ulm, University of Ulm, Steinhövelstrasse 5, 89073, Ulm, Germany
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
| | | | - Benedetto Vitiello
- Division of Child Neurology and Psychiatry, Department of Public Health and Pediatric Sciences, Regina Margherita Pediatric Hospital, University of Turin, Turin, Italy
| | - Thorsten Sukale
- Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital Ulm, University of Ulm, Steinhövelstrasse 5, 89073, Ulm, Germany
| | - Marc Schmid
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
| | - Jörg M Fegert
- Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital Ulm, University of Ulm, Steinhövelstrasse 5, 89073, Ulm, Germany.
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Bwirire D, Crutzen R, Ntabe Namegabe E, Letschert R, de Vries N. Health inequalities in post-conflict settings: A systematic review. PLoS One 2022; 17:e0265038. [PMID: 35286351 PMCID: PMC8920275 DOI: 10.1371/journal.pone.0265038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 02/23/2022] [Indexed: 11/18/2022] Open
Abstract
Conflict can be a primary driver of health inequalities, but its impact on the distribution of social determinants of health is not very well documented. Also, there is limited evidence on the most suitable approaches aiming at addressing health inequalities in post-conflict settings. Thus, we undertook a systematic review of the literature concerning the current knowledge and knowledge gaps about structural determinants of health inequalities and assessed the effects of approaches aimed at addressing health inequalities in post-conflict settings. We performed a systematic search in bibliographic databases such as Web of Science, PubMed, and PsycINFO for relevant publications, as well as institutional websites that are relevant to this topic. The search was initiated in March 2018 and ultimately updated in December 2020. No time or geographical restrictions were applied. The quality of each study included in this review was independently assessed using criteria developed by CASP to assess all study types. Sixty-two articles were deemed eligible for analysis. The key findings were captured by the most vulnerable population groups, including the civilian population, women, children, internally displaced persons (IDPs), and people with symptoms of mental illness. A considerable range of approaches has been used to address health inequalities in post-conflict settings. These approaches include those used to address structural determinants of health inequalities which are accountable for the association between poverty, education, and health inequalities, the association between human rights and health inequalities, and the association between health inequalities and healthcare utilization patterns. However, these approaches may not be the most applicable in this environment. Given the multifactorial characteristics of health inequalities, it is important to work with the beneficiaries in developing a multi-sector approach and a strategy targeting long-term impacts by decision-makers at various levels. When addressing health inequalities in post-conflict settings, it may be best to combine approaches at different stages of the recovery process.
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Affiliation(s)
- Dieudonne Bwirire
- Faculty of Health, Medicine and Life Science, Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Rik Crutzen
- Faculty of Health, Medicine and Life Science, Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Edmond Ntabe Namegabe
- Faculté de Santé et Développement Communautaires, Université Libre des Pays des Grands Lacs (ULPGL), Goma, Democratic Republic of the Congo
| | | | - Nanne de Vries
- Faculty of Health, Medicine and Life Science, Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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Choonara I. Global peace dividend and child health. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2022-001442. [PMID: 35604805 PMCID: PMC8919443 DOI: 10.1136/bmjpo-2022-001442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/01/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
- Imti Choonara
- Child Health, University of Nottingham School of Medicine, Derby, UK
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57
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Martinez Garcia D, Amsalu R, Harkensee C, Janet S, Kadir A, Kampalath VN, Nejat S, Wise PH. Humanitarian paediatrics: A statement of purpose. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001431. [PMID: 36962911 PMCID: PMC10021314 DOI: 10.1371/journal.pgph.0001431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Daniel Martinez Garcia
- Geneva University Paediatric Hospital, Geneva, Switzerland
- Médecins Sans Frontières, Toronto, Canada
| | - Ribka Amsalu
- California Preterm Birth Initiative, Department of Obstetrics, Gynaecology, & Reproductive Sciences, University of California San Francisco, San Francisco, San Francisco, California, United States of America
| | | | | | | | - Vinay N Kampalath
- Division of Emergency Medicine, Department of Paediatrics, Children's Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America
| | | | - Paul H Wise
- Stanford University School of Medicine, Stanford, California, United States of America
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Kreif N, Mirelman A, Suhrcke M, Buitrago G, Moreno-Serra R. The impact of civil conflict on child health: Evidence from Colombia. ECONOMICS AND HUMAN BIOLOGY 2022; 44:101074. [PMID: 34839051 DOI: 10.1016/j.ehb.2021.101074] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 06/28/2021] [Accepted: 10/20/2021] [Indexed: 05/24/2023]
Abstract
Internal armed conflicts have become more common and more physically destructive since the mid-20th century, with devastating consequences for health and development in low- and middle-income countries. This paper investigates the causal impacts of the long-term internal conflict on child health in Colombia, following an identification strategy based on the temporal and geographic variation of conflict intensity. We estimate the effect of different levels of conflict intensity on height-for-age (HAZ), weight-for-age (WAZ), and weight-for-height z-scores among children under five years old, and explore the underlying potential mechanisms, through maternal health behavior and health care utilization. We find a harmful effect of exposure to conflict violence in utero and in early childhood for HAZ and WAZ, in the full sample and even more strongly in the rural sample, yet these estimates are smaller than those found for shorter term conflicts. The underlying pathways appear to operate around the time of the pregnancy and birth (in the form of maternal alcohol use, use of antenatal care and skilled birth attendance), rather than during the post-birth period (via breastfeeding or vaccination), and the impacts accumulate over the childhood. The most adverse impacts of conflict violence on child health and utilization of maternal healthcare were observed in municipalities which suffered from intermittent presence of armed groups.
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Affiliation(s)
- Noémi Kreif
- Centre for Health Economics, University of York, Heslington, York YO10 5DD, UK.
| | - Andrew Mirelman
- Centre for Health Economics, University of York, Heslington, York YO10 5DD, UK
| | - Marc Suhrcke
- Centre for Health Economics, University of York, Heslington, York YO10 5DD, UK; Luxembourg Institute of Socio-economic Research, 11 Porte des Sciences, 4366 Esch-sur-Alzette, Luxembourg
| | - Giancarlo Buitrago
- Clinical Research Institute, Universidad Nacional de Colombia, Hospital Universitario Nacional de Colombia, Bogota, DC, Colombia
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Levavi K, Yakov P, Pike A, Deater-Deckard K, Hadar A, Bar G, Froimovici M, Atzaba-Poria N. When COVID-19 Met Families Living in Armed-Conflict Zones: The Importance of Maternal Trauma and Child Self-Regulation. Front Psychiatry 2022; 13:718455. [PMID: 35360126 PMCID: PMC8964179 DOI: 10.3389/fpsyt.2022.718455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 01/17/2022] [Indexed: 11/13/2022] Open
Abstract
The COVID-19 outbreak began in Israel at the end of February 2020, and on March 17, 2020, a general lockdown was announced. Families were instructed to stay at home and schools and non-essential businesses were closed. Aiming to understand how families who were already living in areas of high exposure to armed conflict would be affected by another external stressful condition, data were collected before and after the outbreak. Mothers and children (aged 10-45 months) were recruited from areas with high (n = 40) and low (n = 78) exposure to armed conflict. Mothers reported on their posttraumatic stress symptoms (PTSS) and on their child's effortful control tendencies prior to the outbreak. Toward the end of the first lockdown, mothers were interviewed regarding adverse effects of the outbreak on their family. No group differences were found for maternal perceptions of adverse effects of COVID-19. However, a moderation model was revealed, indicating that maternal PTSS as well as child effortful control predicted adverse effects of COVID-19 only in the high-exposure group. Results are discussed considering cumulative stress and risk factors.
