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Stark L, Mutumba M, Ssewamala F, Brathwaite R, Brown DS, Atwebembere R, Mwebembezi A. Protocol for a discrete choice experiment: understanding preferences for seeking health services for survivors of sexual violence in Uganda. BMJ Open 2024; 14:e081663. [PMID: 39107025 PMCID: PMC11308909 DOI: 10.1136/bmjopen-2023-081663] [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: 11/02/2023] [Accepted: 07/19/2024] [Indexed: 08/09/2024] Open
Abstract
INTRODUCTION Sexual violence is a significant public health concern with severe physical, social and psychological consequences, which can be mitigated by health service utilisation. However, in Uganda and much of sub-Saharan Africa, these services are significantly underused, with 9 out of 10 survivors not seeking care due to a range of psychological, cultural, economic and logistical factors. Thus, there is a strong need for research to improve health service utilisation for survivors of sexual violence. METHODS AND ANALYSIS The proposed study seeks to address the underutilization of health services for female survivors of sexual violence using a discrete choice experiment (DCE). The study will be conducted in the greater Masaka region of southwestern Uganda and target adult female survivors of sexual violence. We will first undertake qualitative interviews with 56 survivors of sexual violence to identify the key attributes and levels of the DCE. In order to ensure a sufficiently powered sample, 312 women who meet inclusion criteria will be interviewed. Our primary analysis will employ a mixed (random parameters) logit model. We will also model the role of individual-specific characteristics through latent class models. ETHICS AND DISSEMINATION The study protocol was reviewed and approved by the following ethics review boards in Uganda and the USA: the Uganda Virus Research Institute (UVRI), the Uganda National Council for Science and Technology (HS2364ES), Washington University in St Louis and the University of Michigan. Our methods conform to established guidelines for the protection of human subjects involved in research. Our dissemination plan targets a broad audience, ranging from policymakers and government agencies to healthcare providers, academic communities and survivors themselves.
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Affiliation(s)
- Lindsay Stark
- Washington University in St Louis George Warren Brown School of Social Work, St Louis, Missouri, USA
| | - M Mutumba
- University of Michigan, Ann Arbor, Michigan, USA
| | - Fred Ssewamala
- Washington University in St Louis George Warren Brown School of Social Work, St Louis, Missouri, USA
| | - Rachel Brathwaite
- Washington University in St Louis George Warren Brown School of Social Work, St Louis, Missouri, USA
| | - Derek S Brown
- Washington University in St Louis George Warren Brown School of Social Work, St Louis, Missouri, USA
| | - Raymond Atwebembere
- Washington University in St Louis George Warren Brown School of Social Work, St Louis, Missouri, USA
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Gebreyesus A, Gebremariam AG, Kidanu KG, Gidey S, Haftu H, Nigusse AT, Shishay F, Mamo L. Post-traumatic stress disorder symptoms among internally displaced persons: unveiling the impact of the war of Tigray. DISCOVER MENTAL HEALTH 2024; 4:18. [PMID: 38806962 PMCID: PMC11133275 DOI: 10.1007/s44192-024-00069-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 05/14/2024] [Indexed: 05/30/2024]
Abstract
INTRODUCTION Due to the war in Tigray, 2.1 million people (31% of the total population) were internally displaced. Epidemiological evidence shows that the burden of mental health is higher in war/conflict and post-conflict areas of the world compared to non-conflict places, especially for those who have experienced targeted ethnic violence as a result of civil and political unrest. Post-traumatic stress disorder is one of the common psychiatric disorders experienced during war. Thus, this study aimed to assess the level and aggravating factors of PTSD during the war in Tigray. METHODS A community-based cross-sectional study was conducted among 2132 IDP family heads in Tigray from August 6-30, 2021. Study participants were recruited using a multi-stage sampling technique. Data were collected using a pretested structured questionnaire through face-to-face interviews. The PCL-C checklist, derived from DSM-IV criteria, was used to assess the magnitude of post-traumatic stress disorder. The entered data were exported to the SPSS version 26 statistical package for analysis. Summary statistics were computed, and logistic regression analysis was used to investigate factors associated with developing PTSD. RESULTS A total of 2071 IDPs were surveyed with a response rate of 99.7%. The survey revealed that the level of PTSD among community-hosted IDPs was 57.7%; 95% CI 55.5%-59.8%. Older age (> 50) (AOR 3.1, 95% CI 1.497-6.421), primary and secondary school attendance (AOR 2.1, 95% CI 1.344-3.279; and 1.697, 95% CI 1.067-2.7) respectively, internally displaced persons with a family size of > 6 members (AOR 1.821, 95% CI 1.124-2.95), disability due to the war (AOR 1.702, 95% CI 1.077-2.69), and loss of contact with family members (AOR 1.472, 95% CI 1.032-2.099) were significantly associated with PTSD. CONCLUSION The overall level of PTSD among cIDPs was found to be high (57.7%). Almost every other IDP developed this serious mental health syndrome. Immediate psycho-social health intervention is needed by local and international organizations in collaboration with governmental and non-governmental institutions based on the study's findings.
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Affiliation(s)
- Aregawi Gebreyesus
- Department of Epidemiology, College of Health Science, Mekelle University, Mekelle, Tigray, Ethiopia.
| | | | - Kokob Gebru Kidanu
- Department of Psychiatry, College of Health Science, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Solomon Gidey
- Department of Psychiatry, College of Health Science, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Hansa Haftu
- School of Medicine, College of Health Science, Mekelle University, Mekelle, Tigray, Ethiopia
| | | | - Fiyori Shishay
- Department of Epidemiology, College of Health Science, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Liya Mamo
- Department of Biostatistics, College of Health Science, Mekelle University, Mekelle, Tigray, Ethiopia
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Gebreyesus A, Niguse AT, Shishay F, Mamo L, Gebremedhin T, Tsegay K, Gebremariam AG, Kidanu KG, Gidey S, Tesfay F. Prevalence of depression and associated factors among community hosted internally displaced people of Tigray; during war and siege. BMC Psychiatry 2024; 24:3. [PMID: 38166772 PMCID: PMC10763281 DOI: 10.1186/s12888-023-05333-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 10/31/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Displacement is a psychologically stressful event. Since the war began, the people of Tigray were subjected to stressful events such as torture, rape, the killing of a family member, forced displacement, and even ethnic cleansing in their home countries. Especially displaced individuals are faced mental health problems. This study aimed to assess the prevalence of depression and associated factors among community internally displaced people due to the war on Tigray, in 2021. METHODS The community-based cross-sectional study design was applied from August 06 to 30, 2021 in all Weredas of Tigray. A total of 1,990 cIDP were recruited through a two-stage sampling technique. A structured and standardized questionnaire was used to collect data. Both bivariate and multivariable logistic regression was applied to identify associated risk factors and AOR with 95% confidence interval was used to select statistically significant variables. RESULTS The prevalence of depression among internally displaced people was 81.2% (95% CI: 79.4-83%), with more than 60% categorized as moderate and severe depression. The married and divorced marital status, being government employee, having family size > = 4, destruction of household fixed assets, looting of cereals, and having disabled family members due to the war were the significantly associated risk factors of depression. CONCLUSIONS The prevalence of depression among community internally displaced people during the war on Tigray is very high compared to other studies conducted elsewhere. Almost 8 of 10 IDPs are developed depression and this is a very series health issue that needs immediate intervention by local, international organizations and communities around the world.
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Affiliation(s)
- Aregawi Gebreyesus
- Department of Epidemiology, College of Health Science, Mekelle University, Mekelle, Tigray, Ethiopia
| | | | - Fiyori Shishay
- Department of Epidemiology, College of Health Science, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Liya Mamo
- Department of Biostatistics, College of Health Science, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Teklit Gebremedhin
- School of Medicine, College of Health Science, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Kahsu Tsegay
- School of Nursing, College of Health Science, Mekelle University, Mekelle, Tigray, Ethiopia
| | | | - Kokob Gebru Kidanu
- Department of Psychiatry, College of Health Science, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Solomon Gidey
- Department of Psychiatry, College of Health Science, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Fisaha Tesfay
- Deakin University, Geelong, Institute for Health Transformation, Melbourne, Australia.
- College of Medicine and Public Health, Flinders University, Bedford Park, Australia.
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Lokot M, Hartman E, Hashmi I. Participatory approaches and methods in gender equality and gender-based violence research with refugees and internally displaced populations: a scoping review. Confl Health 2023; 17:58. [PMID: 38066619 PMCID: PMC10704759 DOI: 10.1186/s13031-023-00554-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 11/22/2023] [Indexed: 01/05/2024] Open
Abstract
Using participatory approaches or methods are often positioned as a strategy to tackle power hierarchies in research. Despite momentum on decolonising aid, humanitarian actors have struggled to describe what 'participation' of refugees and internally displaced persons (IDPs) means in practice. Efforts to promote refugee and IDP participation can be tokenistic. However, it is not clear if and how these critiques apply to gender-based violence (GBV) and gender equality-topics that often innately include power analysis and seek to tackle inequalities. This scoping review sought to explore how refugee and IDP participation is conceptualised within research on GBV and gender equality. We found that participatory methods and approaches are not always clearly described. We suggest that future research should articulate more clearly what constitutes participation, consider incorporating feminist research methods which have been used outside humanitarian settings, take more intentional steps to engage refugees and IDPs, ensure compensation for their participation, and include more explicit reflection and strategies to address power imbalances.
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Affiliation(s)
- Michelle Lokot
- London School of Hygiene and Tropical Medicine, London, UK.
| | - Erin Hartman
- London School of Hygiene and Tropical Medicine, London, UK
| | - Iram Hashmi
- London School of Hygiene and Tropical Medicine, London, UK
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Makinde OA, Olamijuwon E, Mgbachi I, Sato R. Childhood exposure to armed conflict and nutritional health outcomes in Nigeria. Confl Health 2023; 17:15. [PMID: 36978100 PMCID: PMC10053485 DOI: 10.1186/s13031-023-00513-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 03/19/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Armed conflicts are associated with an increased risk of food insecurity, the leading cause of malnutrition in low-and-middle-income countries. Multiple studies have uncovered significant influences of childhood malnutrition on children's overall health and development. As a result, it is increasingly important to understand how childhood experience of armed conflict intersects with childhood malnutrition in conflict-prone countries like Nigeria. This study examined the association between different measures of childhood experiences of armed conflicts and the nutritional health outcomes of children aged 36-59 months. METHODS We used data from the Nigeria Demographic and Health Survey linked with Uppsala Conflict Data Program Geo-Referenced Events Dataset using geographic identifiers. Multilevel regression models were fitted on a sample of 4226 children aged 36-59 months. RESULTS The prevalence of stunting, underweight and wasting was 35%, 20% and 3%, respectively. Armed conflicts were mostly recorded in the North-eastern states of Borno (222 episodes) and Adamawa (24 episodes). Exposure to armed conflicts ranged from 0 (no experience of armed conflict) to 3.75 conflicts per month since the child's birth. An increase in the frequency of armed conflicts is associated with increased odds of childhood stunting [AOR = 2.52, 95%CI: 1.96-3.25] and underweight [AOR = 2.33, 95%CI: 1.19-4.59] but not wasting. The intensity of armed conflict was only marginally associated with stunting and underweight but not wasting. Longer conflicts that occurred in the last year were also associated with the odds of stunting [AOR = 1.25, 95%CI: 1.17-1.33] and underweight [AOR = 1.19, 95%CI: 1.11-1.26] but not wasting. CONCLUSION Childhood exposure to armed conflict is associated with long-term malnutrition in children aged 36-59 months in Nigeria. Strategies that aim to end childhood malnutrition could target children exposed to armed conflicts.
