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Harphoush S, Shahood B, Harphoush I, Awudi DA, Ahmad S, Zaitoun M, Weeto MM, Li Z. The impact of crisis and COVID-19 on Syrian children growth, health awareness and nutritional practices. a cross-sectional study. BMC Pediatr 2023; 23:295. [PMID: 37322455 PMCID: PMC10268436 DOI: 10.1186/s12887-023-04115-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/07/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Despite the great steadfastness that Syria has achieved in the face of more than a decade of stifling crisis followed by the global COVID-19 pandemic, the heavy impacts of these long rough years are certain and crucial on the health and nutrition levels, specially on vulnerable groups like women and children. Moreover, the lack of research and data on health and nutritional status of children within Syria makes it very difficult to draw conclusions and act effectively. The purpose of the current study was to evaluate growth development and give an insight about the public health awareness and nutritional practices among Syrian primary schools children. METHODS A cross-sectional study was conducted among private and public primary schools' students aged 6 to 9 years old in Homs governorate in January to April 2021, anthropometric measures were taken and data assessment of socioeconomic background, nutritional practices, and health awareness was achieved by conducting two surveys answered by parents and students. RESULTS We defined the total prevalence of obesity (11.8%), underweight (5.6%) and stunting (13.8%), with a significant increased in underweight and stunting prevalence ,(9%, 21.6%) respectively, among public schools' students compared to private schools' students. Differences in nutritional practices and health awareness were recorded between public and private schools' students under socioeconomic impact. CONCLUSIONS This study contributes to evaluate the burden of crisis and COVID-19 pandemic on Syrian children growth and health practices in Syria. Improving health awareness and nutritional support among Syrian families to help children meet their growth needs is recommended. Moreover, additional research should be conducted to evaluate micro-nutrients deficiencies and provide appropriate medical support effectively.
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Affiliation(s)
- Seba Harphoush
- The Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, 211166 China
- Department of Nutrition, Faculty of Health Science, Al-Baath University, Homs, Syria
| | - Bashar Shahood
- Department of Oral Implantology, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, 210029 PR China
| | - Ihab Harphoush
- Research Institute of Economic and Management, Southwestern University of Finance and Economic, Chengdu, PR China
| | - Doris Abra Awudi
- Department of Nutrition and Food Hygiene, School of Public Health, Nanjing Medical University, Nanjing, 211166 PR China
| | - Shakeel Ahmad
- Department of Nutrition and Food Hygiene, School of Public Health, Nanjing Medical University, Nanjing, 211166 PR China
| | - Margaret Zaitoun
- Department of Nutrition and Food Hygiene, School of Public Health, Nanjing Medical University, Nanjing, 211166 PR China
| | - Makhala Mary Weeto
- Department of Nutrition and Food Hygiene, School of Public Health, Nanjing Medical University, Nanjing, 211166 PR China
| | - Zhong Li
- The Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, 211166 China
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Meagher K, Khaity M, Hafez S, Rodo M, Achi NE, Patel P. Strengthening health systems and peacebuilding through women's leadership: a qualitative study. Global Health 2023; 19:21. [PMID: 36959675 PMCID: PMC10035971 DOI: 10.1186/s12992-023-00920-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 03/11/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Active and protracted conflict settings demonstrate the need to prioritise the peace through health agenda. This can be achieved by reorienting attention toward gender diverse leadership and more effective governance within health systems. This approach may enable women to have a greater voice in the decision-making of health and social interventions, thereby enabling the community led and context specific knowledge required to address the root causes of persistent inequalities and inequities in systems and societies. METHODS We conducted a qualitative study, which included semi-structured interviews with 25 key informants, two focus group discussions and one workshop with humanitarian workers in local and international non-governmental organisations (NGOs), United Nations (UN) agencies, health practitioners, and academics, from Sub-Saharan Africa, Middle East and North Africa (MENA), and Latin America. Findings were then applied to the peacebuilding pyramid designed by John Paul Lederach which provides a practical framework for mediation and conflict resolution in several conflict-affected settings. The purpose of the framework was to propose an adapted conceptualisation of leadership to include women's leadership in the health system and be more applicable in protracted conflict settings. RESULTS Five interrelated themes emerged. First, perceptions of terms such as gender equality, equity, mainstreaming, and leadership varied across participants and contexts. Second, armed conflict is both a barrier and an enabler for advancing women's leadership in health systems. Third, health systems themselves are critical in advancing the nexus between women's leadership, health systems and peacebuilding. Fourth, across all contexts we found strong evidence of an instrumental relationship between women's leadership in health systems in conflict-affected settings and peacebuilding. Lastly, the role of donors emerged as a critical obstacle to advance women's leadership. CONCLUSION Continuing to empower women against social, cultural, and institutional barriers is crucial, as the emerging correlation between women's leadership, health systems, and peacebuilding is essential for long-term stability, the right to health, and health system responsiveness.
