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Bojórquez I, Infante C, Villanueva-Borbolla MA, Orjuela-Grimm M. Solidarity through food: Coping with food insecurity among adolescent migrants in transit through Mexico and Central America. Appetite 2024; 200:107549. [PMID: 38862079 PMCID: PMC11227384 DOI: 10.1016/j.appet.2024.107549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/31/2024] [Accepted: 06/07/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND The food choices of migrants are frequently limited by lack of access to sufficient and adequate food. Food insecurity (FI) during adolescence has potential negative health consequences, however the experiences of FI of adolescent in-transit migrants have seldom been reported. OBJECTIVE To explore the experiences of FI of adolescent in-transit migrants and their ways of coping with it. METHODS Qualitative study, with 19 semi-structured interviews with adolescents (ages 13-19 years), in shelters for migrants in Mexico in 2022-2023. We followed a reflexive thematic analysis strategy. RESULTS Most participants had experienced FI during the journey, and responded by limiting intake, choosing food according to price, seeking temporary work or asking for food or money in the streets. We defined "solidarity through food" as a central theme that summarized participants' experiences of sharing food with other migrants, as givers or recipients. Solidarity through food was a response to FI, benefitting the more disadvantaged (e.g. young children, those who had been robbed). Despite their young age, interviewees took part in this, giving their food to others and restricting their intake to prioritize younger siblings. DISCUSSION/CONCLUSIONS Solidarity through food was a form of generalized reciprocity, enacted not only among family members or friends, but extended to other migrants sharing the route. In further studies, it will be important to explore the role and nuances of food sharing as a practice of social exchange of responsibility and care, on adolescent migrants' health, and in their psychological and relational development into adulthood.
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Affiliation(s)
- Ietza Bojórquez
- Departamento de Estudios de Población, El Colegio de la Frontera Norte, Tijuana, Baja California, Mexico
| | - Cesar Infante
- Centro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Pública de México, Cuernavaca, Morelos, Mexico.
| | | | - Manuela Orjuela-Grimm
- Department of Epidemiology, Mailman School of Public Health, and Department of Pediatrics, Columbia University, USA
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Stark L, Meinhart M, Hermosilla S, Kajungu R, Cohen F, Agaba GS, Obalim G, Knox J, Onyango Mangen P. Improving psychosocial well-being and parenting practices among refugees in Uganda: Results of the journey of life effectiveness trial. Glob Ment Health (Camb) 2024; 11:e42. [PMID: 38628157 PMCID: PMC11018555 DOI: 10.1017/gmh.2024.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 02/07/2024] [Accepted: 03/19/2024] [Indexed: 04/19/2024] Open
Abstract
Caregivers play a critical role in mediating the impacts of forced displacement on children; however, humanitarian programming remains hampered by a lack of evidence-based programming. We present findings from an evaluation of a group-based curriculum delivered over the course of 12 sessions, journey of life (JoL). A waitlist-control quasi-experimental design was implemented in the Kiryandongo refugee settlement (intervention n = 631, control n = 676). Caregiver mental distress, measured using the Kessler-6, was the primary outcome. Secondary outcomes included (a) functioning, (b) social support and (c) caregiving attitudes and behaviors. Propensity score matching (PSM) and Cohen's d estimates were used to examine the intervention effects. According to our primary PSM analysis, JoL led to significant improvements in mental distress (coef.: 2.33; p < 0.001), social support (coef.: 1.45; p < 0.001), functioning (coef.: 2.64; p < 0.001), parental warmth/affection (coef.: 2.48; p < 0.001), parental undifferentiated rejection (coef.: 0.49; p < 0.001) and attitudes around violence against children (VAC) (coef.: 1.98; p < 0.001). Evidence from Cohen's d analysis underscored the value of the intervention's effect on parental warmth/affection (0.74), mental distress (0.70) and VAC attitudes (0.68). This trial adds to the evidence on holistic parenting programming to improve the mental health and parenting outcomes among refugee caregivers.