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Affiliation(s)
- Olusesan Ayodeji Makinde
- Viable Knowledge Masters, Plot C114, First Avenue, Gwarimpa, Abuja, Federal Capital Territory, Nigeria
- Viable Helpers Development Organization, Abuja, Federal Capital Territory, Nigeria
| | - Emmanuel Olamijuwon
- School of Geography and Sustainable Development, University of St Andrews, St Andrews, KY16 9AL, UK.
| | - Ifeanyi Mgbachi
- Viable Helpers Development Organization, Abuja, Federal Capital Territory, Nigeria
| | - Ryoko Sato
- Harvard University, 677 Huntington Ave, Boston, MA, 02115, USA
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James PB, Osborne A, Bah AJ, Margao EK, Conteh-Barrat M. Sexual risk behaviour among school-going adolescents in Sierra Leone and Liberia: a secondary analysis of the 2017 Global school-based student health surveys. Contracept Reprod Med 2022; 7:27. [PMID: 36566228 DOI: 10.1186/s40834-022-00193-w] [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: 08/08/2022] [Accepted: 10/18/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Sierra Leone and Liberia have experienced civil wars and, recently, Ebola outbreaks that led to profound economic hardship, psychopathologies and family disruptions. These factors are associated with sexual risk behaviours among youths. However, there is very little information on sexual risk behaviour among Sierra Leonean and Liberian school-going adolescents. The present study assessed the prevalence and determinants of sexual risk behaviours among school-going adolescents (10-19 years) in Sierra Leone and Liberia. METHOD: We used publicly available nationally representative cross-sectional datasets of the 2017 Sierra Leone and Liberia Global school health survey. The sample consisted of 2798 and 2744 school-going adolescents from Sierra Leone and Liberia, respectively. Complex sample descriptive and regression analysis was used to analyse our data. RESULTS The majority of adolescents in the two countries were involved in multiple sexual risk behaviour (80.2%), with a higher prevalence observed in Sierra Leone (85.2%) than in Liberia (75.3%). Liberian adolescents showed lesser odds of indulging in multiple sexual risk behaviours than their Sierra Leonean counterparts (AOR = 0.572; 95%CI: 0.345-0.946). Male, compared to females, were more likely to engage in multiple sexual risk behaviour (AOR = 2.310;95%CI:1.543-3.458), with a similar pattern observed in both countries. Alcohol use was associated with multiple sexual risk behaviour (AOR = 3.064; 95%CI: 2.137-4.392). Also, in Sierra Leone and Liberia, adolescents with one and two or more forms of psychological distress were more likely to have ever had sex than those who did not show any form of psychological distress. Missing class/school was associated with multiple sexual risk behaviour (AOR = 1.655; 95%CI:1.133-2.418). Peer support was only found to be a protective factor against no condom use among Liberian adolescents (AOR = 0.608; 95%CI: 0.435-0.850). Less parental support was only associated with ever had sex among adolescents in Sierra Leone (AOR = 2.027; 95%CI: 1.322-3.107) but not in Liberia (AOR = 1.034; 95%CI: 0.650-1.644). CONCLUSION Our study found a high sexual risk behaviour among school-going adolescents in Sierra Leone and Liberia. Our finding highlights the need to strengthen sexual and reproductive health education in schools and communities that incorporate mental health promotion activities tailored to this group.
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Affiliation(s)
- Peter Bai James
- National Centre for Naturopathic Medicine, Faculty of Health, Southern Cross University, Lismore, Australia. .,Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
| | - Augustus Osborne
- Department of Biological Sciences, School of Environmental Sciences, Njala University, Njala Campus, Njala, Sierra Leone
| | - Abdulai Jawo Bah
- Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.,Institute for Global Health and Development, Queen Margaret University Edinburg, Musselburgh, Scotland, UK
| | - Emmanuel Kamanda Margao
- Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
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Abi Chahine M, Kienzler H. Ageism, an invisible social determinant of health for older Syrian refugees in Lebanon: a service providers' perspective. Confl Health 2022; 16:62. [PMID: 36434728 PMCID: PMC9694515 DOI: 10.1186/s13031-022-00491-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 10/31/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Older refugees face particular challenges because their health and social needs are largely overlooked in humanitarian programmes, policies and research. The few studies available have shown that older refugees suffer from a high prevalence of non-communicable diseases, including mental health problems, increased social isolation and poverty, and difficulty accessing health and social services. This article aims to provide further in-depth understanding of how service providers perceive health and social challenges of older Syrian refugees living in Lebanon by focusing on (1) their health and social challenges; (2) the available and lacking services; (3) participation; and (4) policy recommendations to improve services. METHODS This study is based on a qualitative research approach. Fifteen semi-structured interviews were conducted with health and social workers providing services to older Syrian refugees living in Lebanon. All interviews were digitally recorded, transcribed, coded and analysed using thematic analysis. RESULTS Study results clearly show that older refugees face increased marginalisation and neglect, mainly because of ageism. Ageism experienced at aid agency, family and individual levels, impacts negatively on older refugees. They have a sense of social isolation, neglect and feel they are a burden, consequently their social participation decreases, impacting negatively on their physical and mental health as well as their access to social and health care. Linked to experiences of ageism, study participants noted: (1) high prevalence rates of non-communicable diseases and mental health problems; (2) difficulties accessing care, with inadequate services to support the needs of older refugees; and (3) policy recommendations calling for an holistic approach to aid which takes into consideration the specific needs of older refugees as well as their capabilities. CONCLUDING REMARKS Ageism is a key determinant of health which negatively impacts the physical, mental and social health, and wellbeing of older Syrian refugees. It pushes them to the margins of society where they are left behind by the humanitarian response, policy makers and researchers, as well as their communities and families. To mitigate this situation, this article calls for directly addressing ageism on social, service and policy levels.
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Affiliation(s)
- Maya Abi Chahine
- grid.22903.3a0000 0004 1936 9801Faculty of Health Sciences, American University of Beirut, Bliss Street, Beirut, Lebanon
| | - Hanna Kienzler
- grid.13097.3c0000 0001 2322 6764Department of Global Health and Social Medicine, ESRC Centre for Society and Mental Health, King’s College London, Bush House (NE) 3.15, 40 Aldwych, London, WC2B 4BG UK
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Namubiru T, Mbabazi N, Namirembe T, Lugobe HM, Musiime V. Thinness among children aged 5–17 years living in Nakivale refugee settlement, South Western Uganda: a cross-sectional study. BMC Nutr 2022; 8:132. [PMCID: PMC9662126 DOI: 10.1186/s40795-022-00632-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 11/03/2022] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background
Hunger and malnutrition are rampant among refugees and displaced populations, many of whom are infants and children. We sought to determine the prevalence and factors associated with thinness among children aged 5–17 years living in Nakivale refugee settlement, Isingiro district, southwestern Uganda.
Methods
This was a cross sectional study that enrolled 420 children aged 5 to 17 years. The World Health Organization cluster sampling was used to select 30 villages from which 14 households were selected by consecutive sampling and participants were then chosen per household by simple random sampling. Data were collected on the participant socio-demographic, family, dietary, medical, hygiene and refugee status factors. Thinness was defined as having a z-score < -2 standard deviations of Body Mass Index-for-age from the median WHO growth standards. The prevalence of thinness was determined by ascertaining the total number of children with thinness over the total number of children studied. Multivariable logistic regression model was used to determine the factors independently associated with thinness with p < 0.05 level of significance.
Results
A total of 420 children aged 5–17 years were enrolled into the study. The median age (IQR) was 8.6 (6.8–11.8) and majority 248 (59.1%) were female. The prevalence of thinness was 5.5% (95% CI: 3.7-8.1%). The factors independently associated with thinness were; living with a chronic disease (aOR 6.47, 95%CI; 1.63–24.64, p = 0.008), use of water from natural sources (aOR 3.32, 95%CI; 1.27–8.71, p = 0.015), and duration of stay in the settlement of less or equal to 10 years (aOR 3.19, 95%CI; 1.15–8.83, p = 0.025).
Conclusion
Five in every 100 children aged 5–17 years in Nakivale refugee settlement have thinness. Thinness was more likely among children who are living with a chronic disease, used water from natural sources and those whose families had stayed shorter in the settlement. Our findings suggest that children with chronic disease should receive extra food supplementation and have routine growth monitoring as part of their chronic care. The study reiterates a need to have clean and safe water supply and close nutrition assessment and monitoring, especially for newly registered refugee children.
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Yalcinoz-Ucan B, Zilney L, Zientarska-Kayko A, Ireland T, Browne DT. Examining the effectiveness of psychological interventions for marginalised and disadvantaged women and individuals who have experienced gender-based violence: protocol for a scoping review. BMJ Open 2022; 12:e060479. [PMID: 35798531 PMCID: PMC9263928 DOI: 10.1136/bmjopen-2021-060479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Exposure to gender-based violence (GBV) has devastating psychological outcomes for victims/survivors. Particularly in conditions where GBV intersects with multiple forms of oppression, the negative impacts of violence are more challenging to overcome and potential pathways for recovery become less accessible. However, evidence regarding the availability and effectiveness of mental health interventions for GBV survivors from marginalised and disadvantaged communities has yet to be systematically integrated and synthesised. The proposed scoping review will examine the relevant literature regarding the availability and effectiveness of psychological interventions for survivors of GBV from marginalised and disadvantaged backgrounds. This review will (i) document what psychological interventions have been available and empirically established for marginalised and disadvantaged women and individuals with experiences of GBV, (ii) provide a narrative examination of the treatment outcomes of identified interventions regarding their effectiveness and (iii) examine the degree to which GBV interventions in selected sources are designed and applied with a recognition of the social determinants of mental health. METHODS AND ANALYSIS The search for the proposed scoping review will include five electronic databases: PsycINFO, Scopus, Web of Science, Ovid Medline, and CINAHL. The database search will be completed in June 2022. An additional search will be conducted before the completion of the study in December 2022. The search will target research studies published after 2010. The primary eligibility criterion for study selection is having a focus on psychological interventions for GBV survivors from marginalised and disadvantaged groups. Two reviewers will conduct screening and data extraction. The data will be evaluated to map the treatment outcomes of interventions and their effectiveness. Implications for clinical services will be discussed. ETHICS AND DISSEMINATION No ethical consideration is foreseen for this scoping review. The dissemination will be done through a publication in a top-tier open access journal and conference presentations.