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Affiliation(s)
- Kinneret Levavi
- Duet Center, Department of Psychology, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Porat Yakov
- Duet Center, Department of Psychology, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Alison Pike
- School of Psychology, University of Sussex, Brighton, United Kingdom
| | - Kirby Deater-Deckard
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, United States
| | | | - Guy Bar
- Fertility and IVF Unit, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | | | - Naama Atzaba-Poria
- Duet Center, Department of Psychology, Ben-Gurion University of the Negev, Be'er Sheva, Israel
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Ottolini M, Cirks B, Madden KB, Rajnik M. Pediatric Infectious Diseases Encountered During Wartime-Part 1: Experiences and Lessons Learned From Armed Conflict in the Modern Era. Curr Infect Dis Rep 2021; 23:27. [PMID: 34903952 PMCID: PMC8656442 DOI: 10.1007/s11908-021-00770-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE OF REVIEW Armed conflicts occur globally, with some regions experiencing heightened instability for many years. A better understanding of the infectious disease impact on children in armed conflict will allow aid organizations to anticipate and mitigate the most serious problems. RECENT FINDINGS Armed conflicts are estimated to have caused approximately 30 million civilian deaths during the past 27 years, with two-thirds occurring in women and children. Children are extremely vulnerable to the mass population displacements, experiencing a combined loss of safety, nutrition, shelter, hygiene, and health care. Under these circumstances, the emergence and prevalence of multiple infectious diseases can result in heightened morbidity and mortality long after active conflict ceases. SUMMARY Factors leading to increased infectious diseases in populations in crisis due to armed conflict and lessons learned from recent outbreaks are discussed in detail. Acute respiratory infections, diphtheria, measles, varicella, and cholera are a few of the more common infectious diseases that take advantage of populations displaced or disrupted by conflict. Key issues include the ability of countries or non-governmental organizations (NGOs) to keep up with basic childhood immunizations, and how rapidly disease outbreaks are recognized and addressed with disease-specific interventions.
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Affiliation(s)
- Martin Ottolini
- Departments of Pediatrics and Academic Affairs, The Uniformed Services University of the Health Sciences, Bethesda, MD USA
| | - Blake Cirks
- Departments of Pediatrics and Academic Affairs, The Uniformed Services University of the Health Sciences, Bethesda, MD USA
| | - Kathleen B. Madden
- Departments of Pediatrics and Academic Affairs, The Uniformed Services University of the Health Sciences, Bethesda, MD USA
| | - Michael Rajnik
- Departments of Pediatrics and Academic Affairs, The Uniformed Services University of the Health Sciences, Bethesda, MD USA
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Oppong Asante K, Quarshie ENB, Onyeaka HK. Epidemiology of suicidal behaviours amongst school-going adolescents in post-conflict Sierra Leone. J Affect Disord 2021; 295:989-996. [PMID: 34706473 DOI: 10.1016/j.jad.2021.08.147] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 07/17/2021] [Accepted: 08/27/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Children and young people living in post-conflict contexts are at an increased risk of suicidal behaviours (ideations and attempts). Not much is known about the extent of suicidal behaviours amongst adolescents in most notable post-conflict countries in sub-Saharan Africa, including Sierra Leone. METHODS We performed a secondary analysis of data from the 2017 Sierra Leone World Health Organisation Global School-based Student Health Survey conducted amongst students in secondary schools nationwide. We estimated the 12-month prevalence and performed bivariable and multivariable analyses to assess the correlates of suicidal behaviours. RESULTS Of the 2,798 analytic sample, 14.6% (males = 15.1%, females = 14.0%) reported suicidal ideation, and the 12-month prevalence estimate of suicide attempt was 19.6% (male = 20.9%, females =17.8%). The factors associated with suicidal behaviours were multi-layered. While no statistically significant gender association with suicide ideation or attempt was observed at the personal level, being aged 18 or older, loneliness, and health risk behaviours (cannabis use, and leisure time sedentary behaviour) were associated with increased odds of suicidal behaviours. Within the family context, parental monitoring was associated with increased odds of suicidal ideation, but parental supervision was associated with reduced odds of suicide ideation. LIMITATIONS The cross-sectional nature of the data did not support causal inferences. CONCLUSIONS Taken together, professional mental healthcare would be helpful in treating adolescent emotional problems (e.g., depression and loneliness) related to suicidal behaviours; but prevention and intervention programmes targeted at addressing adolescent health risk behaviours, and familial and interpersonal problems may yield more favourable outcomes.
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Affiliation(s)
- Kwaku Oppong Asante
- Department of Psychology, University of Ghana, Legon, Accra, Ghana; Department of Psychology, University of the Free State, Bloemfontein, South Africa
| | - Emmanuel Nii-Boye Quarshie
- School of Psychology, University of Leeds, Lifton Place, Leeds LS2 9JT, UK; Department of Psychology, University of Ghana, Legon, Accra, Ghana.
| | - Henry K Onyeaka
- Department of Psychiatry, Massachusetts General Hospital/Mclean Hospital, Boston, USA; Harvard Medical School, Boston, USA
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Mattelin E, Khanolkar AR, Fröberg F, Jonsson L, Korhonen L. 'Long journey to shelter': a study protocol: a prospective longitudinal analysis of mental health and its determinants, exposure to violence and subjective experiences of the migration process among adolescent and young adult migrants in Sweden. BMJ Open 2021; 11:e043822. [PMID: 34593481 PMCID: PMC8487179 DOI: 10.1136/bmjopen-2020-043822] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION According to the UN Refugee Agency (UNHCR), around 40% of the 79.5 million forcibly displaced persons in the end of the year 2019 were children. Exposure to violence and mental health problems such as posttraumatic stress disorder are frequently reported among migrant children, but there is a knowledge gap in our understanding of the complex longitudinal interplay between individual, social and societal risk and resilience factors that impact mental health and well-being, quality of life and ability to function and adapt. There is also an urgent societal need to facilitate interdisciplinary and intersectoral collaborative efforts to develop effective methods to prevent, detect and respond to the needs of the migrants. This project will study adolescent and young adult migrants in Sweden using multiple methods such as quantitative analysis of data from a prospective cohort study and qualitative analysis of data gathered from teller-focused interviews. The aim is to understand how different factors impact mental health and integration into the Swedish society. Furthermore, individual experiences related to the migration process and exposure to violence will be studied in detail. METHODS AND ANALYSIS Study participants will include 490 migrants aged 12-25 years recruited through social services, healthcare, social media and the civil society. A subsample of adolescents (n=160) will be re-interviewed after 1 year. Data are collected using structured and semi-structured interviews along with saliva and hair sampling. Measures include sociodemographic data, longitudinal data on mental health and its determinants, including genotypes and stress-hormone levels, access to healthcare and the process of migration, including settlement in Sweden. ETHICS AND DISSEMINATION The Regional Ethics Board of Linköping (2018/292-31 and 2018/504-32) and the National Ethics Board (2019-05473,2020-00949 and 2021-03001) have approved the study. Results will be made available to participants, their caregivers, professionals working with migrants, researchers and the funders.
