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Domingo A, Little M, Beggs B, Brubacher LJ, Lau LL, Dodd W. Examining the role of community health workers amid extreme weather events in low- and middle-income countries: a scoping review. Public Health 2024; 236:133-143. [PMID: 39182471 DOI: 10.1016/j.puhe.2024.07.023] [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: 11/28/2023] [Revised: 05/29/2024] [Accepted: 07/12/2024] [Indexed: 08/27/2024]
Abstract
OBJECTIVES The increased frequency and severity of extreme weather events (EWEs) have underscored the need to strengthen climate-resilient health systems and capacity. Community health workers (CHWs) are integral health systems actors with the potential to protect and improve population health in a changing climate. The aim of this review was to synthesize the literature on the roles of CHWs amid EWEs in low- and middle-income countries, the barriers and facilitators to implement these roles, and program supports to strengthen CHW capacity and health system functions. STUDY DESIGN Scoping review. METHODS Four academic databases and gray literature published between January 2000 and June 2023 were searched. Data were thematically analyzed using a deductive-inductive approach guided by the World Health Organization's (WHO's) Operational framework for building climate-resilient health systems. RESULTS Thirty sources were included. Amid EWEs, CHW roles included: 1) delivery of diagnostic, treatment, and other clinical services; 2) support with access, utilization, or navigation of health services and/or referrals; 3) community education and health promotion; 4) data collection and health surveillance; 5) psychosocial supports; and 6) weather-related health emergency response. Facilitators and barriers to the provision of CHW supports amid EWEs were categorized within WHO's building blocks of health systems. Considerations for strengthening CHW programs to enhance climate-resilient health systems are also discussed. CONCLUSIONS CHWs are uniquely positioned to provide health-related supports amid EWEs that extend to emergency preparedness and response to climate-health challenges. These efforts can contribute to the community and health systems resilience to climate change.
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Affiliation(s)
- A Domingo
- School of Public Health Sciences, University of Waterloo, 200 University Ave. W, Waterloo, Ontario N2L 3G1, Canada; Department of Human Health and Nutritional Sciences, University of Guelph, 50 Stone Rd East, Guelph, Ontario N1G 2W1, Canada
| | - M Little
- School of Public Health Sciences, University of Waterloo, 200 University Ave. W, Waterloo, Ontario N2L 3G1, Canada; School of Public Health and Social Policy, University of Victoria, 3800 Finnerty Rd, Victoria, BC V8P 5C2, Canada
| | - B Beggs
- School of Public Health Sciences, University of Waterloo, 200 University Ave. W, Waterloo, Ontario N2L 3G1, Canada
| | - L J Brubacher
- School of Public Health Sciences, University of Waterloo, 200 University Ave. W, Waterloo, Ontario N2L 3G1, Canada
| | - L L Lau
- School of Public Health Sciences, University of Waterloo, 200 University Ave. W, Waterloo, Ontario N2L 3G1, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College St, M5T 3M7 Toronto, ON, Canada; International Care Ministries, Unit 1701, 17th Floor, West Tower, Philippine Stock Exchange Centre, Exchange Road, Metro Manila, 1605 Pasig City, Philippines
| | - W Dodd
- School of Public Health Sciences, University of Waterloo, 200 University Ave. W, Waterloo, Ontario N2L 3G1, Canada.
