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Aultman JM, Zaaeed N, Payton C, DiVito B, Holland T, Atem J. Research with Refugee Populations in North America: Applying the NIH Guiding Principles for Ethical Research. Ethics Hum Res 2024; 46:2-16. [PMID: 38944882 DOI: 10.1002/eahr.500214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
This article examines the ethics of research design and the initiation of a study (e.g., recruitment of participants) involving refugee participants. We aim to equip investigators and members of IRBs with a set of ethical considerations and pragmatic recommendations to address challenges in refugee-focused research as it is developed and prepared for IRB review. We discuss challenges including how refugees are being defined and identified; their vulnerabilities before, during, and following resettlement that impacts their research participation; recruitment; consent practices including assent and unaccompanied minors; and conflicts of interest. Ethical guidance and regulatory oversight provided by international bodies, federal governments, and IRBs are important for enforcing the protection of participants. We describe the need for additional ethical guidance and awareness, if not special protections for refugee populations as guided by the National Institutes of Health (NIH) Guiding Principles for Ethical Research.
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Affiliation(s)
- Julie M Aultman
- Dean and professor of the College of Graduate Studies and director of medical ethics and humanities at Northeast Ohio Medical University
| | - Najah Zaaeed
- Assistant professor in the Department of Health Promotion and Wellness and an adjunct professor in the Department of Counseling and Psychological Services in the School of Education at State University of New York Oswego
| | - Colleen Payton
- Assistant professor of public health and director of the Public Health Program in the School of Nursing and Public Health at Moravian University
| | - Brittany DiVito
- Family Nurse Practitioner, and a director and clinical assistant professor at the Edson College of Nursing and Health Innovation at Arizona State University
| | - Tim Holland
- Head of the Department of Bioethics at Dalhousie University and medical lead at Newcomer Health Clinic
| | - Jacob Atem
- Serves as both a public health practitioner and the chief executive officer of the Southern Sudan Healthcare Organization (SSHCO)
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Sahoo KC, Sahay MR, Dubey S, Nayak S, Negi S, Mahapatra P, Bhattacharya D, Barrio MOD, Pati S. Community engagement and involvement in managing the COVID-19 pandemic among urban poor in low-and middle-income countries: a systematic scoping review and stakeholders mapping. Glob Health Action 2023; 16:2133723. [PMID: 36537837 PMCID: PMC9769144 DOI: 10.1080/16549716.2022.2133723] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Community engagement and involvement (CEI) was crucial for the COVID-19 pandemic response, particularly among the urban poor in low-and middle-income countries (LMICs). However, no evidence synthesis explores how CEI can benefit public health emergencies. OBJECTIVE We conducted a systematic scoping review of the CEI with an emphasis on stakeholder identification, accountability mapping, the support system, and the engagement process among urban poor populations in LMICs during the COVID-19 pandemic. METHODS We searched eleven databases, including PubMed, Embase, Web of Science, and CINAHL, following the PRISMA-2020 guidelines to find articles published between November 2019 and August 2021. PROSPERO registration No: CRD42021283599. We performed the quality assessment using a mixed-method appraisal tool. We synthesized the findings using thematic framework analysis. RESULTS We identified 6490 records. After the title and abstract screening, 133 studies were selected for full-text review, and finally, we included 30 articles. Many stakeholders were involved in COVID-19 support, particularly for health care, livelihoods, and WASH infrastructure, and their accountability mapping by adopting an interest - influence matrix. This review emphasizes the significance of meaningful CEI in designing and implementing public health efforts for pandemic management among urban slum populations. The interest - influence matrix findings revealed that specific community volunteers, community-based organizations, and civil society organizations had high interest but less influence, indicating that it is necessary to recognize and engage them. CONCLUSION Motivation is crucial for those with high influence but less interest, such as corporate responsibility/conscience and private food supply agencies, for the health system's preparedness plan among urban populations.