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Affiliation(s)
- Erica Mattelin
- Barnafrid and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Amal R Khanolkar
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Frida Fröberg
- Barnafrid and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Linda Jonsson
- Department of Social Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Laura Korhonen
- Barnafrid and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Child and Adolescent Psychiatry and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Piñeros-Ortiz S, Moreno-Chaparro J, Garzón-Orjuela N, Urrego-Mendoza Z, Samacá-Samacá D, Eslava-Schmalbach J. Mental health consequences of armed conflicts in children and adolescents: An overview of literature reviews. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2021; 41:424-448. [PMID: 34559491 PMCID: PMC8525875 DOI: 10.7705/biomedica.5447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 02/24/2021] [Indexed: 11/21/2022]
Abstract
Introduction: Armed conflicts affect the mental health of children and adolescents. Their outcomes in these populations have been documented identifying vulnerability and significant biopsychosocial damage as the most common factors. Objective: To identify and synthesize the mental health consequences of armed conflicts in children and adolescents. Materials and methods: We carried out a comprehensive and systematic search of reviews published until July 2019 in the MEDLINE (Ovid), EMBASE, Cochrane Central Register of Controlled Trials, and LILACS databases, as well as in additional sources. The information was retrieved and analyzed narratively by describing the characteristics and objectives of the studies and the mental health consequences of armed conflicts in three periods of time: pre-armed conflict, during the armed conflict, and post-conflict. Results. Out of 587 potentially relevant studies, we finally selected 72. In the pre-armed conflict period, we described in detail the psychological experiences and the anticipatory somatic symptoms. During the conflict, we identified regressive, behavioral, and cognitive symptoms such as enuresis, fear, sadness, aggression, hyperactivity, and inattention, among others. Direct mental health consequences such as adjustment disorders, depression, anxiety, and post-traumatic stress were also identified. Finally, in the postconflict period, we referred to the transmission of mental health consequences and resilience processes. On the other hand, we reviewed in depth the potential consequences of armed conflicts on biopsychosocial development, morality, identity, culture, education, and society. Conclusion. The development of mental health consequences due to the exposure to armed conflicts in these populations is a complex process that depends on the stage of the exposure, the length of the conflict, and contextual factors.
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Affiliation(s)
- Sandra Piñeros-Ortiz
- Grupo de Investigación Violencia y Salud, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C., Colombia; Departamento de Psiquiatría, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C., Colombia.
| | - Jaime Moreno-Chaparro
- Grupo de Investigación en Equidad en Salud, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C., Colombia; Escuela de Medicina, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D. C., Colombia.
| | - Nathaly Garzón-Orjuela
- Grupo de Investigación en Equidad en Salud, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C., Colombia.
| | - Zulma Urrego-Mendoza
- Grupo de Investigación Violencia y Salud, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C., Colombia; Departamento de Salud Pública, Facultad de Medicina, Universidad Nacional de Colombia,Bogotá, D.C., Colombia.
| | - Daniel Samacá-Samacá
- Grupo de Investigación en Equidad en Salud, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C., Colombia.
| | - Javier Eslava-Schmalbach
- Grupo de Investigación en Equidad en Salud, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C., Colombia; Hospital Universitario Nacional de Colombia, Universidad Nacional de Colombia, Bogotá, D. C., Colombia.
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64
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Moran D, Taylor LK. Outgroup prosocial behaviour among children and adolescents in conflict settings. Curr Opin Psychol 2021; 44:69-73. [PMID: 34571368 DOI: 10.1016/j.copsyc.2021.08.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/24/2021] [Accepted: 08/25/2021] [Indexed: 11/16/2022]
Abstract
More than 420 million children live amid political conflict. In such settings, understanding the development of prosocial behaviours, specifically directed at outgroups, can provide opportunities for peacebuilding. Informed by research on intergroup competition and structural inequality, we focus on outgroup prosocial behaviour targeting conflict rivals. Already from a young age, children are politically socialised and show intergroup biases that dampen helping behaviours towards conflict rivals, which continue into adulthood. We review factors that shape youth's interpersonal helping and broader forms of prosociality, such as civic engagement, across group lines. We conceptualise outgroup prosocial behaviour along a continuum, ranging from interpersonal acts to broader structural and cultural constructive change. We conclude with directions for future research.
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Affiliation(s)
| | - Laura K Taylor
- University College Dublin, Ireland; Queen's University Belfast, Ireland.
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65
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Ahmad A, Rassa N, Orcutt M, Blanchet K, Haqmal M. Urgent health and humanitarian needs of the Afghan population under the Taliban. Lancet 2021; 398:822-825. [PMID: 34454686 DOI: 10.1016/s0140-6736(21)01963-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 08/20/2021] [Indexed: 11/20/2022]
Affiliation(s)
- Ayesha Ahmad
- Institute for Medical and Biomedical Education, St George's University of London, London SW17 0RE, UK.
| | | | - Miriam Orcutt
- Institute for Global Health, University College London, London, UK
| | - Karl Blanchet
- Geneva Centre of Humanitarian Studies, University of Geneva, Geneva, Switzerland
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66
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Goto R, Frodl T, Skokauskas N. Armed Conflict and Early Childhood Development in 12 Low- and Middle-Income Countries. Pediatrics 2021; 148:peds.2021-050332. [PMID: 34404740 DOI: 10.1542/peds.2021-050332] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/05/2021] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES Despite 1 in 10 children being affected by armed conflicts, there is limited evidence on the effects of conflicts on early childhood development (ECD), an important Sustainable Development Goals indicator. We aimed to elucidate the relationship between exposure to conflicts and ECD. METHODS We conducted a multinational observational study using population-based data on 27 538 children 36 to 59 months old from Demographic and Health Surveys from 12 low- and middle-income countries merged with prospective data on conflicts from Uppsala Conflict Data Program. We estimated the association between 1 to 5 consecutive years of exposure to conflicts within 50 km and ECD after inverse probability of treatment weighting. Mediators of the relationship between conflicts and ECD were identified. We also estimated the association between conflicts and individual domains of ECD. RESULTS Exposure to conflicts was associated with a 5.9% decrease (95% confidence interval -7.5% to -4.3%) in the probability of a child being developmentally on track from the first year of exposure. This was compounded after the second year, with 5 consecutive years of exposure associated with a 10.4% decrease in the probability of a child being developmentally on track (95% confidence interval -13.7% to -7.2%). A lack of access to early childhood education was a significant mediator into the fifth year of exposure. Among individual ECD domains, socioemotional development was disproportionately impaired. CONCLUSIONS Exposure to nearby conflicts is associated with an increased probability of delayed ECD, especially with chronic exposure. Children in affected areas should be provided psychosocial support and early childhood education from an early stage.