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Campos MAG, Cutrim ÉAM, Cutrim ÉMM, de Oliveira JVP, de Oliveira EJSG, Pontes DDB, de Figueiredo JA, Silva GEB. Accuracy of the Verbal Autopsy questionnaire in the diagnosis of COVID-19 deaths in a Brazilian capital. Rev Inst Med Trop Sao Paulo 2024; 66:e33. [PMID: 38747854 PMCID: PMC11095245 DOI: 10.1590/s1678-9946202466033] [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] [Received: 01/17/2024] [Accepted: 03/27/2024] [Indexed: 05/19/2024] Open
Abstract
The Verbal Autopsy (VA) is a questionnaire about the circumstances surrounding a death. It was widely used in Brazil to assist in postmortem diagnoses and investigate excess mortality during the Coronavirus Disease 2019 (COVID-19) pandemic. This study aimed to determine the accuracy of investigating acute respiratory distress syndrome (ARDS) using VA. This is a cross-sectional study with prospective data collected from January 2020 to August 2021 at the Death Verification Service of Sao Luis city, Brazil. VA was performed for suspected COVID-19 deaths, and one day of the week was randomly chosen to collect samples from patients without suspected COVID-19. Two swabs were collected after death and subjected to reverse transcription-polymerase chain reaction (RT-PCR) for SARS-CoV-2 detection. Of the 250 cases included, the VA questionnaire identified COVID-19-related ARDS in 67.2% (52.98% were positive for COVID-19). The sensitivity of the VA questionnaire was 0.53 (0.45-0.61), the specificity was 0.75 (0.64-0.84), the positive predictive value was 0.81 (0.72-0.88), and the negative predictive value was 0.44 (0.36-0.53). The VA had a lower-than-expected accuracy for detecting COVID-19 deaths; however, because it is an easily accessible and cost-effective tool, it can be combined with more accurate methods to improve its performance.
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Affiliation(s)
- Marcos Adriano Garcia Campos
- Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Hospital das Clínicas, Botucatu, São Paulo, Brazil
| | | | - Érico Murilo Monteiro Cutrim
- Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Hospital das Clínicas, Botucatu, São Paulo, Brazil
| | | | | | | | | | - Gyl Eanes Barros Silva
- Universidade Federal do Maranhão, Faculdade de Medicina, São Luís, Maranhão, Brazil
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Patologia e Medicina Legal, Ribeirão Preto, São Paulo, Brazil
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Macias-Konstantopoulos WL, Perttu E, Weerasinghe S, Dlamini D, Willis B. Causes of preventable death among children of female sex worker mothers in low- and middle-income countries: A community knowledge approach investigation. J Glob Health 2024; 14:04052. [PMID: 38454881 PMCID: PMC10921126 DOI: 10.7189/jogh.14.04052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Abstract
Background Female sex workers (FSW) in low- and middle-income countries (LMIC) are disproportionately vulnerable to poor health, social, and economic outcomes. The children of female sex workers (CFSW) experience health risks based on these challenging circumstances and the unique conditions to which they are exposed. Although country child mortality data exist, little is known about the causes of death among CFSW specifically, thereby severely limiting an effective public health response to the needs of this high-risk group of children. Methods The Community Knowledge Approach (CKA) was employed between January and October 2019 to survey a criterion sample of 1280 FSW participants across 24 cities in eight LMIC countries. Participants meeting pre-determined criteria provided detailed reports of deaths among the CFSW within their community of peers. Newborn deaths were gleaned from FSW maternal death reports where the infants also died following birth. Results Of the 668 child deaths reported, 589 were included in the analysis. Nutritional deficiencies comprised the leading cause of mortality accounting for 20.7% of deaths, followed closely by accidents (20.0%), particularly house fires, overdoses (19.4%), communicable diseases (18.5%), and homicides (9.8%). Other reported causes of death included neonatal conditions, respiratory illnesses, and suicides. Conclusions The causes of CFSW death in these eight countries are preventable with improved protections. Governments, intergovernmental organisations like the United Nations, nongovernmental stakeholder organisations (e.g. sex worker organisations), and funders can implement targeted policies and programmes to protect CFSW and assist vulnerable FSW who are pregnant and raising children. Further research is needed to identify effective child welfare safeguards for CFSW.