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Affiliation(s)
| | | | | | - Timothy Ireland
- Information Services and Resources, University of Waterloo, Waterloo, Ontario, Canada
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Grasser LR. Addressing Mental Health Concerns in Refugees and Displaced Populations: Is Enough Being Done? Risk Manag Healthc Policy 2022; 15:909-922. [PMID: 35573980 PMCID: PMC9094640 DOI: 10.2147/rmhp.s270233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 04/26/2022] [Indexed: 01/22/2023] Open
Abstract
There are over 82.4 million forcibly displaced people worldwide, about a quarter of whom are resettling as refugees. In the wake of the global refugee crisis spurred by conflict, religious and political persecution, human rights violations, and climate disasters, a mental health has crisis followed. Not only does trauma experienced in home countries and as part of forced migration affect mental health, so too do post-migration traumatic events, discrimination, lack of access to quality and affordable healthcare and housing, and acculturation. To address mental health concerns in refugees and displaced populations, collective action is needed not only from health care providers but also from mental health researchers, funders, journals, resettlement agencies, government entities, and humanitarian organizations. The present review highlights the work of numerous scholars and organizations with the goal of understanding the mental health concerns of forcibly displaced persons within and across ecological systems. The present review seeks to bring attention to the experiences of forcibly displaced persons, summarize the growing body of research understanding the acute and chronic effects of forced displacement and possible interventions, and give a call to action for all members of the global community at every level to engage in joint efforts to improve mental health in refugees and displaced persons. Notably, there is a need for more interventions at the familial and community level that serve not only as treatment but also as prevention. Smartphone-based interventions, mind-body modalities, and interventions delivered by lay and non-clinician community members hold promise. Numerous strides could be made in refugee mental health and treatment when funding agencies include these goals in their research priorities. Despite the challenges they have faced, persons who resettle as refugees are incredibly resilient and deserve to be afforded every right, opportunity, dignity, and respect.
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Affiliation(s)
- Lana Ruvolo Grasser
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
- Correspondence: Lana Ruvolo Grasser, 3901 Chrysler Dr., Suite 2C Room 273, Detroit, MI, 48201, USA, Tel +1 248 535 6371, Email
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Ojeleke O, Groot W, Pavlova M. Care delivery among refugees and internally displaced persons affected by complex emergencies: a systematic review of the literature. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-020-01343-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Abstract
Aim
This study reviews the empirical evidence on care delivery in complex emergencies (CEs) to better understand ways of improving care delivery and mitigating inequity in care among refugees and internally displaced persons (IDPs) in CEs.
Subject and methods
A systematic search was conducted in Web of Science, MEDLINE, PubMed and Embase. A manual search was conducted in the WHO Global Index Medicus and Google Scholar. Peer-reviewed English-language publications that reported results on care delivery in CEs were included for review. There was no limitation on the year or the geographical location of the studies. The content of the publications was qualitatively analysed, and the results are thematically presented in tabular form.
Results
Thirty publications were identified. Information regarding coverage, accessibility, quality, continuity and comprehensiveness of care service delivery was extracted and synthesized. Findings showed that constant insecurity, funding, language barriers and gender differences were factors impeding access to and coverage and comprehensiveness of care delivery in CEs. The review also showed a preference for traditional treatment among some refugees and IDPs.
Conclusion
Evidence from this systematic review revealed a high level of unmet healthcare need among refugees and IDPs and the need for a paradigm shift in the approach to care delivery in CEs. We recommend further research aimed at a more critical evaluation of care delivery in CEs with a view to providing a more innovative and context-specific care service delivery in these settings.
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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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Polonsky JA, Ivey M, Mazhar MKA, Rahman Z, le Polain de Waroux O, Karo B, Jalava K, Vong S, Baidjoe A, Diaz J, Finger F, Habib ZH, Halder CE, Haskew C, Kaiser L, Khan AS, Sangal L, Shirin T, Zaki QA, Salam MA, White K. Epidemiological, clinical, and public health response characteristics of a large outbreak of diphtheria among the Rohingya population in Cox's Bazar, Bangladesh, 2017 to 2019: A retrospective study. PLoS Med 2021; 18:e1003587. [PMID: 33793554 PMCID: PMC8059831 DOI: 10.1371/journal.pmed.1003587] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 04/21/2021] [Accepted: 03/15/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Unrest in Myanmar in August 2017 resulted in the movement of over 700,000 Rohingya refugees to overcrowded camps in Cox's Bazar, Bangladesh. A large outbreak of diphtheria subsequently began in this population. METHODS AND FINDINGS Data were collected during mass vaccination campaigns (MVCs), contact tracing activities, and from 9 Diphtheria Treatment Centers (DTCs) operated by national and international organizations. These data were used to describe the epidemiological and clinical features and the control measures to prevent transmission, during the first 2 years of the outbreak. Between November 10, 2017 and November 9, 2019, 7,064 cases were reported: 285 (4.0%) laboratory-confirmed, 3,610 (51.1%) probable, and 3,169 (44.9%) suspected cases. The crude attack rate was 51.5 cases per 10,000 person-years, and epidemic doubling time was 4.4 days (95% confidence interval [CI] 4.2-4.7) during the exponential growth phase. The median age was 10 years (range 0-85), and 3,126 (44.3%) were male. The typical symptoms were sore throat (93.5%), fever (86.0%), pseudomembrane (34.7%), and gross cervical lymphadenopathy (GCL; 30.6%). Diphtheria antitoxin (DAT) was administered to 1,062 (89.0%) out of 1,193 eligible patients, with adverse reactions following among 229 (21.6%). There were 45 deaths (case fatality ratio [CFR] 0.6%). Household contacts for 5,702 (80.7%) of 7,064 cases were successfully traced. A total of 41,452 contacts were identified, of whom 40,364 (97.4%) consented to begin chemoprophylaxis; adherence was 55.0% (N = 22,218) at 3-day follow-up. Unvaccinated household contacts were vaccinated with 3 doses (with 4-week interval), while a booster dose was administered if the primary vaccination schedule had been completed. The proportion of contacts vaccinated was 64.7% overall. Three MVC rounds were conducted, with administrative coverage varying between 88.5% and 110.4%. Pentavalent vaccine was administered to those aged 6 weeks to 6 years, while tetanus and diphtheria (Td) vaccine was administered to those aged 7 years and older. Lack of adequate diagnostic capacity to confirm cases was the main limitation, with a majority of cases unconfirmed and the proportion of true diphtheria cases unknown. CONCLUSIONS To our knowledge, this is the largest reported diphtheria outbreak in refugee settings. We observed that high population density, poor living conditions, and fast growth rate were associated with explosive expansion of the outbreak during the initial exponential growth phase. Three rounds of mass vaccinations targeting those aged 6 weeks to 14 years were associated with only modestly reduced transmission, and additional public health measures were necessary to end the outbreak. This outbreak has a long-lasting tail, with Rt oscillating at around 1 for an extended period. An adequate global DAT stockpile needs to be maintained. All populations must have access to health services and routine vaccination, and this access must be maintained during humanitarian crises.
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Affiliation(s)
- Jonathan A. Polonsky
- World Health Organization, Geneva, Switzerland
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- * E-mail:
| | - Melissa Ivey
- Médecins Sans Frontières, Amsterdam, the Netherlands
| | | | - Ziaur Rahman
- Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Olivier le Polain de Waroux
- World Health Organization, Geneva, Switzerland
- Global Outbreak Alert and Response Network (GOARN), Geneva, Switzerland
- Public Health England, London, United Kingdom
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- UK-Public Health Rapid Support Team, London, United Kingdom
| | - Basel Karo
- Global Outbreak Alert and Response Network (GOARN), Geneva, Switzerland
- Information Centre for International Health Protection (ZIG 1), Robert Koch Institute (RKI), Berlin, Germany
| | - Katri Jalava
- World Health Organization Country Office for Bangladesh, Dhaka, Bangladesh
| | - Sirenda Vong
- World Health Organization South-East Asia Regional Office, New Delhi, India
| | - Amrish Baidjoe
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- World Health Organization South-East Asia Regional Office, New Delhi, India
| | - Janet Diaz
- World Health Organization, Geneva, Switzerland
| | - Flavio Finger
- Global Outbreak Alert and Response Network (GOARN), Geneva, Switzerland
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Epicentre, Paris, France
| | - Zakir H. Habib
- Institute of Epidemiology Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | | | | | - Laurent Kaiser
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Ali S. Khan
- Global Outbreak Alert and Response Network (GOARN), Geneva, Switzerland
- College of Public Health, University of Nebraska Medical Center, Nebraska, United States of America
| | - Lucky Sangal
- World Health Organization Country Office for India, New Delhi, India
| | - Tahmina Shirin
- Institute of Epidemiology Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | - Quazi Ahmed Zaki
- Institute of Epidemiology Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | | | - Kate White
- Médecins Sans Frontières, Amsterdam, the Netherlands
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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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Naal H, Mendelsohn R, Brome D, Noubani A, Nabulsi D, Muhieddine D, Saleh S. Evaluating a capacity building program on women's health for displaced community health workers in fragile settings in Lebanon. HUMAN RESOURCES FOR HEALTH 2021; 19:37. [PMID: 33743708 PMCID: PMC7981387 DOI: 10.1186/s12960-021-00585-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 03/15/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Displaced populations in fragile settings experience health disparities that are seldom attended to. Task-shifting, which involves training non-specialized community health workers (CHW) to deliver basic education and health services is a favorable strategy to address this problem, however very little data exist on this topic in the Middle East region. We conducted a long-term evaluation of the Women's Health Certificate delivered to Syrian refugees and host community in informal tented settlements in Lebanon under the Mobile University for Health (MUH) program. The training was delivered through a mobile classroom approach that incorporated a blended learning modality. METHODS We collected short-term data from the 42 trained CHW (knowledge assessments and satisfaction measures) during the delivery of the intervention between March and August 2019, and long-term data (semi-structured interviews with 8 CHW and focus group discussion with 9 randomly selected community members) one year later between July and August 2020. The evaluation approach was informed by the Kirkpatrick evaluation model, and the qualitative data were analyzed using qualitative content analysis. RESULTS Data from the CHWs and community members were triangulated, and they showed that the training enhanced access to education due to its mobile nature and provided opportunities for CHWs to engage and interact with learning material that enhanced their knowledge and favorable behaviors regarding women's health. In turn, CHWs were empowered to play an active role in their communities to transfer the knowledge they gained through educating community members and providing women's health services and referrals. Community members benefited from the CHWs and called for the implementation of more similar training programs. CONCLUSION This is one of few studies reporting a long-term community-level evaluation of a task-shifting program on women's health among displaced populations in Lebanon. Our findings support the need to increase funding for similar programs, and to focus on delivering programs for a variety of health challenges. It is also essential to enhance the reach and length of recruitment to wider communities, to design concise, interactive, and engaging sessions, and to provide tools to facilitate circulation of learning material, and resources for referrals to health services.
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Affiliation(s)
- Hady Naal
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Rebecca Mendelsohn
- Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor, USA
| | - Dayana Brome
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Aya Noubani
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Dana Nabulsi
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Dina Muhieddine
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Shadi Saleh
- Global Health Institute, American University of Beirut, Beirut, Lebanon.
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
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16
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Bwire G, Orach CG, Aceng FL, Arianitwe SE, Matseketse D, Tumusherure E, Makumbi I, Muruta A, Merrill RD, Debes A, Ali M, Sack DA. Refugee Settlements and Cholera Risks in Uganda, 2016-2019. Am J Trop Med Hyg 2021; 104:1225-1231. [PMID: 33556038 PMCID: PMC8045616 DOI: 10.4269/ajtmh.20-0741] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 08/28/2020] [Indexed: 11/07/2022] Open
Abstract
During 2016 to 2019, cholera outbreaks were reported commonly to the Ministry of Health from refugee settlements. To further understand the risks cholera posed to refugees, a review of surveillance data on cholera in Uganda for the period 2016-2019 was carried out. During this 4-year period, there were seven such outbreaks with 1,495 cases and 30 deaths in five refugee settlements and one refugee reception center. Most deaths occurred early in the outbreak, often in the settlements or before arrival at a treatment center rather than after arrival at a treatment center. During the different years, these outbreaks occurred during different times of the year but simultaneously in settlements that were geographically separated and affected all ages and genders. Some outbreaks spread to the local populations within Uganda. Cholera control prevention measures are currently being implemented; however, additional measures are needed to reduce the risk of cholera among refugees including oral cholera vaccination and a water, sanitation and hygiene package during the refugee registration process. A standardized protocol is needed to quickly conduct case-control studies to generate information to guide future cholera outbreak prevention in refugees and the host population.
