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Mueller A, Salek M, Oszer A, Evseev D, Yakimkova T, Wlodarski M, Vinitsky A, Kizyma R, Pogorelyy M, Zuber M, Escalante J, Lipska E, Fendler W, Nowicka Z, Szyszka A, Kacharian A, Rodriguez-Galindo C, Wise PH, Agulnik A, Mlynarski W. Retrospective comparative analysis of two medical evacuation systems for Ukrainian patients affected by war. Eur J Cancer 2024; 210:114271. [PMID: 39232428 DOI: 10.1016/j.ejca.2024.114271] [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: 06/21/2024] [Revised: 07/31/2024] [Accepted: 08/02/2024] [Indexed: 09/06/2024]
Abstract
INTRODUCTION Coordinated medical evacuations represent an important strategy for emergency response when healthcare systems are impaired by armed conflict, particularly for patients diagnosed with life-threatening conditions such as cancer. In this study, we compare the experiences of two parallel medical evacuation systems developed to meet the medical needs of Ukrainians affected by war. METHODS This retrospective study compared outcomes of two medical evacuation systems, developed by the European Union Emergency Response Coordination Centre (ERCC) and Supporting Action for Emergency Response in Ukraine (SAFER Ukraine) collaborative, in the first 10 months after the war's intensification in Ukraine (February 24 to December 21, 2022). Each groups' respective registries served as data sources. Patient demographics and allocation data were summarized descriptively. Median time for patient referral were analyzed statistically. RESULTS The ERCC pathway evacuated 1385 patients (median age: 36 [0 - 85] years) to 16 European countries; 78.7 % (n = 1091) suffered from trauma-related injuries and 13.4 % (n = 185) from cancer. SAFER Ukraine evacuated 550 patients (median age: 9 [0 - 22] years) to 14 European and North American countries; 97.1 % (n = 534) were children diagnosed with cancer or blood disorders. The median evacuation time for the SAFER Ukraine cohort was shorter than the ERCC cohort (p < 0.001), though comparable (six versus seven days). CONCLUSION The ERCC and SAFER Ukraine collaborative successfully developed medical evacuation pathways to meet the needs of Ukrainian patients impacted by war. System comparison provides opportunity to identify strategies for parallel system harmonization and a pragmatic example of how to anticipate support of these patients in future armed conflicts.
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Affiliation(s)
- Alexandra Mueller
- University Medical Center Freiburg, Pediatric Hematology and Oncology, Freiburg, Germany.
| | - Marta Salek
- St. Jude Children's Research Hospital, Department of Global Pediatric Medicine, Memphis, TN, United States
| | - Aleksandra Oszer
- Medical University of Lodz, Department of Pediatrics, Oncology and Hematology, Lodz, Poland
| | - Dmitry Evseev
- St. Jude Children's Research Hospital, Department of Global Pediatric Medicine, Memphis, TN, United States
| | - Taisiya Yakimkova
- St. Jude Children's Research Hospital, Department of Global Pediatric Medicine, Memphis, TN, United States
| | - Marcin Wlodarski
- St. Jude Children's Research Hospital, Department of Hematology, Memphis, TN, United States
| | - Anna Vinitsky
- St. Jude Children's Research Hospital, Department of Oncology, Memphis, TN, United States
| | - Roman Kizyma
- Western Ukrainian Specialized Children's Medical Centre, Clinic of Pediatric Oncology and Stem Cell Transplantation, Lviv, Ukraine
| | - Mikhail Pogorelyy
- St. Jude Children's Research Hospital, Department of Immunology, Memphis, TN, United States
| | - Maria Zuber
- European Commission - DG ECHO, Emergency Response Coordination Centre, Brussels, Belgium
| | - Juan Escalante
- European Commission - DG ECHO, Emergency Response Coordination Centre, Brussels, Belgium
| | - Elzbieta Lipska
- Institute of Mother and Child, Endocrinology Outpatient Clinic, Warsaw, Poland
| | - Wojciech Fendler
- Medical University of Lodz, Department of Biostatistics and Translational Medicine, Lodz, Poland
| | - Zuzanna Nowicka
- Medical University of Lodz, Department of Biostatistics and Translational Medicine, Lodz, Poland
| | - Adam Szyszka
- Polish Center for International Aid, Warsaw, Poland
| | | | - Carlos Rodriguez-Galindo
- St. Jude Children's Research Hospital, Department of Global Pediatric Medicine, Memphis, TN, United States
| | - Paul H Wise
- Stanford University School of Medicine, Pediatrics and Health Policy, Palo Alto, CA, United States
| | - Asya Agulnik
- St. Jude Children's Research Hospital, Department of Global Pediatric Medicine, Memphis, TN, United States
| | - Wojciech Mlynarski
- Medical University of Lodz, Department of Pediatrics, Oncology and Hematology, Lodz, Poland