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Affiliation(s)
- Lindsay Stark
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - Melissa Meinhart
- National Coalition of Independent Scholars, Battleboro, Vermont, USA
| | - Sabrina Hermosilla
- Department of Population and Family Health, Columbia University, New York, NY, USA
| | - Rehema Kajungu
- Transcultural Psychosocial Organization (TPO) Uganda, Kampala, Uganda
| | - Flora Cohen
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - Gary S. Agaba
- Transcultural Psychosocial Organization (TPO) Uganda, Kampala, Uganda
| | - Grace Obalim
- Transcultural Psychosocial Organization (TPO) Uganda, Kampala, Uganda
| | - Justin Knox
- Department of Psychiatry, Columbia University, New York, NY, USA
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
- Department of Sociomedical Sciences, Columbia University, New York, NY, USA
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Meinhart M, Mangen PO, Hermosilla S, Cohen F, Agaba GS, Kajungu R, Knox J, Obalim G, Stark L. Refugee caregivers: Associations between psychosocial wellbeing and parenting in Uganda. Stress Health 2023; 39:1014-1025. [PMID: 36812652 DOI: 10.1002/smi.3236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 02/24/2023]
Abstract
Caregivers in humanitarian settings experience compounding stressors that may challenge their ability to provide quality parenting to children in their care. In recognition of this precarity, our analysis examines the linkage between psychosocial wellbeing and parenting behaviours among caregivers in Kiryandongo Settlement, Uganda. Using baseline data from an evaluation of a psychosocial intervention designed to support caregiver wellbeing and engage caregivers to support children in their communities, multi-variable ordinary least square regressions were used to estimate how various measures of psychosocial wellbeing (i.e. psychological distress, social support, and functioning) and parenting attitudes (related to violence against children) are associated with parental warmth and rejection. Profound livelihood challenges were found, as nearly half of the sample (48.20%) indicated cash from INGOs as their income source and/or reported never attending school (46.71%). Increased social support (coef. 0.11; 95% CIs: 0.08-0.15) and positive attitudes (coef. 0.21; 95% CIs: 0.14-0.29) were significantly associated with more desirable parental warmth/affection. Similarly, positive attitudes (coef. 0.16; 95% CIs 0.11-0.20), reduced distress (coef. 0.11; 95% CIs: 0.08-0.14) and increased functioning (coef. 0.03; 95% CIs: 0.01-0.04) were significantly associated with more desirable scores of parental undifferentiated rejection. While further research is needed to examine underlining mechanisms and causal pathways, our findings both link individual wellbeing characteristics with parenting behaviours and suggest further exploration into whether and how broader elements of the ecosystem may influence parenting outcomes.
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Affiliation(s)
- Melissa Meinhart
- National Coalition of Independent Scholars, Battleboro, Vermont, USA
| | | | | | - Flora Cohen
- Washington University in St. Louis, St. Louis, Missouri, USA
| | | | - Rehema Kajungu
- Transcultural Psychosocial Organization Uganda, Kampala, Uganda
| | - Justin Knox
- Columbia University, New York, New York, USA
| | - Grace Obalim
- Transcultural Psychosocial Organization Uganda, Kampala, Uganda
| | - Lindsay Stark
- Washington University in St. Louis, St. Louis, Missouri, USA
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Meyer SR, Stark L. Development of an index to measure the strength of child protection Systems in Refugee Settings: Conceptual and practical considerations. CHILD ABUSE & NEGLECT 2022; 134:105920. [PMID: 36371849 DOI: 10.1016/j.chiabu.2022.105920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/02/2022] [Accepted: 10/04/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The United Nations Refugee Agency [UNHCR] implements a Framework for Child Protection for refugee children, based on a child protection systems-strengthening approach. Measurement of child protection system strength in humanitarian contexts is nascent, and existing methodologies do not capture the multiple components of the Framework. OBJECTIVE To develop, pilot and refine a measure of child protection system strength in humanitarian contexts. PARTICIPANTS AND SETTING The Child Protection Index [CPI] was implemented in two humanitarian contexts - Kiziba Camp, Rwanda and Kiryandongo and Adjumani refugee camps, Uganda, at two time points [Time 1 = T1; Time 2 = T2]. Data collection in Kiziba camp was conducted in December 2013 and October/November 2015, and in Kiryandongo and Adjumani in December 2014/February 2015 and June-August 2016. Participants were staff members of international non-governmental organizations (T1: n = 17, T2: n = 29), local non-governmental organizations (T1: n = 3, T2: n = 2), Government bodies (T1: n = 3, T2: n = 3) and United Nations agencies (T1: n = 14, T2: n = 9) who were purposively selected to respond to the items included in the CPI. Selection was made on the basis of identifying individuals with the most knowledge and expertise to address the questions in the CPI. METHODS We conducted a qualitative study, conducting key informant interviews based on an interview guide developed to address the items in the CPI, and tailored to the expertise of each key informant. The CPI included scoring, to translate key informants' responses to numerical scores of child protection system strength. RESULTS The pilot test conducted in Kiziba Camp indicated moderate child protection system strength, with a score of 61/100. At T2, results indicated a change in CPI score of +18.5 to 79.5. At T1, Kiryandongo refugee settlement received a total of 46/100 on the CPI, and at T2, the score improved by 13.5 points. At T1, Adjumani refugee settlement scored a total of 60/100, and at T2, received a total score change of +4.5. CONCLUSIONS Findings from implementation, adaptation, and evaluation of the CPI offer valuable insights about practicality, validity and potential breadth of measurement of child protection system strengthening in humanitarian settings.