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Affiliation(s)
- Kristen Meagher
- Research for Health Systems Strengthening in Syria (R4HSSS) and the Conflict and Health Research Centre CCRC, Department of War Studies, King's College London, London, UK.
| | | | - Sali Hafez
- Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Nassim El Achi
- Research for Health Systems Strengthening in Syria (R4HSSS) and the Conflict and Health Research Centre CCRC, Department of War Studies, King's College London, London, UK
| | - Preeti Patel
- Research for Health Systems Strengthening in Syria (R4HSSS) and the Conflict and Health Research Centre CCRC, Department of War Studies, King's College London, London, UK
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Meagher K, Mkhallalati H, El Achi N, Patel P. A missing piece in the Health for Peace agenda: gender diverse leadership and governance. BMJ Glob Health 2022; 7:bmjgh-2021-007742. [PMID: 36210063 PMCID: PMC9535196 DOI: 10.1136/bmjgh-2021-007742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 12/03/2021] [Indexed: 11/15/2022] Open
Abstract
The purpose of this paper is to explore how gender diverse leadership and governance of health systems may contribute to the Health for Peace Agenda. Despite recent momentum, the evidence base to support, implement and evaluate ‘Health for Peace’ programmes remains limited and policy-makers in conflict settings do not consider peace when developing and implementing interventions and health policies. Through this analysis, we found that gender diverse leadership in health systems during active conflict offers greater prospects for sustainable peace and more equitable social economic recovery in the post-conflict period. Therefore, focusing on gender diversity of leadership and governance in health systems strengthening offers a novel way of linking peace and health, particularly in active conflict settings. While components of health systems are beginning to incorporate a gender lens, there remains significant room for improvement particularly in complex and protracted conflicts. Two case studies are explored, north-west Syria and Afghanistan, to highlight that an all-encompassing health systems focus may provide an opportunity for further understanding the link between gender, peace and health in active conflict and advocate for long-term investment in systems impacted by conflict. This approach may enable women and gender minorities to have a voice in the decision-making of health programmes and interventions that supports systems, and enables the community-led and context-specific knowledge and action required to address the root causes of inequalities and inequities in systems and societies.
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Affiliation(s)
- Kristen Meagher
- Department of War Studies, King's College London, London, UK
| | - Hala Mkhallalati
- Saw Swee Hock School of Public Health, National University Singapore, Singapore
| | - Nassim El Achi
- School of Geography and the Environment, Oxford University, Oxford, UK
| | - Preeti Patel
- Department of War Studies, King's College London, London, UK
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Nasir MA, Nugroho AD, Lakner Z. Impact of the Russian-Ukrainian Conflict on Global Food Crops. Foods 2022; 11:2979. [PMID: 36230055 PMCID: PMC9563949 DOI: 10.3390/foods11192979] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/09/2022] [Accepted: 09/06/2022] [Indexed: 11/17/2022] Open
Abstract
The Russian-Ukrainian conflict has been proven to cause significant losses of life and goods on both sides. This may have potentially impacted the agricultural sector. This study examines the impact of the conflict between Russia and Ukraine on the global food situation. We performed a descriptive analysis and literature review to answer this objective. Russia and Ukraine play essential roles in world food production and trade. However, the war has disrupted food production in Ukraine. Estimated Ukrainian wheat, soybean, and maize production in 2022-2023 fell precipitously. On the other hand, Russian production of these three food products shows positive growth during the same period. Furthermore, the global supply chain and food trade are hampered, causing an increase in the world's food prices. From March to May 2022, the average global price of wheat, soybeans, and maize increased dramatically compared to during and before the COVID-19 pandemic. Finally, this poses a danger to global food security, particularly for low-income countries that depend heavily on food imports from both countries. Therefore, all countries must be prepared for the possibility that the Sustainable Development Goals cannot be achieved.