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Affiliation(s)
- Ryunosuke Goto
- Department of Pediatrics, University of Tokyo Hospital, Tokyo, Japan
| | - Thomas Frodl
- Department of Psychiatry and Psychotherapy, University Hospital, Otto-von-Guericke-University, Magdeburg, Germany
| | - Norbert Skokauskas
- Regional Centre for Child and Youth Mental Health and Child Welfare - Central Norway, IPH, Norwegian University of Science and Technology, Trondheim, Norway
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67
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Druetz T, Browne L, Bicaba F, Mitchell MI, Bicaba A. Effects of terrorist attacks on access to maternal healthcare services: a national longitudinal study in Burkina Faso. BMJ Glob Health 2021; 5:bmjgh-2020-002879. [PMID: 32978211 PMCID: PMC7520815 DOI: 10.1136/bmjgh-2020-002879] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 08/10/2020] [Accepted: 08/14/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Most of the literature on terrorist attacks' health impacts has focused on direct victims rather than on distal consequences in the overall population. There is limited knowledge on how terrorist attacks can be detrimental to access to healthcare services. The objective of this study is to assess the impact of terrorist attacks on the utilisation of maternal healthcare services by examining the case of Burkina Faso. METHODS This longitudinal quasi-experimental study uses multiple interrupted time series analysis. Utilisation of healthcare services data was extracted from the National Health Information System in Burkina Faso. Data span the period of January 2013-December 2018 and include all public primary healthcare centres and district hospitals. Terrorist attack data were extracted from the Armed Conflict Location and Event Data project. Negative binomial regression models were fitted with fixed effects to isolate the immediate and long-term effects of terrorist attacks on three outcomes (antenatal care visits, of facility deliveries and of cesarean sections). RESULTS During the next month of an attack, the incidence of assisted deliveries in healthcare facilities is significantly reduced by 3.8% (95% CI 1.3 to 6.3). Multiple attacks have immediate effects more pronounced than single attacks. Longitudinal analysis show that the incremental number of terrorist attacks is associated with a decrease of the three outcomes. For every additional attack in a commune, the incidence of cesarean sections is reduced by 7.7% (95% CI 4.7 to 10.7) while, for assisted deliveries, it is reduced by 2.5% (95% CI 1.9 to 3.1) and, for antenatal care visits, by 1.8% (95% CI 1.2 to 2.5). CONCLUSION Terrorist attacks constitute a new barrier to access of maternal healthcare in Burkina Faso. The exponential increase in terrorist activities in West Africa is expected to have negative effects on maternal health in the entire region.
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Affiliation(s)
- Thomas Druetz
- Social and Preventive Medicine, University of Montreal, Montreal, Québec, Canada .,Centre de recherche en santé publique, Montreal, Québec, Canada.,Center for Applied Malaria Research and Evaluation, New Orleans, Louisiana, USA
| | - Lalique Browne
- Social and Preventive Medicine, University of Montreal, Montreal, Québec, Canada
| | - Frank Bicaba
- Société d'Études et de Recherches en Santé Publique, Ouagadougou, Burkina Faso
| | | | - Abel Bicaba
- Société d'Études et de Recherches en Santé Publique, Ouagadougou, Burkina Faso
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68
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Abstract
This article documents the increasing numbers of children impacted annually by 1 or more types of violence against children and describes the range of types of injuries and their immediate and long-term impacts on child outcomes. The article describes the growing number of international collaborations to decrease the numbers of children impacted by violence and to mitigate the consequences thereof, with a particular emphasis on children living in war zones.
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Affiliation(s)
- Bonita Stanton
- Hackensack Meridian School of Medicine, 340 Kingsland Street, Nutley, NJ 07110, USA.
| | - Brittney Davis
- New York Academy of Medicine, 1216 Fifth Avenue, New York, NY 10029, USA
| | - Danielle Laraque-Arena
- New York Academy of Medicine, Mailman School of Public Health, Columbia University, SUNY Upstate Medical University, 1216 Fifth Avenue, New York, NY 10029, USA
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69
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Wise PH, Shiel A, Southard N, Bendavid E, Welsh J, Stedman S, Fazal T, Felbab-Brown V, Polatty D, Waldman RJ, Spiegel PB, Blanchet K, Dayoub R, Zakayo A, Barry M, Martinez Garcia D, Pagano H, Black R, Gaffey MF, Bhutta ZA. The political and security dimensions of the humanitarian health response to violent conflict. Lancet 2021; 397:511-521. [PMID: 33503458 DOI: 10.1016/s0140-6736(21)00130-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 10/01/2020] [Accepted: 10/02/2020] [Indexed: 11/22/2022]
Abstract
The nature of armed conflict throughout the world is intensely dynamic. Consequently, the protection of non-combatants and the provision of humanitarian services must continually adapt to this changing conflict environment. Complex political affiliations, the systematic use of explosive weapons and sexual violence, and the use of new communication technology, including social media, have created new challenges for humanitarian actors in negotiating access to affected populations and security for their own personnel. The nature of combatants has also evolved as armed, non-state actors might have varying motivations, use different forms of violence, and engage in a variety of criminal activities to generate requisite funds. New health threats, such as the COVID-19 pandemic, and new capabilities, such as modern trauma care, have also created new challenges and opportunities for humanitarian health provision. In response, humanitarian policies and practices must develop negotiation and safety capabilities, informed by political and security realities on the ground, and guidance from affected communities. More fundamentally, humanitarian policies will need to confront a changing geopolitical environment, in which traditional humanitarian norms and protections might encounter wavering support in the years to come.