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Affiliation(s)
- Sarah R Meyer
- Mailman School of Public Health, Columbia University, New York, NY, United States; Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians-Universität München, Elisabeth-Winterhalter-Weg 6, 81377, München, Germany
| | - Lindsay Stark
- Brown School at Washington University in St Louis, St Louis, MO, United States.
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Bukuluki P, Kisaakye P, Mwenyango H, Palattiyil G. Adolescent sexual behaviour in a refugee setting in Uganda. Reprod Health 2021; 18:131. [PMID: 34167555 PMCID: PMC8222959 DOI: 10.1186/s12978-021-01181-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 06/11/2021] [Indexed: 11/10/2022] Open
Abstract
Background Children under 18 years old constituted more than half (52%) of the refugee population in 2017. Adolescent Sexual and reproductive health is an essential component of primary health care. Yet, not every refugee adolescent is able to access sexual and reproductive health services. Methods Using quantitative data from 356 refugee adolescents and qualitative data (17 in-depth interviews and nine key informant interviews), we examine refugee adolescent sexual behaviour in Bidibidi settlement—the largest refugee settlement in Uganda using a binary logistic regression model. Results The results show that 25% of refugee adolescents in Bidibidi refugee settlement had ever had sex. After controlling for all factors, results show that refugee adolescents aged 16–18 years (OR = 3.47; 95% CI = 1.09–10.94), males (OR = 17.59; 95% CI = 4.48–69.07), not in school (OR = 14.57; 95% CI = 2.20–96.35) were more likely to engage in sexual behaviour than their counterparts. Refugee adolescents who do not agree that a girl cannot get pregnant if she has sex while standing up (knowledge about getting pregnant) were significantly less associated with sexual behaviour (OR = 0.30; 95% CI = 0.10–0.85). Conclusions Results from this study show that keeping refugee adolescents in school and providing sexual and reproductive health information are likely to delay refugee adolescents’ engagement in sexual behaviour. Therefore, there is need to promote keeping refugee adolescents in school in order to improve sexual and reproductive health of adolescent refugees living in low-income countries such as Uganda. Sexual and reproductive health is an essential component of primary health care. Limited access to sexual and reproductive health (SRH) services for adolescent refugees particularly in low income countries can affect their reproductive health. Similarly, limited knowledge of the determinants of sexual behaviour of adolescent refugees in low income countries puts them at risk of SRH challenges. This study uses quantitative data from 356 adolescent refugees and qualitative (17 in-depth interviews with adolescent refugees and nine key informant interviews with service providers) to examine the factors that influence the sexual behaviour of adolescent refugees in Bidibidi refugee settlement. The findings show that older age, male sex, not being in school and having knowledge of getting pregnant were associated with sexual behaviour among adolescent refugees in Bidibidi refugee settlement in Uganda. There is need to promote keeping refugee adolescents in school and providing them with relevant SRH information to contribute to improving sexual and reproductive health of adolescent refugees living in low-income countries such as Uganda.