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Affiliation(s)
- Wendy L Macias-Konstantopoulos
- Global Health Promise, Portland, Oregon, USA
- Center for Social Justice and Health Equity, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | | | - Swarna Weerasinghe
- Global Health Promise, Portland, Oregon, USA
- Department of Community Health and Epidemiology, Dalhousie University, Faculty of Medicine, Halifax, Nova Scotia, Canada
| | - Duduzile Dlamini
- Global Health Promise, Portland, Oregon, USA
- Mothers for the Future, Cape Town, Republic of South Africa
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Dahie HA, Dakane MM, Hassan BS. Prevalence, patterns, and determinants of gender-based violence among women and girls in IDP camps, Mogadishu-Somalia. J Migr Health 2023; 8:100193. [PMID: 37637858 PMCID: PMC10450962 DOI: 10.1016/j.jmh.2023.100193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 04/10/2023] [Accepted: 06/21/2023] [Indexed: 08/29/2023] Open
Abstract
Background Gender-based violence (GBV) against women and girls, is a global pandemic that affects 1 in 3 women in their lifetime. Somalia is one of the leading countries in human rights violations and has one of the highest rates of sexual and gender-based violence (SGBV) worldwide. Such violence is more prevalent among women and girls in internally displaced persons (IDP) camps who lack livelihood and civil protections. Therefore, this study was designed to identify the prevalence and the determinants of gender-based violence in IDP camps in Deynile district, Somalia. Methods This is a cross-sectional study design conducted in IDP camps in Deynile District from August 1 to September 30, 2022. A total of three hundred eighty-four women and girls aged 18 years and above living in the selected IDP camps were involved in the study. The camps were selected randomly while households and participants were selected systematic random sampling. The recall period was set at 12 months (August 2021 to July 2022). Participants were interviewed by well-trained research assistants using pre-tested structured questionnaire. Data was entered into and analyzed with SPSS 25.0. Logistic regression was used, and the significance level was set at p value ≤ 0.05. Result The study revealed that gender-based violence was quite common in the IDP camps in Mogadishu's Deynile area. Physical abuse was the most prevalent type of GBV, which was primarily committed by intimate partners, parents, and other family members. The main factors associated with gender-based violence were young age (OR=4.77, 95% CI: 1.96-11.63, p<0.001), extended family structure (OR=7.89, 95% CI: 4.30-14.47, p<0.001), household size >5 individuals (OR=1.86, 95% CI:1.04-3.30, p<0.005), employment (OR=1.57, 95% CI: 1.0.41-2.32, p<0.05), substance misuse (OR=3.25, 95% CI: 1.57-6.73, p<0.05), a long distance to the nearest police station (OR=2.75, 95% CI:1.51-5.00, p<0.005), and camp safety protection (OR=1.94, 95% CI:1.24-3.30, p<0.005). Conclusion and recommendations There was a high prevalence of gender-based violence in the IDP camps in Mogadishu's Deynile area. The most common form of GBV was physical violence mainly perpetuated by intimate partners. The study recommends improving some of the modifiable factors that were strongly associated with gender-based violence.
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Checchi F. Inferring the impact of humanitarian responses on population mortality: methodological problems and proposals. Confl Health 2023; 17:16. [PMID: 36998020 PMCID: PMC10061806 DOI: 10.1186/s13031-023-00516-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/24/2023] [Indexed: 04/01/2023] Open
Abstract
Reducing excess population mortality caused by crises due to armed conflict and natural disasters is an existential aim of humanitarian assistance, but the extent to which these deaths are averted in different humanitarian responses is mostly unknown. This information gap arguably weakens governance and accountability. This paper considers methodological challenges involved in making inferences about humanitarian assistance's effect on excess mortality, and outlines proposed approaches. Three possible measurement questions, each of which contributes some inferential evidence, are presented: (1) whether mortality has remained within an acceptable range during the crisis (for which different direct estimation options are presented); (2) whether the humanitarian response is sufficiently appropriate and performant to avert excess mortality (a type of contribution analysis requiring in-depth audits of the design of humanitarian services and of their actual availability, coverage and quality); and (3) the actual extent to which humanitarian assistance has reduced excess deaths (potentially the most complex question to answer, requiring application of causal thinking and careful specification of the exposure, and for which either quasi-experimental statistical modelling approaches or a combination of verbal and social autopsy methods are proposed). The paper concludes by considering possible 'packages' of the above methods that could be implemented at different stages of a humanitarian response, and calls for investment in improved methods and actual measurement.