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Affiliation(s)
- Paul H Wise
- Department of Pediatrics, Stanford University, CA, USA; Center for Innovation in Global Health, Stanford University, CA, USA; Stanford University School of Medicine, and The Freeman Spogli Institute for International Studies, Stanford University, CA, USA.
| | - Annie Shiel
- Stanford University School of Medicine, and The Freeman Spogli Institute for International Studies, Stanford University, CA, USA; Center for Civilians in Conflict, Washington DC, USA
| | - Nicole Southard
- Stanford University School of Medicine, and The Freeman Spogli Institute for International Studies, Stanford University, CA, USA
| | - Eran Bendavid
- Center for Innovation in Global Health, Stanford University, CA, USA; Department of Medicine, Stanford University, CA, USA; Stanford University School of Medicine, and The Freeman Spogli Institute for International Studies, Stanford University, CA, USA
| | - Jennifer Welsh
- Department of Political Science, McGill University, Montreal, QC, Canada
| | - Stephen Stedman
- Stanford University School of Medicine, and The Freeman Spogli Institute for International Studies, Stanford University, CA, USA
| | - Tanisha Fazal
- Department of Political Science, University of Minnesota, Minneapolis, MN, USA
| | - Vanda Felbab-Brown
- The Initiative on Nonstate Armed Actors, Foreign Policy Program, The Brookings Institution, Washington DC, USA
| | - David Polatty
- Civilian-Military Humanitarian Response Program, United States Naval War College, Newport, RI, USA
| | - Ronald J Waldman
- Milken Institute School of Public Health, George Washington University, Washington DC, USA
| | - Paul B Spiegel
- Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Karl Blanchet
- Geneva Centre for Education and Research in Humanitarian Action, University of Geneva, Geneva, Switzerland; Health and Humanitarian Crises Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Rita Dayoub
- Centre on Global Health Security, Chatham House, London, UK
| | | | - Michele Barry
- Center for Innovation in Global Health, Stanford University, CA, USA; Department of Medicine, Stanford University, CA, USA; Stanford University School of Medicine, and The Freeman Spogli Institute for International Studies, Stanford University, CA, USA
| | | | | | - Robert Black
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michelle F Gaffey
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Centre of Excellence in Women and Child Health and Institute for Global Health and Development, The Aga Khan University, Karachi, Pakistan
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70
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Abu-Rmeileh NME, Alderete E, Husseini A, Livaudais-Toman J, Pérez-Stable EJ. Country and gender differences in the association between violence and cigarette smoking among youth. Confl Health 2020; 14:87. [PMID: 33317610 PMCID: PMC7734849 DOI: 10.1186/s13031-020-00332-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 11/30/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Exposure to violence in youth may be associated with substance use and other adverse health effects. This study examined cigarette smoking in two middle-income areas with different levels and types of exposure to violence. METHODS Association of exposure to verbal and physical violence with cigarette smoking in the West Bank oPt (2008) and in Jujuy Argentina (2006) was examined using cross-sectional surveys of 14 to 17-year old youth in 7th to 10th grade using probabilistic sampling. RESULTS Violence exposure rates were more than double for Palestinian girls (99.6% vs. 41.2%) and boys (98.7% vs. 41.1%) compared with Argentinians. The rate of current cigarette smoking was significantly higher among Argentinian girls compared with Palestinian girls (33.1% vs. 7.1%, p < 0.001). Exposure to verbal violence from family and to physical violence increased the odds of current cigarette smoking, respectively, among Argentinian girls (aOR = 1.3, 95% CI = 1.0-1.7; aOR = 2.5, 95%CI = 1.7-3.8), Palestinian girls (aOR 2.2, 95%CI = 1.1-2.4; aOR = 2.0, 95%CI = 1.1-3.6) and Argentinian boys (aOR = 1.5, 95%CI = 1.1-2.0; aOR = 2.2, 95%CI = 1.6-3.0), but not among Palestinian boys. CONCLUSION Findings highlight the importance of producing context and gender specific evidence from exposure to violence, to inform and increase the impact of targeted smoking prevention strategies.
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Affiliation(s)
- Niveen M. E. Abu-Rmeileh
- Institute of Community and Public Health- Birzeit University, West Bank, Occupied Palestinian Territory (oPt), Birzeit, Palestine
| | - Ethel Alderete
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Universidad Nacional de Jujuy, Instituto de Ciencia y Tecnología Regional (ICTER), Jujuy, Argentina
| | - Abdullatif Husseini
- Institute of Community and Public Health- Birzeit University, West Bank, Occupied Palestinian Territory (oPt), Birzeit, Palestine
| | - Jennifer Livaudais-Toman
- Division of General Internal Medicine, Department of Medicine, at the University of California, San Francisco, USA
| | - Eliseo J. Pérez-Stable
- Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, USA
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71
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Noriega I, Trejos-Castillo E, Chae Y, Calderon-Delgado L, Barrera-Valencia M, Al-Khalil K, O'Boyle MW. Emotional memory processing in post-traumatic stress disorder affected Colombian youth. INTERNATIONAL JOURNAL OF PSYCHOLOGY 2020; 56:387-393. [PMID: 33236404 DOI: 10.1002/ijop.12730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 10/22/2020] [Indexed: 11/09/2022]
Abstract
Post-traumatic stress disorder (PTSD) is a neuropsychological condition caused by exposure to chronic stressors and extreme trauma. In past decades, Colombia (South America) has experienced high levels of armed conflict, which created an environment of chronic stress, resulting in an increased incidence of PTSD in children. Limited research exists on the effects of PTSD on emotional memory functioning of these Colombian youth living in chronically stressful environments. In the present study, 23 PTSD affected youth and 26 controls were asked to recall items from a memorised word list, as well as remembering details from a short emotional story. Although no significant differences were found for word list memory, deficits for emotional story content were found in the PTSD youth, particularly for facts involving negative emotional details. The latter may suggest a deficit in executive functioning for the integration of emotionally laden stimuli, perhaps induced as a by-product of their traumatic experiences.
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Affiliation(s)
- Ivette Noriega
- Begun Center for Violence Prevention Research and Education, Case Western Reserve University, Cleveland, Ohio, USA
| | | | - Yoojin Chae
- Department of Human Development and Family Sciences, Texas Tech University, Lubbock, Texas, USA
| | - Liliana Calderon-Delgado
- Facultad de Psicología, Universidad CES, Medellín, Colombia.,Department of Political Science, Hradec Králové University, Hradec Králové, Czech Republic
| | - Mauricio Barrera-Valencia
- Departamento de Psicología, Universidad de Antioquia, Medellín, Colombia.,Department of Political Science, Hradec Králové University, Hradec Králové, Czech Republic
| | - Kareem Al-Khalil
- MIND Research Network, University of New Mexico, Albuquerque, New Mexico, USA
| | - Michael W O'Boyle
- Department of Human Development and Family Sciences, Texas Tech University, Lubbock, Texas, USA
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72
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Mordeno IG, Badawi JK, Marcera JL, Ramos JM, Cada PB. Psychological distress and perceived threat serially mediate the relationship between exposure to violence and political exclusionist attitude. CURRENT PSYCHOLOGY 2020. [DOI: 10.1007/s12144-020-01170-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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73
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Rizkalla N, Mallat NK, Arafa R, Adi S, Soudi L, Segal SP. "Children Are Not Children Anymore; They Are a Lost Generation": Adverse Physical and Mental Health Consequences on Syrian Refugee Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228378. [PMID: 33198333 PMCID: PMC7696198 DOI: 10.3390/ijerph17228378] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 12/14/2022]
Abstract
This research examines Syrian refugee mothers’ accounts of the physical and mental health of their children being affected by war traumas and displacement challenges. Open-ended audio-recorded interviews were conducted in Arabic with 23 mothers residing in Jordan. Using a narrative approach in the data collection and analysis, five major themes were identified: (1) children were exposed to diverse war traumatic experiences in Syria; (2) the escape journey and refugee camps threatened children’s lives; (3) displacement and family stressors exposed children to poverty, hostility from local peers, educational and recreational challenges, child labor, and domestic violence (these three major themes were considered as trauma related variables); (4) children were not only directly affected physically and mentally by their own traumatic experiences and displacement stressors, but these experiences were mediated and magnified by familial interrelated processes, evidenced in intergenerational transmission of trauma, harsh parenting style, parental control, and parentification; and (5) adverse consequences of both trauma related variables and family processes directly and indirectly traumatized children and adversely impacted their physical and mental health. We examined the themes that emerged from the data in view of three theoretical frameworks and the impact of trauma in the family system on child development. To conclude, humanitarian organizations that provide services and interventions to refugees need to take into account familial processes and not only individual factors affecting refugee children’s physical and mental health. Further implications on policies and trauma research are discussed.