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Affiliation(s)
- Paul Bukuluki
- Department of Social Work and Social Administration, School of Social Sciences, Makerere University, Kampala, Uganda
| | - Peter Kisaakye
- Department of Population Studies, School of Statistics and Planning, Makerere University, Kampala, Uganda.
| | - Hadijah Mwenyango
- Department of Social Work and Social Administration, School of Social Sciences, Makerere University, Kampala, Uganda
| | - George Palattiyil
- Social Work, School of Social and Political Science, The University of Edinburgh, Scotland, UK
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Arakelyan S, Ager A. Annual Research Review: A multilevel bioecological analysis of factors influencing the mental health and psychosocial well-being of refugee children. J Child Psychol Psychiatry 2021; 62:484-509. [PMID: 33277944 PMCID: PMC8246898 DOI: 10.1111/jcpp.13355] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/22/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND This paper revisits the themes of an influential 1993 review regarding the factors shaping the mental health and psychosocial well-being of refugees to take stock of developments in the evidence base and conceptualisation of issues for refugee children over the last 25 years. METHODS The study deployed a systematic search strategy. This initially identified 784 papers, which was reduced to 65 studies following application of inclusion and exclusion criteria. We used a later iteration of Bronfenbrenner's bioecological model of human development - the PPCT model - to consolidate evidence. RESULTS We identify a range of risk and protective factors operating at individual, familial, community and institutional and policy levels that influence outcomes for refugee children. The dynamics shaping the interaction of these influences are linked to the life course principles of socio-historical time and developmental age, proximal processes and child agency. CONCLUSIONS Actions at individual, familial, community, school, institutional and policy levels all have potential traction on mental health and psychosocial well-being of refugee children. However, evidence suggests that greatest impact will be secured by multilevel interventions addressing synergies between ecological systems, approaches engaging proximal processes (including parenting programmes) and interventions facilitating the agency of the developing refugee child.
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Affiliation(s)
- Stella Arakelyan
- Institute for Global Health and DevelopmentQueen Margaret UniversityEdinburghUK
| | - Alastair Ager
- Institute for Global Health and DevelopmentQueen Margaret UniversityEdinburghUK
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Salami B, Fernandez-Sanchez H, Fouche C, Evans C, Sibeko L, Tulli M, Bulaong A, Kwankye SO, Ani-Amponsah M, Okeke-Ihejirika P, Gommaa H, Agbemenu K, Ndikom CM, Richter S. A Scoping Review of the Health of African Immigrant and Refugee Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073514. [PMID: 33800663 PMCID: PMC8038070 DOI: 10.3390/ijerph18073514] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/18/2021] [Accepted: 03/22/2021] [Indexed: 12/02/2022]
Abstract
Migration is a growing phenomenon around the world, including within the African continent. Many migrants, especially African children, face challenges related to health and social inclusion and can face increased health risks. A systematic scoping review of available literature on the health of African migrant children across the globe was conducted to offer insight into these health risks. The review was conducted over a 15-month period from January 2019 to April 2020, yielding 6602 articles once duplicates were removed. This search included electronic databases, reference lists of articles reviewed, and searches of libraries of relevant organisations. A total of 187 studies met the inclusion criteria, of which 159 were quantitative, 22 were qualitative, and 6 used mixed methods. The findings reveal decreased health in this population in areas of nutrition, infectious diseases, mental health, birth outcomes, sexual and reproductive health, physical and developmental health, parasitic infections, oral health, respiratory health, preventative health, endocrine disorders, health care services, and haematological conditions. The findings offer insights into factors influencing the health of African immigrant and refugee children. Further studies, especially qualitative studies, are needed to determine barriers to service access after migration and to investigate other underexplored and overlooked health concerns of African migrant children, including pneumonia and child maltreatment.
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Affiliation(s)
- Bukola Salami
- Faculty of Nursing, University of Alberta, 11405 87 Avenue, Edmonton, AB T6G 0Z7, Canada; (H.F.-S.); (M.T.); (A.B.); (S.R.)
- Correspondence:
| | - Higinio Fernandez-Sanchez
- Faculty of Nursing, University of Alberta, 11405 87 Avenue, Edmonton, AB T6G 0Z7, Canada; (H.F.-S.); (M.T.); (A.B.); (S.R.)
| | - Christa Fouche
- Faculty of Education and Social Work, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand;
| | - Catrin Evans
- School of Health Sciences, University of Nottingham, University Park, Nottingham NG7 2RD, UK;
| | - Lindiwe Sibeko
- Department of Nutrition, School of Public Health and Health Sciences, University of Massachusetts, 204 Chenoweth Laboratory, Amherst, MA 01003-9282, USA;
| | - Mia Tulli
- Faculty of Nursing, University of Alberta, 11405 87 Avenue, Edmonton, AB T6G 0Z7, Canada; (H.F.-S.); (M.T.); (A.B.); (S.R.)