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Bahattab AAS, Zain O, Linty M, Amat Camacho N, Von Schreeb J, Hubloue I, Della Corte F, Ragazzoni L. Development and evaluation of scenario-based e-simulation for humanitarian health training: a mixed-methods action research study. BMJ Open 2024; 14:e079681. [PMID: 39107011 PMCID: PMC11308908 DOI: 10.1136/bmjopen-2023-079681] [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: 09/08/2023] [Accepted: 07/01/2024] [Indexed: 08/09/2024] Open
Abstract
OBJECTIVES This study aimed to develop and evaluate a scenario-based e-simulation (SBES) to address the limited avilability of accessible and practical training for humanitarian public health responders. The objectives included SBES customisation, effectiveness evaluation, and identifying learning-enhancing design elements. DESIGN A university-based, mixed-methods action research design. SETTING The study was conducted at an international university's academic centre in Italy, and at a university-based master's programme in Yemen. PARTICIPANTS The study involved 20 multidisciplinary global health and education experts and 66 international medical and health sciences students. RESULTS Between September 2020 and July 2022, four SBES modules were developed, implemented and evaluated using a rapid prototype model. The modules, which targeted health professionals new to or with limited experience in the humanitarian field, included health needs assessment, essential health services, communicable diseases and health system. Formative evaluation improved the design and implementation of the SBES, which was found to be effective in the summative evaluation, evident from positive student reactions (the overall mean satisfaction rate was 6.03 out of 7, 95% CI 5.95 to 6.47) and the significant improvement in knowledge scores (p<0.001, effect size: 1.179). The identified effective design of SBES includes overlapping elements among content, strategy and technology. Poor internet access was recognised as a potential barrier to delivering the training in the humanitarian context, highlighting the need to develop an offline version in the next phase. CONCLUSION The developed SBES met the training needs of the academic institution involved. The study findings will contribute to advancing future SBES training initiatives for disaster medicine and global health. Further studies are recommended to evaluate and address the challenges associated with SBES implementation beyond the study setting.
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Affiliation(s)
- Awsan Abdullah Saeed Bahattab
- CRIMEDIM – Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department for Sustainable Development and Ecological Transition, Università del Piemonte Orientale, Vercelli, Italy
| | - Omar Zain
- Department of Community Medicine and Public Health, University of Aden, Aden, Yemen
| | - Monica Linty
- CRIMEDIM – Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department for Sustainable Development and Ecological Transition, Università del Piemonte Orientale, Vercelli, Italy
| | - Nieves Amat Camacho
- Department of Global Public Health, Center for Research on Health Care in Disasters, Karolinska Institutet, Stockholm, Sweden
| | - Johan Von Schreeb
- Department of Global Public Health, Center for Research on Health Care in Disasters, Karolinska Institutet, Stockholm, Sweden
| | - Ives Hubloue
- ReGEDiM – Research Group on Emergency and Disaster Medicine, Vrije Universiteit Brussel, Brussel, Belgium
| | - Francesco Della Corte
- CRIMEDIM – Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Luca Ragazzoni
- CRIMEDIM – Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department for Sustainable Development and Ecological Transition, Università del Piemonte Orientale, Vercelli, Italy
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Alburez-Gutierrez D, Acosta E, Zagheni E, Williams NE. The long-lasting effect of armed conflicts deaths on the living: Quantifying family bereavement. SCIENCE ADVANCES 2024; 10:eado6951. [PMID: 39058772 PMCID: PMC11277369 DOI: 10.1126/sciadv.ado6951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 06/25/2024] [Indexed: 07/28/2024]
Abstract
Armed conflicts escalate combatant and civilian mortality and produce considerable levels of family bereavement. Yet, we know little about the prevalence of bereavement in conflict-affected populations. The violent loss of kin affects individuals across several dimensions, including trauma, mental health, socioeconomic status, and caregiving, especially during childhood and old age. Here, we propose a method to quantify population-level loss of parents and offspring in conflict-affected populations. Our analyses demonstrate that bereavement levels consistently surpass fatality rates in 16 conflict-affected settings. Using demographic projections, we show that these populations will continue to experience considerable levels of bereavement in the coming decades, independent of the future development of the respective conflicts. This quantification underscores bereavement as a profound yet understudied consequence of conflict with potentially far-reaching implications lingering long after the conflict's end.