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Affiliation(s)
- Niveen Rizkalla
- Mack Center on Mental Health & Social Conflict, School of Social Welfare, University of California Berkeley, 120 Haviland Hall, #7400, Berkeley, CA 94720, USA;
- Correspondence: ; Tel.: +1-510-230-6422
| | - Nour K. Mallat
- School of Public Health, University of California Berkeley, 2121, Berkeley Way #5302, Berkeley, CA 94704, USA; (N.K.M.); (R.A.)
| | - Rahma Arafa
- School of Public Health, University of California Berkeley, 2121, Berkeley Way #5302, Berkeley, CA 94704, USA; (N.K.M.); (R.A.)
| | - Suher Adi
- Political Science & Middle Eastern Studies, University of California Berkeley, 210 Barrows Hall #1950, Berkeley, CA 94720, USA;
| | - Laila Soudi
- School of Medicine, Stanford University, 291 Campus Drive, Stanford, CA 94305, USA;
| | - Steven P. Segal
- Mack Center on Mental Health & Social Conflict, School of Social Welfare, University of California Berkeley, 120 Haviland Hall, #7400, Berkeley, CA 94720, USA;
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74
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Aboubaker S, Evers ES, Kobeissi L, Francis L, Najjemba R, Miller NP, Wall S, Martinez D, Vargas J, Ashorn P. The availability of global guidance for the promotion of women's, newborns', children's and adolescents' health and nutrition in conflicts. BMJ Glob Health 2020; 5:e002060. [PMID: 33223502 PMCID: PMC7684670 DOI: 10.1136/bmjgh-2019-002060] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 10/24/2020] [Accepted: 10/29/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Significant global gains in sexual, reproductive, maternal, newborn, child and adolescent health and nutrition (SRMNCAH&N) will be difficult unless conflict settings are adequately addressed. We aimed to determine the amount, scope and quality of publically available guidance documents, to characterise the process by which agencies develop their guidance and to identify gaps in guidance on SRMNCAH&N promotion in conflicts. METHODS We identified guidance documents published between 2008 and 2018 through English-language Internet sites of humanitarian response organisations, reviewed them for their scope and assessed their quality with the AGREE II (Appraisal of Guidelines for REsearch and Evaluation II) tool. Additionally, we interviewed 22 key informants on guidance development, dissemination processes, perceived guidance gaps and applicability. FINDINGS We identified 105 conflict-relevant guidance documents from 75 organisations. Of these, nine were specific to conflicts, others were applicable also to other humanitarian settings. Fifteen documents were technical normative guidelines, others were operational guides (67), descriptive documents (21) or advice on legal, human rights or ethics questions (2). Nutrition was the most addressed health topic, followed by communicable diseases and violence. The documents rated high quality in their 'scope and purpose' and 'clarity of presentation' and low for 'rigour of development' and 'editorial independence'. Key informants reported end user need as the primary driver for guideline development and WHO technical guidelines as their main evidence base. Insufficient local contextualisation, lack of inter-agency coordination and lack of systematic implementation were considered problems in guideline development. Several guidance gaps were noted, including abortion care, newborn care, early child development, mental health, adolescent health beyond sexual and reproductive health and non-communicable diseases. INTERPRETATION Organisations are motivated and actively producing guidance for SRMNCAH&N promotion in humanitarian settings, but few documents address conflicts specifically and there are important guidance gaps. Improved inter-organisation collaboration for guidance on SRMNCAH&N promotion in conflicts and other humanitarian settings is needed.
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Affiliation(s)
| | - Egmond Samir Evers
- Department of Maternal, Newborn, Child and Adolescent Health, WHO, Geneva, Switzerland
| | - Loulou Kobeissi
- Department of Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Lauren Francis
- Department of Maternal, Newborn, Child and Adolescent Health, WHO, Geneva, Switzerland
| | | | | | - Steve Wall
- Saving Newborn Lives, Save the Children, Washington, DC, USA
| | | | | | - Per Ashorn
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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75
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Gaffey MF, Ataullahjan A, Das JK, Mirzazada S, Tounkara M, Dalmar AA, Bhutta ZA. Researching the delivery of health and nutrition interventions for women and children in the context of armed conflict: lessons on research challenges and strategies from BRANCH Consortium case studies of Somalia, Mali, Pakistan and Afghanistan. Confl Health 2020; 14:69. [PMID: 33088339 PMCID: PMC7574460 DOI: 10.1186/s13031-020-00315-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/05/2020] [Indexed: 11/19/2022] Open
Abstract
Background The BRANCH Consortium recently conducted 10 mixed-methods case studies to investigate the provision of health and nutrition interventions for women and children in conflict-affected countries, aiming to better understand the dominant influences on humanitarian health actors’ programmatic decision-making and how such actors surmount intervention delivery barriers. In this paper, the research challenges encountered and the mitigating strategies employed by the case study investigators in four of the BRANCH case study contexts are discussed: Somalia, Mali, Pakistan and Afghanistan. Discussion Many of the encountered research challenges were anticipated, with investigators adopting mitigation strategies in advance or early on, but others were unexpected, with implications for how studies were ultimately conducted and how well the original study aims were met. Insecurity was a fundamental challenge in all study contexts, with restricted geographical access and concerns for personal safety affecting sampling and data collection plans, and requiring reliance on digital communications, remote study management, and off-site team meetings wherever possible. The need to navigate complex local sociopolitical contexts required maximum reliance on local partners’ knowledge, expertise and networks, and this was facilitated by early engagement with a wide range of local study stakeholders. Severe lack of reliable quantitative data on intervention coverage affected the extent to which information from different sources could be triangulated or integrated to inform an understanding of the influences on humanitarian actors’ decision-making. Conclusion Strong local partners are essential to the success of any project, contributing not only technical and methodological capacity but also the insight needed to truly understand and interpret local dynamics for the wider study team and to navigate those dynamics to ensure study rigour and relevance. Maintaining realistic expectations of data that are typically available in conflict settings is also essential, while pushing for more resources and further methodological innovation to improve data collection in such settings. Finally, successful health research in the complex, dynamic and unpredictable contexts of conflict settings requires flexibility and adaptability of researchers, as well as sponsors and donors.