| | - Ashley Bulaong
- Faculty of Nursing, University of Alberta, 11405 87 Avenue, Edmonton, AB T6G 0Z7, Canada; (H.F.-S.); (M.T.); (A.B.); (S.R.)
| | - Stephen Owusu Kwankye
- Regional Institute for Population Studies, University of Ghana, P.O. Box LG 96, Legon, Accra GA184, Ghana;
| | - Mary Ani-Amponsah
- School of Nursing, University of Ghana, P.O. Box LG 43, Legon, Accra GA184, Ghana;
| | | | - Hayat Gommaa
- Department of Nursing Science, Ahmadu Bello University, Sokoto Road, PMB 06, Zaria 810107, Nigeria;
| | - Kafuli Agbemenu
- School of Nursing, The State University of New York (SUNY), University at Buffalo, 3435 Main Street, Buffalo, NY 14214, USA;
| | | | - Solina Richter
- Faculty of Nursing, University of Alberta, 11405 87 Avenue, Edmonton, AB T6G 0Z7, Canada; (H.F.-S.); (M.T.); (A.B.); (S.R.)
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Teachers’ Perspectives: Challenges in the Integration of Refugee Children Deported from Israel to Uganda. SOCIAL SCIENCES 2021. [DOI: 10.3390/socsci10030091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In 2012, Israel deported 500 South-Sudanese refugee children and their families. A year later, a civil war broke out in the young South Sudan and the deportees, along with over one million South-Sudanese citizens, fled to the neighboring Uganda. Since then, many of these children have studied in boarding schools in Uganda. We explore, using qualitative methods, the perceptions and experiences of six Ugandan teachers all working with these children for at least 5 years. The research is unique in studying children who have previously lived and studied in a developed Western environment, and experienced, subsequently, a transition to the global south, with far more conservative social norms and an authoritarian, teacher-centered conception of education. The results show a clear progression in the teachers’ conception of the children, beginning with an impression of the children as rebellious, tending to initiate conflicts, and disrespectful. Gradually, they came to view them as being open and assertive, often very articulate and communicative. They observed changes in the children’s behavior: acquiring language skills, being cooperative with staff, integrating with the other children and caring. Working with the refugee children had a great impact on the teachers’ perceptions and on their personal and professional conduct: they substituted punishments—including physical caning—with other methods of discipline. They endorsed open academic methods based on dialogue in class and between teachers and students, and encouraged experiment-based learning methods. On the other hand, the teachers initial perception of children’s parents as ignorant and disruptive remained unchanged and little effort, if any, was made throughout the years of this educational encounter to include the parents in the educational process. The teachers’ recommendations focused mainly on three issues: preparing the children and the staff to the new experience in order to facilitate integration, enhancing the communication and mutual work with the children’s parents, and giving more attention to the children’s emotional state. The discussion section addresses the limitation of this study, directions for future research, and practical implications.
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Klabbers RE, Muwonge TR, Ayikobua E, Izizinga D, Bassett IV, Kambugu A, Tsai AC, Ravicz M, Klabbers G, O'Laughlin KN. Understanding the role of interpersonal violence in assisted partner notification for HIV: a mixed-methods study in refugee settlements in West Nile Uganda. J Glob Health 2020; 10:020440. [PMID: 33312504 PMCID: PMC7719270 DOI: 10.7189/jogh.10.020440] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Assisted partner notification (APN) for HIV was introduced in refugee settlements in West Nile Uganda in 2018 to facilitate testing of sexual partners. While APN is an effective strategy recommended by the World Health Organization, its safety has not been evaluated in a refugee settlement context in which participants have high prior exposure to interpersonal violence. The extent to which interpersonal violence influences APN utilization and the frequency with which post-APN interpersonal violence occurs remains unknown. METHODS To explore the relationship between APN and interpersonal violence, a cross-sectional mixed-methods study was conducted at 11 health centers in refugee settlements in West Nile Uganda. Routinely collected index client and sexual partner data were extracted from APN registers and semi-structured interviews were conducted with health workers. RESULTS Through APN, 1126 partners of 882 distinct index clients were identified. For 8% (75/958) of partners, index clients reported a history of intimate partner violence (IPV). For 20% (226/1126) of partners, index clients were screened for post-APN IPV; 8 cases were reported of which 88% (7/8) concerned partners with whom index clients reported prior history of IPV. In qualitative interviews (N = 32), health workers reported HIV disclosure-related physical, sexual and psychological violence and deprivation or neglect. Incidents of disclosure-related violence against health workers and dependents of index clients were also reported. Fear of disclosure-related violence was identified as a major barrier to APN that prevents index clients from listing sexual partners. CONCLUSIONS Incidents of interpersonal violence have been reported following HIV-disclosure and fear of interpersonal violence strongly influences APN participation. Addressing HIV perception and stigma may contribute to APN uptake and program safety. Prospective research on interpersonal violence involving index clients and sexual partners in refugee settlements is needed to facilitate safe engagement in APN for this vulnerable population.