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Affiliation(s)
- Francesco Checchi
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
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Seal AJ, Mohamed HA, Stokes-Walter R, Mohamed S, Abdille AM, Yakowenko E, Sheikh Omar M, Jelle M. Use of an adapted participatory learning and action cycle to increase knowledge and uptake of child vaccination in internally displaced persons camps (IVACS): A cluster-randomised controlled trial. Vaccine 2023; 41:3038-3046. [PMID: 36906409 DOI: 10.1016/j.vaccine.2023.02.016] [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: 04/28/2022] [Revised: 01/27/2023] [Accepted: 02/05/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Vaccination is a key public health intervention that can reduce excess mortality in humanitarian contexts. Vaccine hesitancy is thought to be a significant problem requiring demand side interventions. Participatory Learning and Action (PLA) approaches have proven effective in reducing perinatal mortality in low income settings and we aimed to apply an adapted approach in Somalia. METHODS A randomised cluster trial was implemented in camps for internally displaced people near Mogadishu, from June to October 2021. An adapted PLA approach (hPLA) was used in partnership with indigenous 'Abaay-Abaay' women's social groups. Trained facilitators ran 6 meeting cycles that addressed topics of child health and vaccination, analysed challenges, and planned and implemented potential solutions. Solutions included a stakeholder exchange meeting involving Abaay-Abaay group members and services providers from humanitarian organisations. Data was collected at baseline and after completion of the 3 month intervention cycle. RESULTS Overall, 64.6% of mothers were group members at baseline and this increased in both arms during the intervention (p = 0.016). Maternal preference for getting young children vaccinated was >95% at baseline and did not change. The hPLA intervention improved the adjusted maternal/caregiver knowledge score by 7.9 points (maximum possible score 21) compared to the control (95% CI 6.93, 8.85; p < 0.0001). Coverage of both measles vaccination (MCV1) (aOR 2.43 95% CI 1.96, 3.01; p < 0.001) and completion of the pentavalent vaccination series (aOR 2.45 95% CI 1.27, 4.74; p = 0.008) also improved. However, adherence to timely vaccination did not (aOR 1.12 95% CI 0.39, 3.26; p = 0.828). Possession of a home-based, child health record card increased in the intervention arm from 18 to 35% (aOR 2.86 95% CI 1.35, 6.06; p = 0.006). CONCLUSION A hPLA approach, run in partnership with indigenous social groups, can achieve important changes in public health knowledge and practice in a humanitarian context. Further work to scale up the approach and address other vaccines and population groups is warranted.
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Evaluation of conditional cash transfers and mHealth audio messaging in reduction of risk factors for childhood malnutrition in internally displaced persons camps in Somalia: A 2 × 2 factorial cluster-randomised controlled trial. PLoS Med 2023; 20:e1004180. [PMID: 36848361 PMCID: PMC9970051 DOI: 10.1371/journal.pmed.1004180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 01/20/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Cash transfer programmes are increasingly used in humanitarian contexts to help address people's needs across multiple sectors. However, their impact on the key objectives of reducing malnutrition and excess mortality remains unclear. mHealth interventions show great promise in many areas of public health, but evidence for their impact on reducing the risk factors for malnutrition is uncertain. We therefore implemented a trial to determine the impacts of 2 interventions in a protracted humanitarian context, a cash transfer conditionality and mHealth audio messages. METHODS AND FINDINGS A 2 × 2 factorial cluster-randomised trial was implemented in camps for internally displaced people (IDP) near Mogadishu, Somalia, starting in January 2019. The main study outcomes were assessed at midline and endline and included coverage of measles vaccination and the pentavalent immunisation series, timely vaccination, caregiver's health knowledge, and child diet diversity. Twenty-three clusters (camps) were randomised to receive or not receive conditional cash transfers (CCTs) and an