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Affiliation(s)
- Godfrey Bwire
- Department of Integrated Epidemiology, Surveillance and Public Health Emergencies, Ministry of Health, Kampala Uganda
| | | | - Freda Loy Aceng
- Department of Integrated Epidemiology, Surveillance and Public Health Emergencies, Ministry of Health, Kampala Uganda
| | | | | | - Edson Tumusherure
- Department of Health, Isingiro District Local Government, Isingiro, Uganda
| | - Issa Makumbi
- Emergency Operational Centre, Ministry of Health, Kampala, Uganda
| | - Allan Muruta
- Department of Integrated Epidemiology, Surveillance and Public Health Emergencies, Ministry of Health, Kampala Uganda
| | - Rebecca D. Merrill
- Division of Global Migration and Quarantine, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amanda Debes
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mohammad Ali
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - David A. Sack
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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17
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Idowu OS, Akindolire AE, Adebayo BE, Adebayo AM, Ariyo O. Determinants of anthropometric characteristics of under-five children in internally displaced persons´ camps in Abuja municipal area council, Abuja, Nigeria. Pan Afr Med J 2020; 36:313. [PMID: 33193967 PMCID: PMC7603821 DOI: 10.11604/pamj.2020.36.313.21221] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 02/19/2020] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION displacement predisposes to deprivation and hunger and consequently malnutrition. In Nigeria, information on anthropometric characteristics and associated factors among displaced under-five children is important to strengthen strategies to ameliorate malnutrition and promote child health. This study was conducted to identify the determinants on anthropometric indices among under-five children in internally displaced persons' camps in Abuja, Nigeria. METHODS this cross-sectional study involved 317 mother-child (0-59 months) pairs selected using two-stage simple random sampling technique. Information on socio-demographic, care practices (infant feeding, immunization, deworming) and anthropometric characteristics of index children was obtained using semi-structured, interviewer-administered questionnaire. Weight and length/height were assessed using standard procedure and analysed using World Health Organization (WHO) Anthro software. Data were analysed using descriptive statistics and logistic regression at p<0.05. RESULTS median age was 24 months, 50.8% were male and 42.3% were delivered at health facility. Only 45.4% were exclusively breastfed, 28.8% were fed complementary foods too early, 45.4% were dewormed in the preceding six months and 43.9% had complete/up-to-date immunisation. Prevalence of underweight, stunting and wasting was 42%, 41% and 29.3%, respectively. Poor anthropometric indices were higher among male than female children, except wasting. Having good anthropometric index was 2.5 times higher among children <12 months than children ≥37 months (CI: 1.08-5.8), 2.4 times higher among 1st birth order than 5th orders (CI: 0.19-0.93), 1.7 times higher among female than male children (CI: 1.08-2.82). CONCLUSION malnutrition is a major health problem among under-five children in internally displaced camps and major determinants include age, birth order, gender and deworming status.
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Affiliation(s)
| | | | | | - Ayodeji Matthew Adebayo
- Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Oluwaseun Ariyo
- Department of Human Nutrition, College of Medicine, University of Ibadan, Ibadan, Nigeria
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18
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Tamming T, Otake Y. Linking coping strategies to locally-perceived aetiologies of mental distress in northern Rwanda. BMJ Glob Health 2020; 5:e002304. [PMID: 32665374 PMCID: PMC7365432 DOI: 10.1136/bmjgh-2020-002304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 05/06/2020] [Accepted: 05/11/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION How and why people in a particular setting turn to a specific coping strategy for their distress is pivotal for strengthening mental healthcare and this needs to be understood from a local point of view. Prior research in northern Rwanda documented common local concepts of distress for the population that cannot receive assistance despite severe adversities; however, the locally-perceived causes, manifestation and coping strategies and their associations are still unclear. METHODS The qualitative study in the Musanze district, northern Rwanda, was informed by Interpretative Phenomenological Analysis. In-depth interviews were conducted with people with lived experience and those in close contact with people with lived experience of distress. Ethnographic observation was conducted and the analyses were complimented by an earlier ethnography in the same village. RESULTS Study participants (n=15) included community members with lived experience of mental distress and/or those with close friends or family with lived experience. The perceived manifestations of the mental distresses were diverse and the causal attributions shifted from more social, concrete and explainable (eg, loss) towards magical, more abstract and unexplainable (eg, poisoning). Finally, participants sought coping strategies in accordance with their causal attribution in ways that made sense to them. CONCLUSION The coping strategies were chosen according to the perceived aetiology of the symptoms and they were perceived to be effective for their distress. Local coping strategies that match people's help-seeking patterns should therefore be supported in policy and programmes. In Rwanda this requires a mutual training of medical professionals and traditional healers and establishing co-treatment within two parallel systems. This also requires the support for programmes and initiatives that strengthen positive interactions and change in circumstances.
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Affiliation(s)
- Teisi Tamming
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Yuko Otake
- School of Anthropology and Museum Ethnography, University of Oxford, Oxford, Oxfordshire, United Kingdom
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19
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Ngo NV, Pemunta NV, Muluh NE, Adedze M, Basil N, Agwale S. Armed conflict, a neglected determinant of childhood vaccination: some children are left behind. Hum Vaccin Immunother 2020; 16:1454-1463. [PMID: 31809650 PMCID: PMC7482736 DOI: 10.1080/21645515.2019.1688043] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/08/2019] [Accepted: 10/28/2019] [Indexed: 01/02/2023] Open
Abstract
Vaccination is an indisputable intervention that has tremendously mitigated the global burden of vaccine-preventable diseases (VPDs). The number of armed conflicts globally seems to be at an all-time high, with devastating effects on vaccination coverage. This paper will examine how armed conflicts affect childhood vaccination and lead to the reemergence and spread of VPDs. Unarguably, socioeconomic factors, population demographics, the apparent long vaccination timetable, multiple vaccine doses, lack of trust in vaccination processes and the rumor of the adverse effects of some vaccines unnerve some parents and create a puzzle. By bringing under the global floodlight, the impact of armed conflicts which contextually affect vaccination coverage, this article will help strengthen the advocacy for vaccination, and call for the fortification of existing treaties on the rule of engagement during conflicts. In order to eliminate or eradicate VPDs, strategies to reach children that are left behind during conflicts is paramount.
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Affiliation(s)
- Ngo Valery Ngo
- Department of Global Health, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ngambouk Vitalis Pemunta
- Department of Global Health, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Miranda Adedze
- Department of Global Health, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Simon Agwale
- Innovative Biotech USA Inc, Havre de Grace, MD, USA
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20
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Belaid L, Bayo P, Kamau L, Nakimuli E, Omoro E, Lobor R, Samson B, Dimiti A. Health policy mapping and system gaps impeding the implementation of reproductive, maternal, neonatal, child, and adolescent health programs in South Sudan: a scoping review. Confl Health 2020; 14:20. [PMID: 32313550 PMCID: PMC7155266 DOI: 10.1186/s13031-020-00258-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 02/06/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Pregnant women, neonates, children, and adolescents are at higher risk of dying in fragile and conflict-affected settings. Strengthening the healthcare system is a key strategy for the implementation of effective policies and ultimately the improvement of health outcomes. South Sudan is a fragile country that faces challenges in implementing its reproductive, maternal, neonatal, child, and adolescent health (RMNCAH) policies. In this paper, we map the key RMNCAH policies and describe the current status of the WHO health system building blocks that impede the implementation of RMNCAH policies in South Sudan. METHODS We conducted a scoping review (39 documents) and individual interviews (n = 8) with staff from the national Ministry of Health (MoH) and implementing partners. We organized a workshop to discuss and validate the findings with the MoH and implementing partner staff. We synthesized and analyzed the data according to the WHO health system building blocks. RESULTS The significant number of policies and healthcare strategic plans focused on pregnant women, neonates, children, and adolescents evidence the political will of the MoH to improve the health of members of these categories of the population. The gap in the implementation of policies is mainly due to the weaknesses identified in different health system building blocks. A critical shortage of human resources across the blocks and levels of the health system, a lack of medicines and supplies, and low national funding are the main identified bottlenecks. The upstream factors explaining these bottlenecks are the 2012 suspension of oil production, ongoing conflict, weak governance, a lack of accountability, and a low human resource capacity. The combined effects of all these factors have led to poor-quality provision and thus a low use of RMNCAH services. CONCLUSION The implementation of RMNCAH policies should be accomplished through innovative and challenging approaches to building the capacities of the MoH, establishing governance and accountability mechanisms, and increasing the health budget of the national government.
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Affiliation(s)
- Loubna Belaid
- Family Medicine Department, McGill University, 5858 Chemin de la Côte des Neiges, Montréal, Québec Canada
| | | | - Lynette Kamau
- African population and health research center, Nairobi, Kenya
| | - Eva Nakimuli
- Partners in Population and Development Africa Regional Office, Kampala, Uganda
| | - Elijo Omoro
- Torit State Ministry of Health, Juba, South Sudan
| | - Robert Lobor
- WHO, South Sudan Country Office, Juba, South Sudan
| | | | - Alexander Dimiti
- Department of Reproductive of Health, Ministry of Health, Juba, South Sudan
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21
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Meteke S, Stefopulos M, Als D, Gaffey M, Kamali M, Siddiqui FJ, Munyuzangabo M, Jain RP, Shah S, Radhakrishnan A, Ataullahjan A, Bhutta ZA. Delivering infectious disease interventions to women and children in conflict settings: a systematic reviefw. BMJ Glob Health 2020; 5:e001967. [PMID: 32341087 PMCID: PMC7213813 DOI: 10.1136/bmjgh-2019-001967] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 02/19/2020] [Accepted: 03/07/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Conflict has played a role in the large-scale deterioration of health systems in low-income and middle-income countries (LMICs) and increased risk of infections and outbreaks. This systematic review aimed to synthesise the literature on mechanisms of delivery for a range of infectious disease-related interventions provided to conflict-affected women, children and adolescents. METHODS We searched Medline, Embase, CINAHL and PsychINFO databases for literature published in English from January 1990 to March 2018. Eligible publications reported on conflict-affected neonates, children, adolescents or women in LMICs who received an infectious disease intervention. We extracted and synthesised information on delivery characteristics, including delivery site and personnel involved, as well as barriers and facilitators, and we tabulated reported intervention coverage and effectiveness data. RESULTS A majority of the 194 eligible publications reported on intervention delivery in sub-Saharan Africa. Vaccines for measles and polio were the most commonly reported interventions, followed by malaria treatment. Over two-thirds of reported interventions were delivered in camp settings for displaced families. The use of clinics as a delivery site was reported across all intervention types, but outreach and community-based delivery were also reported for many interventions. Key barriers to service delivery included restricted access to target populations; conversely, adopting social mobilisation strategies and collaborating with community figures were reported as facilitating intervention delivery. Few publications reported on intervention coverage, mostly reporting variable coverage for vaccines, and fewer reported on intervention effectiveness, mostly for malaria treatment regimens. CONCLUSIONS Despite an increased focus on health outcomes in humanitarian crises, our review highlights important gaps in the literature on intervention delivery among specific subpopulations and geographies. This indicates a need for more rigorous research and reporting on effective strategies for delivering infectious disease interventions in different conflict contexts. PROSPERO REGISTRATION NUMBER CRD42019125221.