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Affiliation(s)
- Muh Amat Nasir
- Faculty of Agriculture, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
| | - Agus Dwi Nugroho
- Doctoral School of Economic and Regional Sciences, Hungarian University of Agriculture and Life Sciences, 2100 Godollo, Hungary
| | - Zoltan Lakner
- Institute of Agricultural and Food Economics, Hungarian University of Agriculture and Life Sciences, 2100 Godollo, Hungary
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Meagher K, Attal B, Patel P. Exploring the role of gender and women in the political economy of health in armed conflict: a narrative review. Global Health 2021; 17:88. [PMID: 34348740 PMCID: PMC8334332 DOI: 10.1186/s12992-021-00738-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 07/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background The ripple effects of protracted armed conflicts include: significant gender-specific barriers to accessing essential services such as health, education, water and sanitation and broader macroeconomic challenges such as increased poverty rates, higher debt burdens, and deteriorating employment prospects. These factors influence the wider social and political determinants of health for women and a gendered analysis of the political economy of health in conflict may support strengthening health systems during conflict. This will in turn lead to equality and equity across not only health, but broader sectors and systems, that contribute to sustainable peace building. Methods The methodology employed is a multidisciplinary narrative review of the published and grey literature on women and gender in the political economy of health in conflict. Results The existing literature that contributes to the emerging area on the political economy of health in conflict has overlooked gender and specifically the role of women as a critical component. Gender analysis is incorporated into existing post-conflict health systems research, but this does not extend to countries actively affected by armed conflict and humanitarian crises. The analysis also tends to ignore the socially constructed patriarchal systems, power relations and gender norms that often lead to vastly different health system needs, experiences and health outcomes. Conclusions Detailed case studies on the gendered political economy of health in countries impacted by complex protracted conflict will support efforts to improve health equity and understanding of gender relations that support health systems strengthening.
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Affiliation(s)
- Kristen Meagher
- Research for Health Systems Strengthening in northern Syria, Conflict and Health Research Group (CHRG), Department of War Studies, King's College London, London, UK.
| | - Bothaina Attal
- Faculty of Medicine and Health Sciences, Sana'a University, Yemen and Centre for Business Research, University of Cambridge, Cambridge, UK
| | - Preeti Patel
- Research for Health Systems Strengthening in northern Syria, Conflict and Health Research Group (CHRG), Department of War Studies, King's College London, London, UK
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Bertone MP, Jowett M, Dale E, Witter S. Health financing in fragile and conflict-affected settings: What do we know, seven years on? Soc Sci Med 2019; 232:209-219. [PMID: 31102931 DOI: 10.1016/j.socscimed.2019.04.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/20/2019] [Accepted: 04/14/2019] [Indexed: 12/21/2022]
Abstract
Over the last few years, there has been growing attention to health systems research in fragile and conflict-affected setting (FCAS) from both researchers and donors. In 2012, an exploratory literature review was conducted to analyse the main themes and findings of recent literature focusing on health financing in FCAS. Seven years later, this paper presents an update of that review, reflecting on what has changed in terms of the knowledge base, and what are the on-going gaps and new challenges in our understanding of health financing in FCAS. A total of 115 documents were reviewed following a purposeful, non-systematic search of grey and published literature. Data were analysed according to key health financing themes, ensuring comparability with the 2012 review. Bibliometric analysis suggests that the field has continued to grow, and is skewed towards countries with a large donor presence (such as Afghanistan). Aid coordination remains the largest single topic within the themes, likely reflecting the dominance of external players, not just substantively but also in relation to research. Many studies are commissioned by external agencies and in addition to concerns about independence of findings there is also likely a neglect of smaller, more home-grown reforms. In addition, we find that despite efforts to coordinate approaches across humanitarian and developmental settings, the literature remains distinct between them. We highlight research gaps, including empirical analysis of domestic and external financing trends across FCAS and non-FCAS over time, to understand better common health financing trajectories, what drives them and their implications. We highlight a dearth of evidence in relation to health financing goals and objectives for UHC (such as equity, efficiency, financial access), which is significant given the relevance of UHC, and the importance of the social and political values which different health financing arrangements can communicate, which also merit in-depth study.
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Affiliation(s)
- Maria Paola Bertone
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK.
| | - Matthew Jowett
- Health Financing Unit, World Health Organisation, Geneva, Switzerland.
| | - Elina Dale
- Health Financing Unit, World Health Organisation, Geneva, Switzerland.
| | - Sophie Witter
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK.