mHealth intervention, and 1,430 households were followed up over 9 months. All camps received cash transfers made at emergency humanitarian level (US$70/household/month) for 3 months followed by a further 6 months at a safety net level (US$35). To be eligible to receive cash, households in camps receiving CCT were required to take their children <5 years age to attend a single health screening at a local clinic and were issued with a home-based child health record card. Participants in camps receiving the mHealth intervention were asked (but not required) to listen to a series of audio messages about health and nutrition that were broadcast to their mobile phone twice a week for 9 months. Participants and investigators were not blinded. Adherence to both interventions was monitored monthly and found to be high (>85%). We conducted intention-to-treat analysis. During the humanitarian intervention phase, the CCT improved coverage of measles vaccination (MCV1) from 39.2% to 77.5% (aOR 11.7, 95% CI [5.2, 26.1]; p < 0.001) and completion of the pentavalent series from 44.2% to 77.5% (aOR 8.9, 95% CI [2.6, 29.8]; p = < 0.001). By the end of the safety net phase, coverage remained elevated from baseline at 82.2% and 86.8%, respectively (aOR 28.2, 95% CI [13.9, 57.0]; p < 0.001 and aOR 33.8, 95% CI [11.0, 103.4]; p < 0.001). However, adherence to timely vaccination did not improve. There was no change in the incidence of mortality, acute malnutrition, diarrhoea, or measles infection over the 9 months of follow-up. Although there was no evidence that mHealth increased Mother's knowledge score (aOR 1.32, 95% CI [0.25, 7.11]; p = 0.746) household dietary diversity increased from a mean of 7.0 to 9.4 (aOR 3.75, 95% CI [2.04, 6.88]; p < 0.001). However, this was not reflected by a significant increase in child diet diversity score, which changed from 3.19 to 3.63 (aOR 2.1, 95% CI [1.0, 4.6]; p = 0.05). The intervention did not improve measles vaccination, pentavalent series completion, or timely vaccination, and there was no change in the incidence of acute malnutrition, diarrhoea, measles infection, exclusive breastfeeding, or child mortality. No significant interactions between the interventions were found. Study limitations included the limited time available to develop and test the mHealth audio messages and the necessity to conduct multiple statistical tests due to the complexity of the study design. CONCLUSIONS A carefully designed conditionality can help achieve important public health benefits in humanitarian cash transfer programmes by substantially increasing the uptake of child vaccination services and, potentially, other life-saving interventions. While mHealth audio messages increased household diet diversity, they failed to achieve any reductions in child morbidity, malnutrition, or mortality. TRIAL REGISTRATION ISRCTN ISRCTN24757827. Registered November 5, 2018.
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Costa BFCD, Carneiro BD, Ramalho A, Freitas A. Characterization of Innovation to Fight Child Mortality: A Systematic Scoping Review. Int J Public Health 2022; 67:1604815. [PMID: 36046259 PMCID: PMC9421644 DOI: 10.3389/ijph.2022.1604815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives: This study aims to summarize how child mortality—a Sustainable Development Goal stated by the United Nations—has been explicitly addressed in the context of innovations. Methods: A scoping review following the PRISMA-ScR Statement was performed analysing indexed and non-indexed literature. Results: Empirical and non-disruptive innovation in the context of process targeting under-five mortality rate was the main subset of literature included in this article. The increment of literature on innovation in the context of SDGs over the last years denotes its growing importance and even though innovation aiming to reduce child mortality is currently being done, a significant part of it is not published in indexed databases but as grey literature. Conclusion: Empirical, disruptive innovation under a structural approach and empirical, non-disruptive innovation under a project point of view are the main types of innovation addressed in the literature and would be of utmost potential to reduce child mortality rate. A systematic review of the methods used for the measures of evaluation of applied innovations, their quality and results would be of great importance in the future.