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Affiliation(s)
- Krushna Chandra Sahoo
- Health Technology Assessment in India (HTAIn), ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Mili Roopchand Sahay
- Health Technology Assessment in India (HTAIn), ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Shubhankar Dubey
- Health Technology Assessment in India (HTAIn), ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Subhasish Nayak
- Health Technology Assessment in India (HTAIn), ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Sapna Negi
- Health Technology Assessment in India (HTAIn), ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Pranab Mahapatra
- Department of Psychiatry, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Debdutta Bhattacharya
- Health Technology Assessment in India (HTAIn), ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Mariam Otmani Del Barrio
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | - Sanghamitra Pati
- Health Technology Assessment in India (HTAIn), ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India,CONTACT Sanghamitra Pati Health Technology Assessment in India (HTAIn), ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha751023, India
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Salti N, McCall SJ, Abi Zeid B, El Salibi N, Alawieh M, Ramadan Z, Ghattas H, Abdulrahim S. The determinants of sustained adherence to COVID-19 preventive measures among older Syrian refugees in Lebanon. PLoS One 2023; 18:e0268851. [PMID: 37347734 PMCID: PMC10286991 DOI: 10.1371/journal.pone.0268851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/06/2023] [Indexed: 06/24/2023] Open
Abstract
INTRODUCTION Lebanon has battled the COVID-19 pandemic in the midst of an economic crisis. The evolution of the pandemic and a fragile health system have meant that public health policy has had to rely heavily on non-pharmaceutical interventions for disease control. However, changes in disease dynamics, an unraveling economy, and pandemic fatigue have meant that disease control policies need to be updated. METHODS Using recent and timely data on older (50 years and above) Syrian refugees in Lebanon, this paper uses multivariate linear probability models to explore the determinants of adherence to two non-pharmaceutical COVID-19 prevention measures (wearing a mask and avoiding social gatherings) among this high-risk subgroup in a vulnerable population. Among respondents who report adhering to these measures, the paper also investigates the determinants of sustained adherence over a period of 6 months. RESULTS The findings suggest that no individual-level characteristics were robustly associated with mask wearing. For avoiding social gatherings, education was inversely associated with adherence to this preventive measure. Avoiding social gatherings was also significantly lower for residents of informal tented settlements (ITSs). Among initial adherents, and for both preventive practices, ITS dwellers were also significantly less likely to maintain adherence. CONCLUSION Identifying variables associated with adherence to non-pharmaceutical preventive practices, particularly for vulnerable groups, can help inform and refine interventions in the face of changing conditions. The material, physical, administrative and socio-economic constraints of life in an ITS suggest that avoiding social gatherings is hardly feasible. Yet despite the challenging conditions of ITSs, the indication to wear a mask is initially complied with, suggesting that tailoring policies to the limits and constrains of context can lead to successful outcomes even in very adverse settings.
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Affiliation(s)
- Nisreen Salti
- Department of Economics, American University of Beirut, Beirut, Lebanon
| | - Stephen J. McCall
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Berthe Abi Zeid
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Noura El Salibi
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | | | | | - Hala Ghattas
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Sawsan Abdulrahim
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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Sahoo KC, Negi S, Mahapatra P, Samantaray K, Dash GC, Dubey S, Sahay MR, Sahoo RK, Bhattacharya D, Sahoo B, Pani SP, Otmani del Barrio M, Pati S. Gender dimensions of health-related challenges among urban poor during COVID-19 pandemic in low-and middle-income countries: a systematic review and gap analysis. Front Public Health 2023; 11:1170386. [PMID: 37361176 PMCID: PMC10288984 DOI: 10.3389/fpubh.2023.1170386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/11/2023] [Indexed: 06/28/2023] Open
Abstract
The COVID-19 pandemic has varying effects on men, women, and the transgender population. However, there is a paucity of systematic evidence on how gender and other social determinants of health during COVID-19 are affected in resource constraint urban settings. This review describes the gender dimensions of health-related challenges among the urban poor during COVID-19 in LMICs. We searched 11 scholarly online repositories including PubMed, Embase, Web of Science, CINAHL using the domain "slums," "COVID-19", "LMICs" and "gender identities." We used thematic framework analysis to synthesize qualitative data, and meta-analysis to determine the pooled prevalence. We registered in PROSPERO (CRD42020203783). We identified 6490 records, and 37 articles included. The studies reported stress among 74% women and 78% men, depression among 59% women and 62% men, and anxiety among 79% women and 63% men. Men had more stress than women during COVID-19; men are primarily responsible for household sustenance. Women had more anxiety than men, possibly because they are often the primary caregivers for children and the older population. While the severity varies according to gender identity, their vulnerability mostly related to their literacy and economy, highlighting the significance of including all social determinants in future primary studies. Systematic review registration https://www.crd.york.ac.uk/prospero/#recordDetails.