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Affiliation(s)
- Sarah Meteke
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Marianne Stefopulos
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Daina Als
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michelle Gaffey
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mahdis Kamali
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Fahad J Siddiqui
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
- Health System and Services Research, Duke-NUS Medical School, Singapore
| | - Mariella Munyuzangabo
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Reena P Jain
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Shailja Shah
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Amruta Radhakrishnan
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Anushka Ataullahjan
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
- Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
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Pehlivanturk-Kizilkan M, Ozmert EN, Derman O, Okur İ, Kaynak MO, Adiguzel A, Sahan-Seref I, Kurekci F, Bideci A, Hasanoglu E. Nutritional Status of Syrian Refugees in Early Adolescence Living in Turkey. J Immigr Minor Health 2020; 22:1149-1154. [PMID: 32124154 DOI: 10.1007/s10903-020-00991-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study evaluated the nutritional status of Syrian refugees in the early adolescent period living in different vulnerable settings. Nutritional assessment of Syrian refugee adolescents is often neglected but essential for a healthy physical, pubertal and mental development. Growth parameters of Syrian refugee adolescents going to a public school in an urban area and in a temporary protection center (TPC) were recorded along with the Turkish adolescents. Stunting percentages were similar between the groups (p = 0.811). While the proportion of children with a BMI over 85th percentile were significantly higher among Syrian adolescents living in TPC, Turkish children have the highest percentage of underweight (p = 0.01). Both food insecurity and unhealthy weight gain continue to be major concerns for refugee adolescents after their resettlement to a host country. The findings suggest that nutritional assessment and intervention at early adolescence is critical for Syrian refugees depending on their living conditions.
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Affiliation(s)
- Melis Pehlivanturk-Kizilkan
- Division of Adolescent Medicine, Department of Pediatrics, Hacettepe University Medical School, 06610, Ankara, Turkey.
| | - Elif N Ozmert
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Hacettepe University Medical School, Ankara, Turkey
| | - Orhan Derman
- Division of Adolescent Medicine, Department of Pediatrics, Hacettepe University Medical School, 06610, Ankara, Turkey
| | - İlyas Okur
- Division of Pediatric Metabolism and Nutrition, Department of Pediatrics, Gazi University Medical School, Ankara, Turkey
| | - Mustafa Oguz Kaynak
- Department of Pediatrics, Hacettepe University Medical School, Ankara, Turkey
| | - Aydin Adiguzel
- Department of Pediatrics, Hacettepe University Medical School, Ankara, Turkey
| | - Irem Sahan-Seref
- Department of Pediatrics, Gazi University Medical School, Ankara, Turkey
| | - Fulya Kurekci
- Department of Pediatrics, Gazi University Medical School, Ankara, Turkey
| | - Aysun Bideci
- Division of Pediatric Endocrinology, Department of Pediatrics, Gazi University Medical School, Ankara, Turkey
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Theurich MA, Humphreys AL, Gosselin LB, McCool-Myers ME. Food safety considerations for commercial complementary foods from global operational guidance on infant and young child feeding in emergencies. Nutr Rev 2019; 77:350-362. [DOI: 10.1093/nutrit/nuy065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Melissa A Theurich
- Division of Metabolic Diseases and Nutritional Medicine, LMU—Ludwig-Maximilians-Universität München, Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children’s Hospital, University of Munich Medical Center, Munich, Germany
| | | | | | - Megan E McCool-Myers
- Division of Family Planning, Department of Gynecology and Obstetrics, Emory University, Atlanta, Georgia, USA
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High burden of co-morbidity and mortality among severely malnourished children admitted to outpatient therapeutic programme facilities in the conflict setting of Borno, Nigeria: a retrospective review. Public Health Nutr 2019; 22:1786-1793. [PMID: 30741140 DOI: 10.1017/s1368980018003968] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To present evidence on the burden and outcomes of co-morbidities among severely malnourished (SAM) children admitted to outpatient therapeutic programme (OTP) facilities in the conflict setting of Borno, Nigeria. DESIGN Retrospective medical chart review. SETTING Facility-based study.ParticipantsChildren aged 6-59 months with SAM enrolled in OTP between June and November 2016 whose medical records were analysed. Only pneumonia and diarrhoea were examined due to data limitations. Stata software was used for descriptive, multivariate and survival analyses. RESULTS Records of 396 children with median age of 15 months were identified and analysed from the date of enrolment to exit from OTP. Mean length of stay in OTP was 61d, with co-infected SAM children having shorter stay (P=0·006). Of the total, 148 (37·4 %) had at least one co-morbidity (pneumonia or diarrhoea), of which thirty-nine (26·4 %) had both. Cumulative rate of mortality during follow-up time was 9·5 (95 % CI 6·0, 15·1) per 10 000 child-days; SAM children with co-morbidities were ten times more likely to die than those without (hazard ratio=10·2; 95 % CI 3·4, 31·0). In multivariable analysis, co-morbidity (P=0·01), oedema (P=0·003), dehydration (P=0·02) and weight on admission (P=0·01) were associated with mortality. Both recovery and defaulter rates (57·8 and 36·1 %, respectively) did not meet SPHERE standards. CONCLUSIONS Children with SAM and co-morbidities are less likely to survive, presenting a significant barrier in improving child survival. The findings call for integrated OTP models that incorporate clinical algorithms and ensure prompt referral for SAM children with co-morbidity.
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Childhood vaccination in Kenya: socioeconomic determinants and disparities among the Somali ethnic community. Int J Public Health 2018; 64:313-322. [PMID: 30535788 DOI: 10.1007/s00038-018-1187-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 11/21/2018] [Accepted: 12/01/2018] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVES Kenya has a significant refugee population, including large numbers of Somali migrants. This study examines the vaccination status of Kenyan children and sociodemographic predictors of vaccination, including Somali ethnicity. METHODS Using the 2014 Kenyan Demographic and Health Survey, we calculated the proportion of non-vaccinated, under-vaccinated, and fully vaccinated children, defining full vaccination as one dose Bacille Calmette-Guerin, three doses polio, three doses pentavalent, and one dose measles. We assessed associations among various factors and vaccination status using multinomial logistic regression and explored the effect of Somali ethnicity through interaction analysis. RESULTS The study sample comprised 4052 children aged 12-23 months, with 79.4% fully, 19.0% under-, and 1.6% non-vaccinated. Among Somalis, 61.9% were fully, 28.7% under-, and 9.4% non-vaccinated. Somalis had significantly greater odds of under- and non-vaccination than the Kikuyu ethnic group. Wealth and birth setting were associated with immunization status for Somalis and non-Somalis. CONCLUSIONS Disparities persist in pediatric vaccinations in Kenya, with Somali children more likely than non-Somalis to be under-vaccinated. Health inequalities among migrants and ethnic communities in Kenya should be addressed.
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Meyer SR, Meyer E, Bangirana C, Mangen PO, Stark L. Protection and well-being of adolescent refugees in the context of a humanitarian crisis: Perceptions from South Sudanese refugees in Uganda. Soc Sci Med 2018; 221:79-86. [PMID: 30572151 DOI: 10.1016/j.socscimed.2018.11.034] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 11/21/2018] [Accepted: 11/23/2018] [Indexed: 11/29/2022]
Abstract
Improved understanding of refugees' perceptions of provision of humanitarian support in these contexts is important to improve design and delivery of humanitarian assistance. Refugee adolescents displaced to low and middle-income countries face a range of adversities. Globally, refugee situations are increasingly characterized by multiple waves of displacement; phase of displacement likely influences risk factors for adolescent refugees. However, evidence is sparse concerning perceptions of the impact of these factors on health and well-being of adolescent refugees. We conducted a qualitative study in November 2016, using focus group discussions [FGDs] with caregivers and adolescent refugees (n = 325: 183 adolescents and 142 caregivers). The study was conducted in two refugee settlements in Uganda (Kiryandongo and Adjumani), which were experiencing a major influx of new refugees from South Sudan. We sought to explore one potential influence on adolescent well-being - the impact of the new influx of refugees from South Sudan on protection risks and well-being of adolescents already settled in Uganda. Themes that emerged indicate that caregivers and adolescents perceived the influx as directly impacting access to basic needs, which had direct and indirect impacts on adolescent psychosocial well-being, for example, educational attainment was impacted due to adolescent hunger while attending school. Lack of food security was described as associated with caregiver use of violence against adolescents, due to stress related to deterioration of household well-being. The immediate basic needs of newly arrived refugees - which are often urgent and life-threatening - may eclipse the on-going needs of previously settled refugees in a context of multiple waves of displacement and continuous conflict. Policy implications of findings in this study include the need to understand conflict and divisions within refugee populations and provide support for community-based protection mechanisms to ensure that changes in humanitarian support do not adversely impact adolescent protection needs.
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Affiliation(s)
- Sarah R Meyer
- Program on Forced Migration and Health, Mailman School of Public Health, Columbia University, 60 Haven Avenue, New York City, NY 10032, USA.
| | - Elizabeth Meyer
- Program on Forced Migration and Health, Mailman School of Public Health, Columbia University, 60 Haven Avenue, New York City, NY 10032, USA
| | - Clare Bangirana
- TPO Uganda, Plot 3271 Kansanga, Opp. KIU, 21646 Kampala, Uganda
| | | | - Lindsay Stark
- Brown School at Washington University in St Louis, One Brookings Drive, St Louis, MO 63130, USA
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Zhao Y, Zeng J, Zhao Y, Liu Q, He Y, Zhang J, Yang Z, Fan Q, Wang Q, Cui L, Cao Y. Risk factors for asymptomatic malaria infections from seasonal cross-sectional surveys along the China-Myanmar border. Malar J 2018; 17:247. [PMID: 29973194 PMCID: PMC6032786 DOI: 10.1186/s12936-018-2398-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 06/22/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Border malaria, a shared phenomenon in the Greater Mekong Sub-region of Southeast Asia, is a major obstacle for regional malaria elimination. Along the China-Myanmar border, an additional problem arose as a result of the settlement of internally displaced people (IDP) in the border region. Since asymptomatic malaria significantly impacts transmission dynamics, assessment of the prevalence, dynamics and risk factors of asymptomatic malaria infections is necessary. METHODS Cross-sectional surveys were carried out in 3 seasons (March and April, July and November) and 2 sites (villages and IDP camps) in 2015. A total of 1680 finger-prick blood samples were collected and used for parasite detection by microscopy and nested RT-PCR (nRT-PCR). Logistic regression models were used to explore the risk factors associated with asymptomatic malaria at individual and household levels. RESULTS The prevalence of asymptomatic Plasmodium infections was 23.3% by nRT-PCR, significantly higher than that detected by microscopy (1.5%). The proportions of Plasmodium vivax, Plasmodium falciparum and mixed-species infections were 89.6, 8.1 and 2.3%, respectively. Asymptomatic infections showed obvious seasonality with higher prevalence in the rainy season. Logistic regression analysis identified males and school children (≤ 15 years) as the high-risk populations. Vector-based interventions, including bed net and indoor residual spray, were found to have significant impacts on asymptomatic Plasmodium infections, with non-users of these measures carrying much higher risks of infection. In addition, individuals living in poorly constructed households or farther away from clinics were more prone to asymptomatic infections. CONCLUSIONS Sub-microscopic Plasmodium infections were highly prevalent in the border human populations from IDP camps and surrounding villages. Both individual- and household-level risk factors were identified, which provides useful information for identifying the high-priority populations to implement targeted malaria control.