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Affiliation(s)
- Michelle F Gaffey
- Centre for Global Child Health, The Hospital for Sick Children, 686 Bay St, Toronto, ON M5G 0A4 Canada
| | - Anushka Ataullahjan
- Centre for Global Child Health, The Hospital for Sick Children, 686 Bay St, Toronto, ON M5G 0A4 Canada
| | - Jai K Das
- Aga Khan University, Karachi, Pakistan
| | | | - Moctar Tounkara
- University of Sciences, Techniques and Technology of Bamako, Bamako, Mali
| | | | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, 686 Bay St, Toronto, ON M5G 0A4 Canada.,Aga Khan University, Karachi, Pakistan
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76
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Feinstein A, Choonara I. Arms sales and child health. BMJ Paediatr Open 2020; 4:e000809. [PMID: 32954017 PMCID: PMC7482471 DOI: 10.1136/bmjpo-2020-000809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/19/2020] [Accepted: 08/20/2020] [Indexed: 01/11/2023] Open
Abstract
The adverse effects of armed conflict on child health are well recognised. The relationships among the arms trade, armed conflict and child health are less clearly defined. The arms trade is one of the largest industries in the world (total expenditure US$1917 billion in 2019), generating colossal profits to private companies and individuals at the expense of taxpayers throughout the world. The money wasted on weapons designed to kill and maim should be used for more socially useful products, such as clean water, food, health and education. The sustainable development goals can be funded by diverting money from the arms companies. Health professionals and their organisations have a responsibility to children to try and curb the ever-expanding arms industry.
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Affiliation(s)
- Andrew Feinstein
- Shadow World Investigations (formerly Corruption Watch UK), London, UK
| | - Imti Choonara
- Child Health, University of Nottingham School of Medicine, Derby, UK
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77
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Abstract
Armed conflicts continue to occur in some regions of the globe, mostly in developing countries. These man-made disasters affect all segments of the population; however, some groups are more vulnerable and suffer more seriously from the unfavorable consequences of such conflicts. Among these, the pediatric population deserves special attention because they cannot protect themselves, and hence carry a higher threat of injuries and probability of death during conflicts. In addition, children who do survive the disaster are more prone to exploitation. Pediatric victims, including those who sustain acute kidney injury or those suffering from chronic kidney disease before armed conflicts, face higher risks of morbidity and mortality as a result of treatment problems, specifically limited dialysis options. Displaced children, forced to flee their homes as a result of armed conflicts, are also at risk for various health problems because they may not find ideal circumstances for disease treatment. Making preparations in anticipation of armed conflicts, such as disaster-relief scenarios and action plans, may be useful to decrease the death toll in these children, who are dependent on their caregivers for survival. Adopting principles of disaster nephrology may contribute to improved survival chances of pediatric kidney patients in chaotic circumstances.
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Abstract
Persons with disabilities (PWDs) living in cities during the COVID-19 pandemic response may be four times more likely to be injured or die than non-disabled persons, not because of their "vulnerable" position but because urban health policy, planning and practice has not considered their needs. In this article, the adverse health impacts on PWDs during the COVID-19 pandemic reveals the "everyday emergencies" in cities for PWDs and that these can be avoided through more inclusive community planning, a whole-of-government commitment to equal access, and implementation of universal design strategies. Importantly, COVID-19 can place PWDs at a higher risk of infection since some may already have compromised immune and respiratory systems and policy responses, such as social distancing, can lead to life-threatening disruptions in care for those that rely on home heath or personal assistants. Living in cities may already present health-damaging challenges for PWDs, such as through lack of access to services and employment, physical barriers on streets and transportation, and smart-city technologies that are not made universally accessible. We suggest that the current pandemic be viewed as an opportunity for significant urban health reforms on the scale of the sanitary and governance reforms that followed ninetieth century urban epidemics. This perspective offers insights for ensuring the twenty-first century response to COVID-19 focuses on promoting more inclusive and healthy cities for all.
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Affiliation(s)
| | - Jason Corburn
- School of Public Health & City & Regional Planning, UC Berkeley, Berkeley, CA USA
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Ataullahjan A, Gaffey MF, Sami S, Singh NS, Tappis H, Black RE, Blanchet K, Boerma T, Langer A, Spiegel PB, Waldman RJ, Wise PH, Bhutta ZA. Investigating the delivery of health and nutrition interventions for women and children in conflict settings: a collection of case studies from the BRANCH Consortium. Confl Health 2020; 14:29. [PMID: 32514294 PMCID: PMC7254714 DOI: 10.1186/s13031-020-00276-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 04/23/2020] [Indexed: 11/10/2022] Open
Abstract
Globally, the number of people affected by conflict is the highest in history, and continues to steadily increase. There is currently a pressing need to better understand how to deliver critical health interventions to women and children affected by conflict. The compendium of articles presented in this Conflict and Health Collection brings together a range of case studies recently undertaken by the BRANCH Consortium (Bridging Research & Action in Conflict Settings for the Health of Women and Children). These case studies describe how humanitarian actors navigate and negotiate the multiple obstacles and forces that challenge the delivery of health and nutrition interventions for women, children and adolescents in conflict-affected settings, and to ultimately provide some insight into how service delivery can be improved.
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Affiliation(s)
| | - Michelle F. Gaffey
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Samira Sami
- Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Neha S. Singh
- Health in Humanitarian Crises Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Hannah Tappis
- Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Robert E. Black
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Karl Blanchet
- Health in Humanitarian Crises Centre, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Ana Langer
- Women and Health Initiative, Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, USA
| | - Paul B. Spiegel
- Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Ronald J. Waldman
- Milken Institute School of Public Health, George Washington University, Washington DC, USA
| | - Paul H. Wise
- The Center for Policy, Outcomes and Prevention, Stanford University, Palo Alto, CA USA
| | - Zulfiqar A. Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
- Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
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80
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Hermosilla S, Metzler J, Savage K, Ager A. Resilience and adjustment trajectories amongst children in displacement-affected communities in Zarqa, Jordan. JOURNAL OF GLOBAL HEALTH REPORTS 2020; 4. [PMID: 35128077 PMCID: PMC8813053 DOI: 10.29392/001c.18233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The experiences of protracted conflict and displacement are clear threats to children's developmental progress. Understanding the factors that shape the trajectories of children's well-being and adjustment in such contexts is important for informing interventions. METHODS We collected data at three time points from a sample of Syrian refugee and Jordanian children (n=650) residing in Zarqa, Jordan who met eligibility criteria for humanitarian programming. We assessed primary outcomes of protection concerns, caregiver stress, mental health, and developmental assets at three time points: baseline (T1), three months later (T2), and fifteen months after baseline (T3). RESULTS Over the fifteen-month study period (T1-T3) child protection concerns and mental health symptoms improved, caregiver stress remained constant, and developmental assets deteriorated. School attendance was independently associated with improvements in protection concerns (β = -1.05, P=0.01), caregiver stress (β = -0.66, P =0.02), and developmental assets (β = 3.84, P =0.02). Concern over lost livelihoods significantly predicted higher protection concerns (β = 4.08, P <0.001) and caregiver stress (β = 2.32, P <0.001). Attending child-focused programming did not significantly impact primary outcomes. CONCLUSIONS This study documents the capacity for adjustment and adaptation of children in the context of protracted displacement. The significant influences of attending school and concern over lost livelihoods on observed trajectories indicate the importance of addressing structural factors, such as education and employment, in supporting processes of resilience in these populations. Programmatic activities for children may secure valuable shorter-term impacts but here, as elsewhere, failed to impact outcomes longer-term.