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Affiliation(s)
- Krushna Chandra Sahoo
- Health Technology Assessment in India, Indian Council of Medical Research (ICMR)-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Sapna Negi
- Health Technology Assessment in India, Indian Council of Medical Research (ICMR)-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Pranab Mahapatra
- Department of Psychiatry, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Kajal Samantaray
- Health Technology Assessment in India, Indian Council of Medical Research (ICMR)-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Girish Chandra Dash
- Health Technology Assessment in India, Indian Council of Medical Research (ICMR)-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Shubhankar Dubey
- Health Technology Assessment in India, Indian Council of Medical Research (ICMR)-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Mili Roopchand Sahay
- Health Technology Assessment in India, Indian Council of Medical Research (ICMR)-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Rakesh Kumar Sahoo
- Health Technology Assessment in India, Indian Council of Medical Research (ICMR)-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Debdutta Bhattacharya
- Health Technology Assessment in India, Indian Council of Medical Research (ICMR)-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Banamber Sahoo
- Health Technology Assessment in India, Indian Council of Medical Research (ICMR)-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | | | - Mariam Otmani del Barrio
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | - Sanghamitra Pati
- Health Technology Assessment in India, Indian Council of Medical Research (ICMR)-Regional Medical Research Centre, Bhubaneswar, Odisha, India
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Armijos A, Bonz AG, Brown FL, Charlet D, Cohen F, Greene MC, Hermosilla S, James LE, Le Roch K. Ensuring equity in mental health and psychosocial support during the COVID-19 pandemic and beyond. Confl Health 2023; 17:7. [PMID: 36804874 PMCID: PMC9938796 DOI: 10.1186/s13031-023-00500-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 01/16/2023] [Indexed: 02/21/2023] Open
Abstract
Populations affected by armed conflict and other humanitarian crises are at elevated risk for mental health problems. While the COVID-19 pandemic has had broadly deleterious effects on livelihoods, economic well-being, and population health worldwide, vulnerable groups have been disproportionately impacted by the pandemic. Providing mental health and psychosocial support (MHPSS) services during these times to vulnerable groups, especially in low- and middle-income countries and humanitarian settings, is essential. In an effort to comply with the public health response to the pandemic and mitigate COVID-19 transmission, significant implementation adaptations were made to service delivery during the pandemic. This short report describes several strategies to ensure that equity was central to these adaptations and public health responses, and provides recommendations for ensuring continuity of this progress post-pandemic. Examples and key lessons learned are given related to strategies to increase access to MHPSS services, improve meaningful stakeholder engagement, develop and support community networks, and implement community-based psychosocial support groups. They come from diverse settings of Bangladesh, Colombia, Ecuador, and Lebanon. The COVID-19 pandemic has highlighted the importance of preventing and treating MHPSS issues. It also has created opportunities for innovative programming to address overlooked problems, improve the quality of services provided, and increase focus on equity. It is vital that we use the momentum and attention generated around MHPSS services during the COVID-19 pandemic to continue to build and improve existing MHPSS services in more equitable ways for vulnerable populations.
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Affiliation(s)
| | - Annie G. Bonz
- grid.446747.20000 0001 2166 084XHIAS, 1300 Spring Street, Suite 500, Silver Spring, MD 20910 USA
| | - Felicity L. Brown
- grid.487424.90000 0004 0414 0756Research and Development Department, War Child Holland, Helmholtzstraat 61-G, 1098 LE Amsterdam, The Netherlands
| | - Danielle Charlet
- grid.281053.d0000 0004 0375 9266University Research Co., LLC, 5404 Wisconsin Ave Suite 800, Chevy Chase, MD 20815 USA
| | - Flora Cohen
- grid.4367.60000 0001 2355 7002Washington University in St. Louis, Brookings Dr, St. Louis, MO 63130 USA
| | - M. Claire Greene
- grid.21729.3f0000000419368729Columbia University Mailman School of Public Health, 722 W 168th St, New York, NY 10032 USA
| | - Sabrina Hermosilla
- grid.214458.e0000000086837370University of Michigan, 400 4th St, Ann Arbor, MI 48103 USA
| | - Leah E. James
- grid.435215.40000 0004 0431 9086Heartland Alliance International, 208 S. LaSalle Street, Suite 1300, Chicago, IL 60604 USA
| | - Karine Le Roch
- grid.452229.a0000 0004 0643 9612Action contre la Faim, 14 Boulevard de Douaumont, 75017 Paris, France
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Sahoo KC, Dubey S, Dash GC, Sahoo RK, Sahay MR, Negi S, Mahapatra P, Bhattacharya D, Sahoo B, Pani SP, del Barrio MO, Pati S. A Systematic Review of Water, Sanitation, and Hygiene for Urban Poor in Low- and Middle-Income Countries during the COVID-19 Pandemic through a Gendered Lens. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191911845. [PMID: 36231147 PMCID: PMC9565771 DOI: 10.3390/ijerph191911845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 05/10/2023]
Abstract
Inadequate water, sanitation, and hygiene (WASH) among urban poor women is a major urban policy concern in low- and middle-income countries (LMICs). There was a paucity of systematic information on WASH among the urban poor during the pandemic. We reviewed the opportunities and challenges faced by the urban poor in LMICs during the COVID-19 pandemic. We used the PRISMA guidelines to conduct a comprehensive search of 11 databases, including MEDLINE, Embase, Web of Science, and CINAHL, between November 2019 and August 2021. We used thematic analysis to synthesize the qualitative data and meta-analyses to estimate the pooled prevalence. We screened 5008 records, conducted a full-text review of 153 studies, and included 38 studies. The pooled prevalence of shared water points was 0.71 (95% CI 0.37-0.97), non-adherence to hygiene practices was 0.15 (95% CI 0.08-0.24), non-adherence to face masks was 0.27 (95% CI 0.0-0.81), and access to shared community toilets was 0.59 (95% CI 0.11-1.00). Insufficient facilities caused crowding and long waiting times at shared facilities, making physical distancing challenging. Women reported difficulty in maintaining privacy for sanitation, as men were present due to the stay-at-home rule. Due to unaffordability, women reported using cloth instead of sanitary pads and scarves instead of masks.