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Affiliation(s)
- Yan Zhao
- Department of Immunology, College of Basic Medical Sciences, China Medical University, Shenyang, 110122, Liaoning, China
| | - Jie Zeng
- Department of Immunology, College of Basic Medical Sciences, China Medical University, Shenyang, 110122, Liaoning, China
| | - Yonghong Zhao
- Department of Immunology, College of Basic Medical Sciences, China Medical University, Shenyang, 110122, Liaoning, China
| | - Qingyang Liu
- Department of Immunology, College of Basic Medical Sciences, China Medical University, Shenyang, 110122, Liaoning, China
| | - Yang He
- Department of Immunology, College of Basic Medical Sciences, China Medical University, Shenyang, 110122, Liaoning, China
| | - Jiaqi Zhang
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, China
| | - Zhaoqing Yang
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, China
| | - Qi Fan
- Dalian Institute of Biotechnology, Dalian, Liaoning, China
| | - Qinghui Wang
- Department of Immunology, College of Basic Medical Sciences, China Medical University, Shenyang, 110122, Liaoning, China.
| | - Liwang Cui
- Department of Immunology, College of Basic Medical Sciences, China Medical University, Shenyang, 110122, Liaoning, China. .,Department of Entomology, Pennsylvania State University, University Park, State College, PA, 16802, USA.
| | - Yaming Cao
- Department of Immunology, College of Basic Medical Sciences, China Medical University, Shenyang, 110122, Liaoning, China.
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Dasaklis TK, Pappis CP. Critical success factors for implementing cholera vaccination campaigns in humanitarian emergencies: a DEMATEL-based approach. EURO JOURNAL ON DECISION PROCESSES 2018. [DOI: 10.1007/s40070-017-0062-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Thomas LM, D'Ambruoso L, Balabanova D. Use of verbal autopsy and social autopsy in humanitarian crises. BMJ Glob Health 2018; 3:e000640. [PMID: 29736275 PMCID: PMC5935165 DOI: 10.1136/bmjgh-2017-000640] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 02/28/2018] [Accepted: 03/02/2018] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Two billion people live in countries affected by conflict, violence and fragility. These are exceptional situations in which mortality shifts dramatically and in which civil registration and vital statistics systems are often weakened or cease to function. Verbal autopsy and social autopsy (VA and SA) are methods used to assign causes of death and understand the contexts in which these occur, in settings where information is otherwise unavailable. This review sought to explore the use of VA and SA in humanitarian crises, with a focus on how these approaches are used to inform policy and programme responses. METHODS A rapid scoping review was conducted on the use of VA and SA in humanitarian crises in low and middle-income countries since 1991. Drawing on a maximum variation approach, two settings of application ('application contexts') were selected and investigated via nine semi-structured expert interviews. RESULTS VA can determine causes of death in crisis-affected populations where no other registration system is in place. Combined with SA and active community involvement, these methods can deliver a holistic view of obstacles to seeking and receiving essential healthcare, yielding context-specific information to inform appropriate responses. The contexts in which VA and SA are used require adaptations to standard tools, and new mobile developments in VA raise specific ethical considerations. Furthermore, collecting and sythesising data in a timely, continuous manner, and ensuring coordination and communication between agencies, is important to realise the potential of these approaches. CONCLUSION VA and SA are valuable research methods to foster evidence-informed responses for populations affected by humanitarian crises. When coordinated and communicated effectively, data generated through these methods can help to identify levels, causes and circumstances of deaths among vulnerable groups, and can enable planning and allocating resources effectively, potentially improving health system resilience to future crises.
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Affiliation(s)
- Lisa-Marie Thomas
- Centre for Global Development and Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
| | - Lucia D'Ambruoso
- Centre for Global Development and Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
| | - Dina Balabanova
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine (LSHTM), London, UK
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Gignoux E, Polonsky J, Ciglenecki I, Bichet M, Coldiron M, Thuambe Lwiyo E, Akonda I, Serafini M, Porten K. Risk factors for measles mortality and the importance of decentralized case management during an unusually large measles epidemic in eastern Democratic Republic of Congo in 2013. PLoS One 2018. [PMID: 29538437 PMCID: PMC5851624 DOI: 10.1371/journal.pone.0194276] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
In 2013, a large measles epidemic occurred in the Aketi Health Zone of the Democratic Republic of Congo. We conducted a two-stage, retrospective cluster survey to estimate the attack rate, the case fatality rate, and the measles-specific mortality rate during the epidemic. 1424 households containing 7880 individuals were included. The estimated attack rate was 14.0%, (35.0% among children aged <5 years). The estimated case fatality rate was 4.2% (6.1% among children aged <5 years). Spatial analysis and linear regression showed that younger children, those who did not receive care, and those living farther away from Aketi Hospital early in the epidemic had a higher risk of measles related death. Vaccination coverage prior to the outbreak was low (76%), and a delayed reactive vaccination campaign contributed to the high attack rate. We provide evidences suggesting that a comprehensive case management approach reduced measles fatality during this epidemic in rural, inaccessible resource-poor setting.
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Affiliation(s)
| | | | | | - Mathieu Bichet
- Médecins Sans Frontières, Geneva, Switzerland
- Médecins Sans Frontières, Paris, France
| | | | | | - Innocent Akonda
- Ministère de la Santé Publique, Kinshassa, République Démocratique du Congo
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Keats EC, Ngugi A, Macharia W, Akseer N, Khaemba EN, Bhatti Z, Rizvi A, Tole J, Bhutta ZA. Progress and priorities for reproductive, maternal, newborn, and child health in Kenya: a Countdown to 2015 country case study. LANCET GLOBAL HEALTH 2018; 5:e782-e795. [PMID: 28716350 PMCID: PMC5599303 DOI: 10.1016/s2214-109x(17)30246-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 05/23/2017] [Accepted: 05/26/2017] [Indexed: 12/28/2022]
Abstract
Background Progress in reproductive, maternal, newborn, and child health (RMNCH) in Kenya has been inconsistent over the past two decades, despite the global push to foster accountability, reduce child mortality, and improve maternal health in an equitable manner. Although several cross-sectional assessments have been done, a systematic analysis of RMNCH in Kenya was needed to better understand the push and pull factors that govern intervention coverage and influence mortality trends. As such, we aimed to determine coverage and impact of key RMNCH interventions between 1990 and 2015. Methods We did a comprehensive, systematic assessment of RMNCH in Kenya from 1990 to 2015, using data from nationally representative Demographic Health Surveys done between 1989 and 2014. For comparison, we used modelled mortality estimates from the UN Inter-Agency Groups for Child and Maternal Mortality Estimation. We estimated time trends for key RMNCH indicators, as defined by Countdown to 2015, at both the national and the subnational level, and used linear regression methods to understand the determinants of change in intervention coverage during the past decade. Finally, we used the Lives Saved Tool (LiST) to model the effect of intervention scale-up by 2030. Findings After an increase in mortality between 1990 and 2003, there was a reversal in all mortality trends from 2003 onwards, although progress was not substantial enough for Kenya to achieve Millennium Development Goal targets 4 or 5. Between 1990 and 2015, maternal mortality declined at half the rate of under-5 mortality, and changes in neonatal mortality were even slower. National-level trends in intervention coverage have improved, although some geographical inequities remain, especially for counties comprising the northeastern, eastern, and northern Rift Valley regions. Disaggregation of intervention coverage by wealth quintile also revealed wide inequities for several health-systems-based interventions, such as skilled birth assistance. Multivariable analyses of predictors of change in family planning, skilled birth assistance, and full vaccination suggested that maternal literacy and family size are important drivers of positive change in key interventions across the continuum of care. LiST analyses clearly showed the importance of quality of care around birth for maternal and newborn survival. Interpretation Intensified and focused efforts are needed for Kenya to achieve the RMNCH targets for 2030. Kenya must build on its previous progress to further reduce mortality through the widespread implementation of key preventive and curative interventions, especially those pertaining to labour, delivery, and the first day of life. Deliberate targeting of the poor, least educated, and rural women, through the scale-up of community-level interventions, is needed to improve equity and accelerate progress. Funding US Fund for UNICEF, Bill & Melinda Gates Foundation.
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Affiliation(s)
- Emily C Keats
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada
| | | | | | - Nadia Akseer
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | | | | | | | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada; Aga Khan University, Nairobi, Kenya; Aga Khan University, Karachi, Pakistan; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
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Dawson-Hahn E, Pak-Gorstein S, Matheson J, Zhou C, Yun K, Scott K, Payton C, Stein E, Holland A, Grow HM, Mendoza JA. Growth Trajectories of Refugee and Nonrefugee Children in the United States. Pediatrics 2016; 138:peds.2016-0953. [PMID: 27940678 PMCID: PMC5127061 DOI: 10.1542/peds.2016-0953] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/26/2016] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Limited data examine longitudinal nutrition outcomes of refugee children after United States resettlement. Among refugee children, our aims were to (1) assess the changes in weight-based nutritional status between baseline (0-3 months) and 10-24 months after arrival and (2) compare the BMI (BMIz) or weight-for-length z score (WFLz) trajectories to nonrefugee children for up to 36 months after arrival. METHODS We conducted a retrospective study of refugees aged 0-16 years from Washington and Pennsylvania and compared them with an age and sex-matched nonrefugee low-income sample from Washington. Data included anthropometric measurements from the initial screening medical visit and subsequent primary care visits. Multilevel linear mixed-effects regression models evaluated the change in BMIz or WFLz trajectory. RESULTS The study included 512 refugee and 1175 nonrefugee children. The unadjusted prevalence of overweight/obesity increased from 8.9% to 20% (P < .001) for 2- to 16-year-old refugees from baseline to 10-24 months. Refugees (2-16 years old) had a steeper increase in their BMIz per 12 months compared with nonrefugees (coefficient 0.18 vs 0.03; P < .001). Refugees <2 years old had a less steep increase in their WFLz per 12 months compared with nonrefugees (coefficient 0.12 vs 0.36, P = .002). CONCLUSIONS Older refugee children exhibited a higher risk of obesity than nonrefugees, whereas refugees <2 years old exhibited a slower increase in their risk of obesity than nonrefugee children. All age groups experienced increasing obesity prevalence. Targeted and culturally tailored obesity prevention interventions may mitigate health and nutrition inequities among refugee children.