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Affiliation(s)
- Robin E Klabbers
- Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Timothy R Muwonge
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Emmanuel Ayikobua
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Diego Izizinga
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Ingrid V Bassett
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Andrew Kambugu
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Alexander C Tsai
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Miranda Ravicz
- Department of Internal Medicine and Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Gonnie Klabbers
- Department of Health, Ethics and Society, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Kelli N O'Laughlin
- Departments of Emergency Medicine and Global Health, University of Washington, Seattle, Washington, USA
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Chiumento A, Rutayisire T, Sarabwe E, Hasan MT, Kasujja R, Nabirinde R, Mugarura J, Kagabo DM, Bangirana P, Jansen S, Ventevogel P, Robinson J, White RG. Exploring the mental health and psychosocial problems of Congolese refugees living in refugee settings in Rwanda and Uganda: a rapid qualitative study. Confl Health 2020; 14:77. [PMID: 33292363 PMCID: PMC7670672 DOI: 10.1186/s13031-020-00323-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 11/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Refugees fleeing conflict often experience poor mental health due to experiences in their country of origin, during displacement, and in new host environments. Conditions in refugee camps and settlements, and the wider socio-political and economic context of refugees' lives, create structural conditions that compound the effects of previous adversity. Mental health and psychosocial support services must address the daily stressors and adversities refugees face by being grounded in the lived reality of refugee's lives and addressing issues relevant to them. METHODS We undertook a rapid qualitative study between March and May 2019 to understand the local prioritisation of problems facing Congolese refugees living in two refugee settings in Uganda and Rwanda. Thirty free list interviews were conducted in each setting, followed by 11 key informant interviews in Uganda and 12 in Rwanda. RESULTS Results from all interviews were thematically analysed following a deductive process by the in-country research teams. Free list interview findings highlight priority problems of basic needs such as food, shelter, and healthcare access; alongside contextual social problems including discrimination/inequity and a lack of gender equality. Priority problems relating to mental and psychosocial health explored in key informant interviews include discrimination and inequity; alcohol and substance abuse; and violence and gender-based violence. CONCLUSIONS Our findings strongly resonate with models of mental health and psychosocial wellbeing that emphasise their socially determined and contextually embedded nature. Specifically, findings foreground the structural conditions of refugees' lives such as the physical organisation of camp spaces or refugee policies that are stigmatising through restricting the right to work or pursue education. This structural environment can lead to disruptions in social relationships at the familial and community levels, giving rise to discrimination/inequity and gender-based violence. Therefore, our findings foreground that one consequence of living in situations of pervasive adversity caused by experiences of discrimination, inequity, and violence is poor mental health and psychosocial wellbeing. This understanding reinforces the relevance of feasible and acceptable intervention approaches that aim to strengthening familial and community-level social relationships, building upon existing community resources to promote positive mental health and psychosocial wellbeing among Congolese refugees in these settings.
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Affiliation(s)
- Anna Chiumento
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, England.