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Affiliation(s)
- Krushna Chandra Sahoo
- Health Technology Assessment in India (HTAIn), ICMR-Regional Medical Research Centre, Bhubaneswar 751023, India
| | - Shubhankar Dubey
- Health Technology Assessment in India (HTAIn), ICMR-Regional Medical Research Centre, Bhubaneswar 751023, India
| | - Girish Chandra Dash
- Health Technology Assessment in India (HTAIn), ICMR-Regional Medical Research Centre, Bhubaneswar 751023, India
| | - Rakesh Kumar Sahoo
- Health Technology Assessment in India (HTAIn), ICMR-Regional Medical Research Centre, Bhubaneswar 751023, India
| | - Mili Roopchand Sahay
- Health Technology Assessment in India (HTAIn), ICMR-Regional Medical Research Centre, Bhubaneswar 751023, India
| | - Sapna Negi
- Health Technology Assessment in India (HTAIn), ICMR-Regional Medical Research Centre, Bhubaneswar 751023, India
| | - Pranab Mahapatra
- Department of Psychiatry, Kalinga Institute of Medical Sciences, Bhubaneswar 751024, India
| | - Debdutta Bhattacharya
- Health Technology Assessment in India (HTAIn), ICMR-Regional Medical Research Centre, Bhubaneswar 751023, India
| | - Banamber Sahoo
- Health Technology Assessment in India (HTAIn), ICMR-Regional Medical Research Centre, Bhubaneswar 751023, India
| | - Subhada Prasad Pani
- Department of Research and Development, Sri Balaji Vidyapeeth Deemed to be University, Puducherry 605007, India
| | - Mariam Otmani del Barrio
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, 1211 Geneva, Switzerland
| | - Sanghamitra Pati
- Health Technology Assessment in India (HTAIn), ICMR-Regional Medical Research Centre, Bhubaneswar 751023, India
- Correspondence:
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Variations in COVID-19 Vaccine Attitudes and Acceptance among Refugees and Lebanese Nationals Pre- and Post-Vaccine Rollout in Lebanon. Vaccines (Basel) 2022; 10:vaccines10091533. [PMID: 36146611 PMCID: PMC9501461 DOI: 10.3390/vaccines10091533] [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: 08/23/2022] [Revised: 09/09/2022] [Accepted: 09/12/2022] [Indexed: 11/17/2022] Open
Abstract
Vaccine hesitancy among displaced populations is associated with inequitable access to services and mistrust of authorities, among other factors. This study evaluated variations in attitudes toward COVID-19 vaccines and factors associated with vaccine acceptance among refugees and Lebanese nationals accessing 60 International Medical Corps-supported health facilities through two cross-sectional surveys pre- (n = 3927; Survey 1) and post- (n = 4174; Survey 2) vaccine rollout. Logistic regression was used to assess predictors of vaccine acceptance using the health beliefs model. Refugees comprised 52.9% (Survey 1) and 54.2% (Survey 2) of respondents. Vaccine acceptance was low among both groups in Survey 1 (25.9% refugees vs. 23.1% Lebanese nationals), but higher in Survey 2 in Lebanese (57.6%) versus refugees (32.9%). Participants reported greater perceived benefits of vaccination, higher perceived COVID-19 susceptibility, and lower perceived vaccination barriers in Survey 2 versus Survey 1. Post-vaccine rollout, refugees had lower odds of vaccine acceptance compared to Lebanese (OR 0.50, 95%CI 0.41–0.60), while older age (OR 1.37, 95%CI 1.06–1.78, ≥51 years vs. 18–30 years) was associated with greater vaccine acceptance. Health beliefs model variables were associated with vaccine acceptance in both surveys. Tailored strategies to respond dynamically to changes in vaccine attitudes among vulnerable groups in Lebanon are essential for equitable vaccine uptake.
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