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Douedari Y, Howard N. Perspectives on Rebuilding Health System Governance in Opposition-Controlled Syria: A Qualitative Study. Int J Health Policy Manag 2019; 8:233-244. [PMID: 31050968 PMCID: PMC6499905 DOI: 10.15171/ijhpm.2018.132] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 12/17/2018] [Indexed: 11/18/2022] Open
Abstract
Background: Ongoing conflict and systematic targeting of health facilities and personnel by the Syrian regime in opposition-controlled areas have contributed to health system and governance mechanisms collapse. Health directorates (HDs) were established in opposition-held areas in 2014 by the interim (opposition) Ministry of Health (MoH), to meet emerging needs. As the local health authorities responsible for health system governance in opposition-controlled areas in Syria, they face many challenges. This study explores ongoing health system governance efforts in 5 oppositioncontrolled areas in Syria.
Methods: A qualitative study design was selected, using in-depth key informant interviews with 20 participants purposely sampled from HDs, non-governmental organisations (NGOs), donors, and service-users. Data were analysed thematically.
Results: Health system governance elements (ie, strategic vision, participation, transparency, responsiveness, equity, effectiveness, accountability, information) were considered important, but not interpreted or addressed equally in opposition-controlled areas. Participants identified HDs as primarily responsible for health system governance in opposition-controlled areas. Main health system governance challenges identified were security (eg, targeting of health facilities and personnel), funding, and capacity. Suggested solutions included supporting HDs, addressing health-worker loss, and improving coordination.
Conclusion: Rebuilding health system governance in opposition-controlled areas in Syria is already progressing, despite ongoing conflict. Local health authorities need support to overcome identified challenges and build sustainable health system governance mechanisms
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Affiliation(s)
- Yazan Douedari
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Natasha Howard
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Michaud J, Moss K, Licina D, Waldman R, Kamradt-Scott A, Bartee M, Lim M, Williamson J, Burkle F, Polyak CS, Thomson N, Heymann DL, Lillywhite L. Militaries and global health: peace, conflict, and disaster response. Lancet 2019; 393:276-286. [PMID: 30663597 DOI: 10.1016/s0140-6736(18)32838-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 11/20/2017] [Accepted: 11/01/2018] [Indexed: 11/17/2022]
Abstract
Many countries show a growing willingness to use militaries in support of global health efforts. This Series paper summarises the varied roles, responsibilities, and approaches of militaries in global health, drawing on examples and case studies across peacetime, conflict, and disaster response environments. Militaries have many capabilities applicable to global health, ranging from research, surveillance, and medical expertise to rapidly deployable, large-scale assets for logistics, transportation, and security. Despite this large range of capabilities, militaries also have limitations when engaging in global health activities. Militaries focus on strategic, operational, and tactical objectives that support their security and defence missions, which can conflict with humanitarian and global health equity objectives. Guidelines-both within and outside militaries-for military engagement in global health are often lacking, as are structured opportunities for military and civilian organisations to engage one another. We summarise policies that can help close the gap between military and civilian actors to catalyse the contributions of all participants to enhance global health.
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Affiliation(s)
- Joshua Michaud
- Henry J Kaiser Family Foundation, Washington, DC, USA; Johns Hopkins University School of Advanced International Studies, Washington, DC, USA.
| | - Kellie Moss
- Henry J Kaiser Family Foundation, Washington, DC, USA
| | - Derek Licina
- US Army Regional Health Command - Pacific, Honolulu, HI, USA
| | - Ron Waldman
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | | | - Maureen Bartee
- Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Matthew Lim
- US Naval Medical Research Center, Silver Spring, MD, USA
| | | | - Frederick Burkle
- Harvard Humanitarian Initiative, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Christina S Polyak
- US Military HIV Research Program, Bethesda, MD, USA; The Henry Jackson Foundation, Bethesda, MD, USA
| | - Nicholas Thomson
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; Centre for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David L Heymann
- Chatham House Royal Institute of International Affairs, London, UK; London School of Hygiene & Tropical Medicine, London, UK
| | - Louis Lillywhite
- Chatham House Royal Institute of International Affairs, London, UK
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Kennedy J, Michailidou D. Civil war, contested sovereignty and the limits of global health partnerships: A case study of the Syrian polio outbreak in 2013. Health Policy Plan 2017; 32:690-698. [DOI: 10.1093/heapol/czw148] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2016] [Indexed: 11/14/2022] Open
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