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Affiliation(s)
| | | | - André Ramalho
- Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Alberto Freitas
- Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
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Zakari A, Taghizadeh-Hesary F, Tawiah V, Alvarado R, Li G. The impact of environmental cleanliness and cultural factors on child health in Africa. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:59619-59632. [PMID: 35389169 DOI: 10.1007/s11356-022-20016-4] [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: 11/26/2021] [Accepted: 03/28/2022] [Indexed: 06/14/2023]
Abstract
Africa is a region with abundant natural resources, but the child mortality rate is higher. Despite World Health Organization (WHO) support, the region remained the highest with the number of child mortality rate. Given this fact, this study examines the role of environmental degradation, clean water source, and sanitation facilities on child mortality and life expectancy/longevity in Africa. To achieve this objective, we employ pooled regression and system generalized method of moment (S-GMM) on 33 African countries between 2000 and 2014. We found that environmental degradation is positively related to child mortality and life expectancy or longevity. However, clean water sources and sanitation facilities help to reduce the child mortality rate and help to improve life expectancy. Also, we found cultural norms improve child mortality and life expectancy. Our results imply that African countries are benefitting from cultural values, clean water sources, and sanitation facilities.
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Affiliation(s)
- Abdulrasheed Zakari
- School of Management and Economics, Beijing Institute of Technology, Beijing, 100081, China.
- Alma Mater Europaea ECM, Maribor, Slovenia.
| | | | | | - Rafael Alvarado
- Esai Business School, Universidad Espíritu Santo, Samborombón, 091650, Ecuador
| | - Guo Li
- School of Management and Economics, Beijing Institute of Technology, Beijing, 100081, China
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Ogbu TJ, Scales SE, de Almeida MM, van Loenhout JAF, Speybroeck N, Guha-Sapir D. Predictors of exceeding emergency under-five mortality thresholds using small-scale survey data from humanitarian settings (1999 - 2020): considerations for measles vaccination, malnutrition, and displacement status. Arch Public Health 2022; 80:160. [PMID: 35765108 PMCID: PMC9238088 DOI: 10.1186/s13690-022-00916-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 06/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Quantifying the effect of measles containing vaccine (MCV) coverage and the prevalence of global acute malnutrition (GAM) on mortality levels in populations of displaced and crisis-affected resident children is important for intervention programming in humanitarian emergencies. METHODS A total of 1597 surveys containing data on under-five death rate, population status (internally displaced, refugee, or crisis-affected resident), measles containing vaccine coverage, and global acute malnutrition were extracted from the Complex Emergency Database (CE-DAT). Under-five mortality rates were dichotomized to those exceeding critical levels or otherwise. A Bayesian multivariable mixed-effect logistic regression model was used to assess the association between an under-five death rate (U5DR) exceeding this threshold and population status (i.e., internally displaced, refugees or residents), GAM prevalence (proxy for food security), and MCV coverage. RESULTS The prevalence of GAM, MCV and U5DR were higher in internally displaced children (IDC) with values of 14.6%, 69.9% and 2.07 deaths per 10 000 per day, respectively. Refugee populations had lower average under-five mortality rate (0.89 deaths per 10 000 per day), GAM of 12.0% and the highest measles containing vaccine coverage (80.0%). In crisis-affected residents the prevalence of GAM, MCV and average U5DR are 11.1%, 65.5% and 1.20 deaths per 10 000 per day respectively. In mixed-effect logistic model taking 2 deaths per 10 000 children less than five years old per as emergency threshold (Model III); MCV (AOR = 0.66, 95% Highest Density Interval (HDI): 0.57, 0.78), GAM (AOR = 1.79, 95% HDI: 1.52, 2.12) were associated with a reduction of the odds of U5DR exceeding critical level accounting for country-specific levels of variability. The odds of U5DR exceeding critical level (2/10000/day) in crisis-affected resident children and refugees were 0.36 (95% HDI: 0.22, 0.58) and 0.25(95% HDI: 0.11, 0.55) less than amongst IDP children adjusting for GAM and MCV. In considering country specific yearly median U5DR (model IV) the odds of U5DR exceeding twice the median U5DR were associated with MCV (AOR = 0.72, 95% HDI: 0.64, 0.82), GAM (AOR = 1.53, 95%HDI: 1.34, 1.76). The odds of U5DR exceeding critical level in crisis-affected resident children was 0.30(95% HDI: 0.20, 0.45) less than IDP children, after adjusting for MCV and GAM. We found no difference between the odds of U5DR exceeding twice the country level median U5DR in the refugee population compared to the IDPs. CONCLUSIONS In this study vaccination coverage and global acute malnutrition (proxy for food security) were associated with U5DR exceeding critical level. The emergency threshold for IDPs and affected residents is significantly different and consistent across the different outcomes, whereas the result is inconsistent for IDPs and refugees. Continued improvement in measles vaccination coverage and reduction of malnutrition in humanitarian emergencies have the potential to minimize the deterioration of mortality level amongst children in emergency settings. To generate a robust understanding of the critical level of child mortality in displaced and affected resident populations, studies accounting for the impact of the duration of displacement, contextual factors in humanitarian settings, and the level of humanitarian assistance provided are needed.