| | - Theoneste Rutayisire
- Mental Health and Behaviour Research Group, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | - M Tasdik Hasan
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, England
| | - Rosco Kasujja
- Department of Mental Health and Community Psychology, Makerere University, Kampala, Uganda
| | - Rachel Nabirinde
- Department of Mental Health and Community Psychology, Makerere University, Kampala, Uganda
| | - Joseph Mugarura
- Department of Mental Health and Community Psychology, Makerere University, Kampala, Uganda
| | - Daniel M Kagabo
- Mental Health & Community Psychology and Behaviour Research Group, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Paul Bangirana
- Department of Psychiatry, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Stefan Jansen
- Center for Mental Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Peter Ventevogel
- Public Health Section, Division of Resilience and Solutions, United Nations High Commissioner for Refugees, Geneva, Switzerland
| | - Jude Robinson
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Ross G White
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, England
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Christie H, Hamilton-Giachritsis C, Alves-Costa F, Tomlinson M, Stewart J, Skeen S, Notholi V, Gqwaka P, Sambudla A, Halligan S. Associations between parental trauma, mental health, and parenting: A qualitative study in a high-adversity South African community. Soc Sci Med 2020; 265:113474. [PMID: 33143952 DOI: 10.1016/j.socscimed.2020.113474] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/08/2020] [Accepted: 10/21/2020] [Indexed: 11/30/2022]
Abstract
RATIONALE Research suggests that parenting behaviours are negatively affected by parental trauma. However, thus far, the evidence base has provided limited insight into why this occurs. Further, the available evidence has focused largely on high income contexts (HICs), and we know much less about the experiences of parents in low- and middle-income countries (LMICs) who are frequently coping with multiple adversities. OBJECTIVE The current qualitative study aimed to gain a more in-depth understanding from the parent's perspective about whether and how their trauma impacted themselves and their parenting behaviours. METHOD We conducted interviews with 30 trauma-exposed, Xhosa speaking parents (28 mothers) from Khayelitsha, a township outside Cape Town in South Africa, 66% of whom reported experiencing moderate to severe posttraumatic stress symptoms. RESULTS Five key themes were identified: consequences for parents as individuals (in terms of mental and physical health); the centrality of community and cultural context to parental experiences; consequences in terms of parenting capacity; trauma related effects on the child and how these may influence parental coping; and mechanisms of coping and achieving recovery. CONCLUSION Findings highlight the difficult nature of parenting following trauma due to impacts on multiple areas of life, and suggest potential avenues for the development of parenting interventions in order to support parents and families more effectively following trauma.
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Affiliation(s)
- Hope Christie
- Department of Clinical Psychology, University of Edinburgh, Edinburgh, UK
| | | | - Filipa Alves-Costa
- Department of Psychology, University of Bath, Bath, United Kingdom; Institute of Psychiatry, Department of Forensic and Neurodevelopmental Sciences, Kings College London, London, United Kingdom
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa; School of Nursing and Midwifery, Queens University, Belfast, UK
| | - Jackie Stewart
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Sarah Skeen
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Vuyolwethu Notholi
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Phumza Gqwaka
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Akhona Sambudla
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Sarah Halligan
- Department of Psychology, University of Bath, Bath, United Kingdom; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
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A qualitative enquiry into the meaning and experiences of wellbeing among young people living with and without HIV in KwaZulu-Natal, South Africa. Soc Sci Med 2020; 258:113103. [PMID: 32535474 DOI: 10.1016/j.socscimed.2020.113103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/22/2020] [Accepted: 06/01/2020] [Indexed: 11/21/2022]
Abstract
Young people in sub-Saharan Africa encounter health and livelihood challenges which may compromise their wellbeing. Understanding how young people's wellbeing is defined could strengthen wellbeing policies. We investigated perceptions and experiences of young people's wellbeing, and whether these aligned with Ryff's psychological wellbeing (PWB) model. Data were collected between January-August 2018 through focus-group discussions (n = 12) and in-depth interviews (n = 16) with young people living with and without HIV, selected purposively from South African healthcare facilities. Key informant interviews (n = 14) were conducted with healthcare workers and subject-matter experts. Using a framework approach, we situated our analysis around dimensions of Ryff's PWB model: autonomy, self-acceptance, purpose in life, environmental mastery, positive relationships, personal growth. Young people's wellbeing was rooted in family and peer relationships. Acceptance and belongingness received from these networks fostered social integration. HIV-related stigma, crime and violence reduced their perceived control and social trust. For males, fulfilling gendered roles made them feel socially valued. Self-perceived failure to uphold sexual norms undermined women's social contribution and autonomy. Social integration and contribution framed young people's wellbeing. However, these dimensions were not fully captured by Ryff's PWB model. Models that consider relationality across socio-ecological levels may be relevant for understanding young people's wellbeing.