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Affiliation(s)
- Elizabeth Dawson-Hahn
- Departments of Pediatrics and .,Seattle Children's Research Institute, Center for Child Health, Behavior and Development, Seattle, Washington
| | - Suzinne Pak-Gorstein
- Departments of Pediatrics and,Global Health, University of Washington, Seattle, Washington
| | - Jasmine Matheson
- Refugee Health Program, Washington State Department of Health, Shoreline, Washington
| | - Chuan Zhou
- Seattle Children’s Research Institute, Center for Child Health, Behavior and Development, Seattle, Washington
| | - Katherine Yun
- PolicyLab, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kevin Scott
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania; and
| | - Colleen Payton
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania; and
| | - Elizabeth Stein
- Seattle Children’s Research Institute, Center for Child Health, Behavior and Development, Seattle, Washington
| | - Annette Holland
- Refugee Screening Clinic, Seattle-King County Public Health, Seattle, Washington
| | | | - Jason A. Mendoza
- Departments of Pediatrics and,Seattle Children’s Research Institute, Center for Child Health, Behavior and Development, Seattle, Washington
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Lam E, Diaz M, Maina AGK, Brennan M. Displaced populations due to humanitarian emergencies and its impact on global eradication and elimination of vaccine-preventable diseases. Confl Health 2016; 10:27. [PMID: 27956938 PMCID: PMC5129240 DOI: 10.1186/s13031-016-0094-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 08/10/2016] [Indexed: 11/10/2022] Open
Abstract
Populations affected by humanitarian emergencies may require unique strategies to ensure access to life-saving vaccines and attain sufficiently high population immunity to interrupt virus circulation. Vaccination strategies among displaced populations should not be an afterthought and must be part of the vaccine-preventable disease eradication and elimination initiatives from the start.
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Affiliation(s)
- Eugene Lam
- Emergency Response and Recovery Branch; Division of Global Health Protection, Center for Global Health; Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30309 USA
| | - Michael Diaz
- Department of Global Epidemiology; Rollins School of Public Health, Emory University, Atlanta, GA USA
| | | | - Muireann Brennan
- Emergency Response and Recovery Branch; Division of Global Health Protection, Center for Global Health; Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30309 USA
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Zhou G, Lo E, Zhong D, Wang X, Wang Y, Malla S, Lee MC, Yang Z, Cui L, Yan G. Impact of interventions on malaria in internally displaced persons along the China-Myanmar border: 2011-2014. Malar J 2016; 15:471. [PMID: 27628040 PMCID: PMC5024476 DOI: 10.1186/s12936-016-1512-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 09/02/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Internally displaced persons (IDP) represent vulnerable populations whose public health conditions merit special attention. In the China-Myanmar border area, human movement and resettlements of IDP can influence malaria transmission. Comparison of disease incidence and vector densities between IDP camps and surrounding local villages allows for better understanding of current epidemiology and to evaluate the effectiveness of interventions in the region. METHODS Malaria and vector surveillance was conducted in three IDP camps and three local villages neighbouring the camps along the China-Myanmar border in Myanmar. Clinical malaria cases were collected from seven hospitals/clinics from April 2011 to December 2014. Malaria vector population dynamics were monitored using CDC light traps. The use of malaria preventive measures and information on aid agencies and their activities was obtained through questionnaire surveys. RESULTS Malaria was confirmed in 1832 patients. Of these cases, 85.4 % were Plasmodium vivax and 11.4 % were Plasmodium falciparum malaria. Annual malaria incidence rates were 38.8 and 127.0 cases/1000 person year in IDP camps and local villages, respectively. Older children of 5-14 years had the highest incidence rate in the camps regardless of gender, while male adults had significantly higher incidence rates than females in local villages and females child-bearing age had significantly lower risk to malaria in IDP camps compare to local villages. Seasonal malaria outbreaks were observed both in the IDP camps and in the local villages from May to August 2013. The proportion of P. vivax remained unchanged in local villages but increased by approximately tenfold in IDP camps from 2011 to 2014. Anopheles vector density was tenfold higher in local villages compared to IDP camps (2.0:0.2 females/trap/night). Over 99 % of households in both communities owned bed nets. While long-lasting insecticidal nets accounted for 61 % of nets used in IDPs, nearly all residents of local villages owned regular nets without insecticide-impregnation. There were more active aid agencies in the camps than in local villages. CONCLUSION Malaria in IDP camps was significantly lower than the surrounding villages through effective control management. The observation of P. vivax outbreaks in the study area highlights the need for increased control efforts. Expansion of malaria intervention strategies in IDP camps to local surrounding villages is critical to malaria control in the border area.
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Affiliation(s)
- Guofa Zhou
- University of California, Irvine, CA USA
| | - Eugenia Lo
- University of California, Irvine, CA USA
| | | | - Xiaoming Wang
- University of California, Irvine, CA USA
- Southern Medical University, Guangzhou, China
| | - Ying Wang
- Third Military Medical University, Chongqing, China
| | | | | | | | - Liwang Cui
- Pennsylvania State University, University Park, PA USA
| | - Guiyun Yan
- University of California, Irvine, CA USA
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Mohamed GA, Ahmed JA, Marano N, Mohamed A, Moturi E, Burton W, Otieno S, Fields B, Montgomery J, Kabugi W, Musa H, Cookson ST. Etiology and Incidence of Viral Acute Respiratory Infections Among Refugees Aged 5 Years and Older in Hagadera Camp, Dadaab, Kenya. Am J Trop Med Hyg 2015; 93:1371-6. [PMID: 26458776 DOI: 10.4269/ajtmh.15-0141] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 06/22/2015] [Indexed: 11/07/2022] Open
Abstract
We used the Centers for Disease Control and Prevention-Kenya Medical Research Institute Acute Respiratory Infection (ARI) Surveillance System data to estimate severe acute respiratory infection (SARI) hospitalization rates, viral etiology, and associated complaints of influenza-like illnesses (ILI) and SARI conditions among those aged 5 years and older in Hagadera, Dadaab refugee camp, Kenya, for 2010-2012. A total of 471 patients aged ≥ 5 years met the case definition for ILI or SARI. SARI hospitalization rates per 10,000 person-years were 14.7 (95% confidence interval [CI] = 9.1, 22.2) for those aged 5-14 years; 3.4 (95% CI = 1.6, 7.2) for those aged 15-24 year; and 3.8 (95% CI = 1.6, 7.2) for those aged ≥ 25 years. Persons between the ages of 5 and 14 years had 3.5 greater odds to have been hospitalized as a result of SARI than those aged ≥ 25 years (odds ratio [OR] = 3.5, P < 0.001). Among the 419 samples tested, 169 (40.3%) were positive for one or more virus. Of those samples having viruses, 36.9% had influenza A; 29.9% had adenovirus; 20.2% had influenza B; and 14.4% had parainfluenza 1, 2, or 3. Muscle/joint pain was associated with influenza A (P = 0.002), whereas headache was associated with influenza B (P = 0.019). ARIs were responsible for a substantial disease burden in Hagadera camp.
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Affiliation(s)
- Gedi A Mohamed
- Rollins School of Public Health, Emory University, Atlanta, Georgia; United States Centers for Disease Control and Prevention, Nairobi, Kenya; Kenya Medical Research Institute, Nairobi, Kenya; United Nations High Commissioner of Refugees, Nairobi, Kenya; International Rescue Committee, Nairobi, Kenya; United States Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jamal A Ahmed
- Rollins School of Public Health, Emory University, Atlanta, Georgia; United States Centers for Disease Control and Prevention, Nairobi, Kenya; Kenya Medical Research Institute, Nairobi, Kenya; United Nations High Commissioner of Refugees, Nairobi, Kenya; International Rescue Committee, Nairobi, Kenya; United States Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nina Marano
- Rollins School of Public Health, Emory University, Atlanta, Georgia; United States Centers for Disease Control and Prevention, Nairobi, Kenya; Kenya Medical Research Institute, Nairobi, Kenya; United Nations High Commissioner of Refugees, Nairobi, Kenya; International Rescue Committee, Nairobi, Kenya; United States Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Abdinoor Mohamed
- Rollins School of Public Health, Emory University, Atlanta, Georgia; United States Centers for Disease Control and Prevention, Nairobi, Kenya; Kenya Medical Research Institute, Nairobi, Kenya; United Nations High Commissioner of Refugees, Nairobi, Kenya; International Rescue Committee, Nairobi, Kenya; United States Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Edna Moturi
- Rollins School of Public Health, Emory University, Atlanta, Georgia; United States Centers for Disease Control and Prevention, Nairobi, Kenya; Kenya Medical Research Institute, Nairobi, Kenya; United Nations High Commissioner of Refugees, Nairobi, Kenya; International Rescue Committee, Nairobi, Kenya; United States Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Wagacha Burton
- Rollins School of Public Health, Emory University, Atlanta, Georgia; United States Centers for Disease Control and Prevention, Nairobi, Kenya; Kenya Medical Research Institute, Nairobi, Kenya; United Nations High Commissioner of Refugees, Nairobi, Kenya; International Rescue Committee, Nairobi, Kenya; United States Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Samora Otieno
- Rollins School of Public Health, Emory University, Atlanta, Georgia; United States Centers for Disease Control and Prevention, Nairobi, Kenya; Kenya Medical Research Institute, Nairobi, Kenya; United Nations High Commissioner of Refugees, Nairobi, Kenya; International Rescue Committee, Nairobi, Kenya; United States Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Barry Fields
- Rollins School of Public Health, Emory University, Atlanta, Georgia; United States Centers for Disease Control and Prevention, Nairobi, Kenya; Kenya Medical Research Institute, Nairobi, Kenya; United Nations High Commissioner of Refugees, Nairobi, Kenya; International Rescue Committee, Nairobi, Kenya; United States Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joel Montgomery
- Rollins School of Public Health, Emory University, Atlanta, Georgia; United States Centers for Disease Control and Prevention, Nairobi, Kenya; Kenya Medical Research Institute, Nairobi, Kenya; United Nations High Commissioner of Refugees, Nairobi, Kenya; International Rescue Committee, Nairobi, Kenya; United States Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Willy Kabugi
- Rollins School of Public Health, Emory University, Atlanta, Georgia; United States Centers for Disease Control and Prevention, Nairobi, Kenya; Kenya Medical Research Institute, Nairobi, Kenya; United Nations High Commissioner of Refugees, Nairobi, Kenya; International Rescue Committee, Nairobi, Kenya; United States Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Hashim Musa
- Rollins School of Public Health, Emory University, Atlanta, Georgia; United States Centers for Disease Control and Prevention, Nairobi, Kenya; Kenya Medical Research Institute, Nairobi, Kenya; United Nations High Commissioner of Refugees, Nairobi, Kenya; International Rescue Committee, Nairobi, Kenya; United States Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan T Cookson
- Rollins School of Public Health, Emory University, Atlanta, Georgia; United States Centers for Disease Control and Prevention, Nairobi, Kenya; Kenya Medical Research Institute, Nairobi, Kenya; United Nations High Commissioner of Refugees, Nairobi, Kenya; International Rescue Committee, Nairobi, Kenya; United States Centers for Disease Control and Prevention, Atlanta, Georgia
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Shakoor S, Mir F, Zaidi AKM, Zafar A. Hospital preparedness in community measles outbreaks-challenges and recommendations for low-resource settings. EMERGING HEALTH THREATS JOURNAL 2015; 8:24173. [PMID: 25882388 PMCID: PMC4400300 DOI: 10.3402/ehtj.v8.24173] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 03/23/2015] [Accepted: 03/23/2015] [Indexed: 12/22/2022]
Abstract
We have reviewed various strategies involved in containment of measles in healthcare facilities during community outbreaks. The strategies that are more applicable to resource-poor settings, such as natural ventilation, mechanical ventilation with heating and air-conditioning systems allowing unidirectional air-flow, and protection of un-infected patients and healthcare workers (HCWs), have been examined. Ventilation methods need innovative customization for resource-poor settings followed by validation and post-implementation analysis for impact. Mandatory vaccination of all HCWs with two doses of measles-containing vaccine, appropriate post-exposure prophylaxis of immunocompromised inpatients, and stringent admission criteria for measles cases can contribute toward reduction of nosocomial and secondary transmission within facilities.