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Affiliation(s)
- Thomas Jideofor Ogbu
- Centre for Research On the Epidemiology of Disasters (CRED), Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium.
| | - Sarah Elizabeth Scales
- University of Delaware College of Health Science, Program in Epidemiology, Newark, Delaware, USA
| | - Maria Moitinho de Almeida
- Centre for Research On the Epidemiology of Disasters (CRED), Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Joris Adriaan Frank van Loenhout
- Centre for Research On the Epidemiology of Disasters (CRED), Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Niko Speybroeck
- Centre for Research On the Epidemiology of Disasters (CRED), Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Debarati Guha-Sapir
- Centre for Research On the Epidemiology of Disasters (CRED), Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
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Yuen A, Warsame A, Checchi F. Exploring the temporal patterns and crisis-related risk factors for population displacement in Somalia (2016-2018). J Migr Health 2022; 5:100095. [PMID: 35434680 PMCID: PMC9006846 DOI: 10.1016/j.jmh.2022.100095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/06/2022] [Accepted: 04/02/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction Over the past 30 years, south-central Somalia, Puntland (north-east) and Somaliland (north-west) have experienced recurring drought- and conflict-related crises. By the end of 2018, the number of internally displaced persons (IDPs) in the region had reached 2.6 million; most were displaced to larger towns under government control, where humanitarian assistance was more accessible. Understanding the drivers of crisis-related displacement can provide insight into how responses can best manage and respond to displacement to prevent downstream morbidity and mortality. We aimed to explore the temporal patterns and crisis-related risk factors for population displacement in Somalia from 2016 to 2018, a period of severe drought. Methods We conducted an ecological study of secondary panel data stratified by district and month. The study population included all people in the region from 2016 to 2018. The outcome was defined as the number of new out-migrating internally displaced persons (IDPs) per district-month. Exposure variables included armed conflict, rainfall, food insecurity and food security services. Lags at one, two and three months were generated to explore possible delayed effects. All univariate and multivariate analyses were conducted using negative binomial regression models with mixed effects incorporating the district as a random effect. Results From 2016 to 2018, the proportion of IDPs increased from 9% to 25% in Somalia, Puntland and Somaliland. We observed strong associations between IDP out-migration rate and failed rains at a three-month lag, food insecurity at a one-month lag, and the presence of therapeutic food services with no lag. IDP out-migration rate was not associated with armed conflict intensity, and cash- and rations-based food security services. Discussion This study identified temporal, and socially and biologically plausible associations between key crisis-related risk factors and displacement in Somalia. The findings suggest a sequence of events spanning a few months, where failed rains and consequent food insecurity likely prompted early population out-migration to larger urban centers where humanitarian services were more accessible. The presence of therapeutics-based food security services could represent a more general correlate of crisis severity and the decision to migrate.
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Warsame A, Osman AY. Verbal autopsy to assess child mortality in a humanitarian setting. THE LANCET GLOBAL HEALTH 2021; 9:e1189-e1190. [DOI: 10.1016/s2214-109x(21)00290-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 06/10/2021] [Indexed: 10/20/2022] Open
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