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Affiliation(s)
- Sabrina Hermosilla
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Janna Metzler
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City, New York, USA
| | - Kevin Savage
- Humanitarian and Emergency Affairs, World Vision International, Geneva, Switzerland
| | - Alastair Ager
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City, New York, USA; Institute for Global Health and Development, Queen Margaret University, Edinburgh, Scotland, UK
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81
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Affiliation(s)
- Anders Hjern
- Sachs Children's Hospital and Clinical Epidemiology Department of Medicine Karolinska Institute Stockholm Sweden
| | - Ayesha Kadir
- Institute for Studies of Migration, Diversity and Welfare Malmo Högskola Malmö Sweden
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Kadir A, Garcia DM, Romero F. New ways to measure the effects of armed conflict in civilian population. THE LANCET GLOBAL HEALTH 2019; 7:e1585-e1586. [PMID: 31669038 DOI: 10.1016/s2214-109x(19)30452-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 10/08/2019] [Indexed: 11/16/2022] Open
Affiliation(s)
- Ayesha Kadir
- Nykøbing Falster Hospital, Nykøbing Falster 4800, Denmark.
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83
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Goldhagen JL, Shenoda S, Oberg C, Mercer R, Kadir A, Raman S, Waterston T, Spencer NJ. Rights, justice, and equity: a global agenda for child health and wellbeing. THE LANCET CHILD & ADOLESCENT HEALTH 2019; 4:80-90. [PMID: 31757760 DOI: 10.1016/s2352-4642(19)30346-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 09/20/2019] [Accepted: 09/23/2019] [Indexed: 11/16/2022]
Abstract
Worldwide challenges to child health and wellbeing are rapidly becoming existential threats to children and childhood. Inequities, armed conflict and violence, nuclear proliferation, forced migration, globalisation, and climate change are among the global issues violating children's rights to optimal survival and development. Child rights-based approaches will be required to enhance the response to the civil-political, social, economic, and cultural determinants of these global child health issues. In this Viewpoint, we present a global agenda for child health and wellbeing as a blueprint for the practice of paediatrics and child health in the domains of clinical care, systems development, and policy formulation. This global agenda is grounded in the principles of rights, justice, and equity and can address the root-cause determinants of health. The 30th anniversary of the UN Convention on the Rights of the Child is a relevant moment to recommit to shared goals for children's health and wellbeing.
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Affiliation(s)
| | | | - Charles Oberg
- University of Minnesota, Divisions of Global Pediatrics and Epidemiology & Community Health, Minneapolis, MN, USA
| | - Raúl Mercer
- Program of Social Sciences and Health, Facultad Latinoamericana de Ciencias Sociales (FLASCO), Buenos Aires, Argentina
| | - Ayesha Kadir
- Department of Paediatrics, Nykøbing Falster Hospital, Nykøbing Falster, Denmark
| | - Shanti Raman
- Department of Community Paediatrics, Sydney and South Western Sydney Local Health Districts, Liverpool, NSW, Australia
| | - Tony Waterston
- Institute of Child Health and Society, University of Newcastle upon Tyne, Newcastle upon Tyne, UK
| | - Nicholas J Spencer
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
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84
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De Jesus M, Hernandes C. Generalized Violence as a Threat to Health and Well-Being: A Qualitative Study of Youth Living in Urban Settings in Central America's "Northern Triangle". INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183465. [PMID: 31540367 PMCID: PMC6765918 DOI: 10.3390/ijerph16183465] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 09/02/2019] [Accepted: 09/10/2019] [Indexed: 11/24/2022]
Abstract
El Salvador, Guatemala, and Honduras rank among the top 10 countries experiencing violence in the world, despite not being at war. Although there is abundant literature on generalized violence in this “northern triangle” of Central America as a driver of out-migration to the United States, very little is known about the perspectives and experiences of youth who do not migrate. This study aimed to elicit the emic perspectives of youth residing in the region on how the day-to-day generalized violence produces a pervasive threat to the overall health and human security of youth as well as the key protective factors and resiliencies at work. We conducted two separate waves of qualitative research in 2015 and 2018 over a 6-month period, which included 60 in-depth interviews and six focus groups among Salvadoran, Guatemalan and Honduran youth living in urban areas. Qualitative thematic analysis revealed two meta-themes: (1) ‘Lack of health,’ defined as not experiencing peace within the family, the community, and the country’ and (2) ‘Resilience.’ Thematic clusters that reflect the first meta-theme are: (1) violence as a common occurrence; (2) living in fear and insecurity; (3) victimization; and (4) lack of state protection and services. Thematic clusters for the second meta-theme are: (1) a positive future outlook and a commitment to education; (2) transnational and local family network support; and (3) engagement in community-based youth groups. To interpret the findings, we adopt the Latin American Social Medicine and Collective Health (LASM-CH) approach that prioritizes perspectives from the region. Generalized violence is conceptualized as a systemic phenomenon that is generated and reproduced through the complex interactions of structural inequities and unequal power relations. The findings of this study provide new insights into the implementation of a different approach to address the generalized violence, insights that may guide multi-sectoral health policies and interventions both in the region and transnationally.
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Affiliation(s)
- Maria De Jesus
- School of International Service, American University, Washington, DC 20016, USA.
- Center on Health, Risk, and Society, American University, Washington, DC 20016, USA.
| | - Carissa Hernandes
- School of International Service, American University, Washington, DC 20016, USA
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85
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Bhutta ZA, Gaffey MF, Blanchet K, Waldman R, Abbasi K. Protecting women and children in conflict settings. BMJ 2019; 364:l1095. [PMID: 30862687 DOI: 10.1136/bmj.l1095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
- Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Michelle F Gaffey
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Karl Blanchet
- Health in Humanitarian Crises Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Ron Waldman
- Milken Institute School of Public Health, George Washington University, Washington DC, USA
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