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Affiliation(s)
- Sadia Shakoor
- Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
- Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan;
| | - Fatima Mir
- Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Anita K M Zaidi
- Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Afia Zafar
- Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
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Lam E, McCarthy A, Brennan M. Vaccine-preventable diseases in humanitarian emergencies among refugee and internally-displaced populations. Hum Vaccin Immunother 2015; 11:2627-36. [PMID: 26406333 PMCID: PMC4685677 DOI: 10.1080/21645515.2015.1096457] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 09/11/2015] [Accepted: 09/16/2015] [Indexed: 10/23/2022] Open
Abstract
Humanitarian emergencies may result in breakdown of regular health services including routine vaccination programs. Displaced populations including refugees and internally displaced persons are particularly susceptible to outbreaks of communicable diseases such as vaccine-preventable diseases (VPDs). Common VPDs encountered in humanitarian emergencies include measles, polio, and depending on geographical location, meningococcal meningitis, yellow fever, hepatitis A, and cholera. We conducted a review of 50 published articles from 2000 to 2015 concerning VPDs in humanitarian emergencies. This article provides an update on the available literature regarding vaccinations among this highly vulnerable population and describes the unique challenges of VPDs during humanitarian emergencies. Humanitarian emergencies place affected populations at risk for elevated morbidity and mortality from VPDs due to creation or exacerbation of factors associated with disease transmission such as mass population movements, overcrowding, malnutrition, and poor water and sanitation conditions. Vaccination is one of the most basic and critical health interventions for protecting vulnerable populations during emergencies. Growing insecurity, as seen in the increasing number of targeted attacks on health workers in recent years, as well as destruction of cold chain and infrastructure for transportation of supplies, are creating new challenges in provision of life saving vaccines in conflict settings. Population displacement can also threaten global VPD eradication and elimination efforts. While highly effective vaccines and guidelines to combat VPDs are available, the trend of increasing number of humanitarian emergencies globally poses new and emerging challenges in providing vaccination among displaced populations.
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Affiliation(s)
- Eugene Lam
- Emergency Response and Recovery Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention; Atlanta, GA USA
| | - Amanda McCarthy
- Department of Global Epidemiology; Rollins School of Public Health, Emory University; Atlanta, GA USA
| | - Muireann Brennan
- Emergency Response and Recovery Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention; Atlanta, GA USA
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Abstract
The last few decades have been marked by a rapid expansion in the world?s population, along with an increasingly dynamic mobility of individuals. This accelerated global inter-connectedness enabled microorganisms to reach virtually any location worldwide more rapidly and efficiently than ever before, reshaping the global dynamics of pathogens. As a result, a local infectious disease outbreak anywhere in the world may almost instantaneously assume global dimensions, and should therefore be considered a global priority. The history of several infectious diseases illustrates that in addition to prophylactic and therapeutic medical interventions, the interplay of social, economic, and political factors makes a fundamental contribution to the outcome of infectious disease outbreaks. Furthermore, this multi- and cross-disciplinary interconnectedness is a key determinant of the outcome of efforts to eradicate vaccine-preventable infectious diseases. A combined framework that incorporates teachings provided by previous outbreaks, and integrates medical and biomedical interventions with contributions made by social, economic, and political factors, emerges as vital requirement of successful global public health initiatives.
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Affiliation(s)
- R A Stein
- Department of Biochemistry and Molecular Pharmacology, New York University School of Medicine, New York, NY, USA
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39
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Polonsky JA, Singh B, Masiku C, Langendorf C, Kagoli M, Hurtado N, Berthelot M, Heinzelmann A, Puren A, Grais RF. Exploring HIV infection and susceptibility to measles among older children and adults in Malawi: a facility-based study. Int J Infect Dis 2014; 31:61-7. [PMID: 25499042 DOI: 10.1016/j.ijid.2014.12.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 11/17/2014] [Accepted: 12/06/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND HIV infection increases measles susceptibility in infants, but little is known about this relationship among older children and adults. We conducted a facility-based study to explore whether HIV status and/or CD4 count were associated with either measles seroprotection and/or measles antibody concentration. METHODS A convenience sample was recruited comprising HIV-infected patients presenting for follow-up care, and HIV-uninfected individuals presenting for HIV testing at Chiradzulu District Hospital, Malawi, from January to September 2012. We recorded age, sex, and reported measles vaccination and infection history. Blood samples were taken to determine the CD4 count and measles antibody concentration. RESULTS One thousand nine hundred and thirty-five participants were recruited (1434 HIV-infected and 501 HIV-uninfected). The majority of adults and approximately half the children were seroprotected against measles, with lower odds among HIV-infected children (adjusted odds ratio 0.27, 95% confidence interval 0.10-0.69; p=0.006), but not adults. Among HIV-infected participants, neither CD4 count (p=0.16) nor time on antiretroviral therapy (p=0.25) were associated with measles antibody concentration, while older age (p<0.001) and female sex (p<0.001) were independently associated with this measure. CONCLUSIONS We found no evidence that HIV infection contributes to the risk of measles infection among adults, but HIV-infected children (including at ages older than previously reported), were less likely to be seroprotected in this sample.
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Affiliation(s)
| | - Beverley Singh
- National Institute for Communicable Diseases/National Health Laboratory Service, Johannesburg, South Africa
| | | | | | | | | | | | | | - Adrian Puren
- National Institute for Communicable Diseases/National Health Laboratory Service, Johannesburg, South Africa; Division of Virology and Communicable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - Rebecca F Grais
- Epicentre, Paris, France, 8 rue saint Sabin, 75011 Paris, France
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40
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Abstract
Measles was an inevitable infection during the human development with substantial degree of morbidity and mortality. The severity of measles virus (MV) infection was largely contained by the development of a live attenuated vaccine that was introduced into the vaccination programs. However, all efforts to eradicate the disease failed and continued to annually result in significant deaths. The development of molecular biology techniques allowed the rescue of MV from cDNA that enabled important insights into a variety of aspects of the biology of the virus and its pathogenesis. Subsequently these technologies facilitated the development of novel vaccine candidates that induce immunity against measles and other pathogens. Based on the promising prospective, the use of MV as a recombinant vaccine and a therapeutic vector is addressed.
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Affiliation(s)
- Hussein Y Naim
- a Life Sciences and Vaccines Consultant; Bern, Switzerland
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41
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Ratnayake R, Degomme O, Roberts B, Spiegel P. Conflict and Health: seven years of advancing science in humanitarian crises. Confl Health 2014; 8:7. [PMID: 24843382 PMCID: PMC4024652 DOI: 10.1186/1752-1505-8-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 04/29/2014] [Indexed: 11/10/2022] Open
Affiliation(s)
- Ruwan Ratnayake
- International Rescue Committee, 122 E 42nd Street, New York 10168, USA
| | - Olivier Degomme
- International Centre for Reproductive Health, Ghent University, De Pintelaan 185 UZP114, Ghent 9000, Belgium
| | - Bayard Roberts
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Paul Spiegel
- Division of Programme Support and Management, United Nations High Commissioner for Refugees, Geneva, Switzerland
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Agoti CN, Mayieka LM, Otieno JR, Ahmed JA, Fields BS, Waiboci LW, Nyoka R, Eidex RB, Marano N, Burton W, Montgomery JM, Breiman RF, Nokes DJ. Examining strain diversity and phylogeography in relation to an unusual epidemic pattern of respiratory syncytial virus (RSV) in a long-term refugee camp in Kenya. BMC Infect Dis 2014; 14:178. [PMID: 24690157 PMCID: PMC4021307 DOI: 10.1186/1471-2334-14-178] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Accepted: 03/24/2014] [Indexed: 01/01/2023] Open
Abstract
Background A recent longitudinal study in the Dadaab refugee camp near the Kenya-Somalia border identified unusual biannual respiratory syncytial virus (RSV) epidemics. We characterized the genetic variability of the associated RSV strains to determine if viral diversity contributed to this unusual epidemic pattern. Methods For 336 RSV positive specimens identified from 2007 through 2011 through facility-based surveillance of respiratory illnesses in the camp, 324 (96.4%) were sub-typed by PCR methods, into 201 (62.0%) group A, 118 (36.4%) group B and 5 (1.5%) group A-B co-infections. Partial sequencing of the G gene (coding for the attachment protein) was completed for 290 (89.5%) specimens. These specimens were phylogenetically analyzed together with 1154 contemporaneous strains from 22 countries. Results Of the 6 epidemic peaks recorded in the camp over the period, the first and last were predominantly made up of group B strains, while the 4 in between were largely composed of group A strains in a consecutive series of minor followed by major epidemics. The Dadaab group A strains belonged to either genotype GA2 (180, 98.9%) or GA5 (2, < 1%) while all group B strains (108, 100%) belonged to BA genotype. In sequential epidemics, strains within these genotypes appeared to be of two types: those continuing from the preceding epidemics and those newly introduced. Genotype diversity was similar in minor and major epidemics. Conclusion RSV strain diversity in Dadaab was similar to contemporaneous diversity worldwide, suggested both between-epidemic persistence and new introductions, and was unrelated to the unusual epidemic pattern.
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Affiliation(s)
- Charles N Agoti
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya.
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Mahamud A, Burton A, Hassan M, Ahmed JA, Wagacha JB, Spiegel P, Haskew C, Eidex RB, Shetty S, Cookson S, Navarro-Colorado C, Goodson JL. Risk factors for measles mortality among hospitalized Somali refugees displaced by famine, Kenya, 2011. Clin Infect Dis 2013; 57:e160-6. [PMID: 23821730 DOI: 10.1093/cid/cit442] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Measles among displaced, malnourished populations can result in a high case fatality ratio. In 2011, a large measles outbreak occurred in Dadaab, Kenya, among refugees fleeing famine and conflict in Somalia. The aim of this study was to identify predictors of measles deaths among hospitalized patients during the outbreak. METHODS A retrospective cohort study design was used to investigate measles mortality among hospitalized measles patients with a date of rash onset during 6 June-10 September 2011. Data were abstracted from medical records and a measles case was defined as an illness with fever, maculopapular rash, and either cough, coryza or conjunctivitis. Vaccination status was determined by patient or parental recall. Independent predictors of mortality were identified using logistic regression analysis. RESULTS Of 388 hospitalized measles patients, 188 (49%) were from hospital X, 70 (18%) from hospital Y, and 130 (34%) from hospital Z; median age was 22 years, 192 (50%) were 15-29 years of age, and 22 (6%) were vaccinated. The mean number of days from rash onset to hospitalization varied by hospital (hospital X = 5, hospital Y = 3, hospital Z = 6; P < .0001). Independent risk factors for measles mortality were neurological complications (odds ratio [OR], 12.8; 95% confidence interval [CI], 3.1-52.4), acute malnutrition (OR, 7.6; 95% CI, 1.3-44.3), and admission to hospital Z (OR, 4.2; 95% CI, 1.3-13.2). CONCLUSIONS Among Somali refugees, in addition to timely vaccination at border crossing points, early detection and treatment of acute malnutrition and proper management of measles cases may reduce measles mortality.
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