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Meyer SR, Yu G, Rieders E, Stark L. Child labor, sex and mental health outcomes amongst adolescent refugees. J Adolesc 2020; 81:52-60. [PMID: 32361065 DOI: 10.1016/j.adolescence.2020.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Refugee adolescents living in camps and settlements in low and middle-income countries are a vulnerable population who face protection and psychosocial risks. This study explores prevalence of child labor amongst adolescent refugees from South Sudan in two refugee settlements in Uganda, to understand impacts of child labor on mental health outcomes, and examines the influence of sex on these impacts. METHODS Surveys were conducted in Adjumani and Kiryandongo refugee settlements, Uganda, with 470 adolescents between 13 and 17 interviewed between December 2014-February 2015. Univariate finite mixture modeling identified a two-cluster model of child labor. Logistic regression models assessed the association of child labor and mental health. RESULTS A two-cluster solution for child labor activity was determined among the 332 adolescents who self-reported engaging in any child labor (Significant child labor: n = 174, 37%; moderate child labor cluster: n = 158, 34%; no child labor cluster: n = 138, 29%. Odds of depression amongst adolescents exposed to significant vs. no child labor was 4.15 (95% CI: 2.01-8.56), in a model examining interaction of sex and child labor and controlling for socio-demographic variables. For the anxiety outcome, girls exposed to significant vs. no child labor are less likely to report higher levels of anxiety (OR: 0.29, 95% CI: 0.09-0.90). CONCLUSIONS Adolescents living in refugee settlements in Uganda report high levels of participation in child labor. Protection of adolescents from the risks involved with child labor in refugee contexts is an important and often over-looked area of child protection in humanitarian settings.
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Affiliation(s)
- Sarah R Meyer
- Mailman School of Public Health, Columbia University, 60 Haven Avenue B-4, New York, NY 10032, USA.
| | - Gary Yu
- NYU Rory Meyers College of Nursing, 433 First Avenue, 7th Floor, New York, NY 10010, USA.
| | - Eliana Rieders
- Save the Children UK, 1 St John's Lane, EC1M 4AR, London, UK.
| | - Lindsay Stark
- Brown School at Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA.
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Sommer M, Daly G, Kabiru C, Lhaki P, Okwaro N, Chandra-Mouli V. Strengthening health care worker engagement with early adolescence in low- and middle-income countries: an overdue area for action. Int J Adolesc Med Health 2020; 34:/j/ijamh.ahead-of-print/ijamh-2019-0171/ijamh-2019-0171.xml. [PMID: 32031974 DOI: 10.1515/ijamh-2019-0171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 11/27/2019] [Indexed: 12/19/2022]
Abstract
The very young adolescent population (ages 10-14) is currently under-served by health care systems, particularly in low- and middle-income countries. Although there is a substantial and growing effort to reach adolescents with the health services and commodities they need, such efforts often overlook the period of early adolescence given this population's lower vulnerability to risk-taking behaviors. However, early adolescence is a period of significant change, with the onset of puberty introducing physiological, emotional, and social changes in girls' and boys' lives. This period also represents a time of intensifying gendered norms, and the transition of youth from childhood focused health care (e.g. deworming programs, nutrition interventions) to additional mid- and older adolescent related care [e.g. human papilloma virus (HPV) vaccine, and contraceptive provision). Strengthening young adolescents' engagement with health care workers around preventative and promotive health behaviors could have profound impacts on their health and wellbeing, which in turn could have cascading effects across the course of their lives. Critically, young adolescents would gain trust in health care systems, and be more likely to return when significant health issues arise later in adolescence or adulthood. Such an effort requires sensitizing health care workers and building their capacity to respond to young adolescents' unique needs, by defining a package of actions that they are mandated to provide, training them, providing them with desk reference tools, and putting in place systems to provide supportive supervision and collaborative learning on the one hand, and encouraging caregivers to connect their pubescent-aged boys and girls with the health care system, on the other hand. This paper presents an argument for increased focus in particular on building attitudes and capacities of health care workers on engaging with early adolescents, applying Principle 3 of the Society of Adolescent Medicine's position paper entitled "Health Care Reform and Adolescents."
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Affiliation(s)
- Marni Sommer
- Mailman School of Public Health, Columbia University, New York, USA
| | - Garrison Daly
- Mailman School of Public Health, Columbia University, New York, USA
| | | | | | | | - Venkatraman Chandra-Mouli
- WHO Department of Reproductive Health and Research/Human Reproduction Programme, Geneva, Switzerland
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