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Affiliation(s)
- Diego Alburez-Gutierrez
- Kinship Inequalities Research Group, Max Planck Institute for Demographic Research (MPIDR), Rostock, Germany
| | - Enrique Acosta
- Centre for Demographic Studies (CED), Barcelona, Spain
- Laboratory of Population Health, Max Planck Institute for Demographic Research (MPIDR), Rostock, Germany
| | - Emilio Zagheni
- Department of Digital and Computational Demography, Max Planck Institute for Demographic Research (MPIDR), Rostock, Germany
| | - Nathalie E. Williams
- Department of Sociology and Jackson School of International Studies, University of Washington, Seattle, WA, USA
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Coly SM, Zorom M, Leye B, Karambiri H, Guiro A. Learning from history of natural disasters in the Sahel: a comprehensive analysis and lessons for future resilience. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2024; 31:40704-40716. [PMID: 37548790 DOI: 10.1007/s11356-023-28989-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 07/21/2023] [Indexed: 08/08/2023]
Abstract
One of the first environmental crises to attract interest in development initiatives and aid was the great drought of the 1970s in the Sahel. This study investigates the extent of damage caused by natural disasters from one of the most widely used databases-EM-DAT-with a sample size of 16 Sahelian countries over the period 1960-2020. These countries have been divided into three regions: Western Africa Sahel (WAS), Central Africa Sahel (CAS), and Eastern Africa Sahel (EAS). The analyses encompass four categories of natural hazards, namely, biological, climatological, hydrological, and meteorological. We used descriptive and test statistics to summarize the natural disaster records. Through this approach, we explore tendencies to identify the most frequently reported natural hazards; we examine their spatial distribution and evaluate their impacts in terms of socioeconomic damage and causalities. During the study period, a total of 1000 events were recorded in the database. The Western Africa Sahel (WAS) region had the highest number of disasters, with 476 events, followed by the Eastern Africa Sahel (EAS) region with 369 events. The most common hazards in the Sahel were hydrological (41.8%), mainly floods, and biological (39.5%) hazards. Approximately 300 million people in the Sahel were affected by natural hazards, with 59.17% in EAS, 36.48% in WAS, and 4.35% in CAS. Although droughts occurred less frequently (14%), they had a significant impact on the population, affecting 84% of those affected by natural hazards. In general, EAS experiences a higher impact from natural hazards, potentially influenced by the pastoral lifestyle of its population. However, WAS is also very vulnerable to natural hazards especially epidemics and nowadays floods. The uncontrolled urbanization in the area may contribute to this vulnerability.
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Affiliation(s)
- Serigne Mbacké Coly
- Laboratoire Eaux Hydro-Systèmes et Agriculture (LEHSA), Institut International d'Ingénierie de l'Eau et de l'Environnement (2iE) 01 BP 594, Ouagadougou, Burkina Faso.
| | - Malicki Zorom
- Laboratoire Eaux Hydro-Systèmes et Agriculture (LEHSA), Institut International d'Ingénierie de l'Eau et de l'Environnement (2iE) 01 BP 594, Ouagadougou, Burkina Faso
| | - Babacar Leye
- Laboratoire Eaux Hydro-Systèmes et Agriculture (LEHSA), Institut International d'Ingénierie de l'Eau et de l'Environnement (2iE) 01 BP 594, Ouagadougou, Burkina Faso
| | - Harouna Karambiri
- Laboratoire Eaux Hydro-Systèmes et Agriculture (LEHSA), Institut International d'Ingénierie de l'Eau et de l'Environnement (2iE) 01 BP 594, Ouagadougou, Burkina Faso
| | - Aboudramane Guiro
- Laboratoire de Mathématiques Informatique et Applications (LaMIA), Université Nazi Boni 01 BP 1091, Bobo-Dioulasso, Burkina Faso
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5
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Jayasinghe S. The 12 dimensions of health impacts of war (the 12-D framework): a novel framework to conceptualise impacts of war on social and environmental determinants of health and public health. BMJ Glob Health 2024; 9:e014749. [PMID: 38777392 PMCID: PMC11116856 DOI: 10.1136/bmjgh-2023-014749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/20/2024] [Indexed: 05/25/2024] Open
Abstract
Global rates of armed conflicts have shown an alarming increase since 2008. These conflicts have devastating and long-term cumulative impacts on health. The overriding aim in these conflicts is to achieve military or political goals by harming human life, which is the antithesis of the moral underpinnings of the health professions. However, the profession has rarely taken on a global advocacy role to prevent and eliminate conflicts and wars. To assume such a role, the health profession needs to be aware of the extensive and multiple impacts that wars have on population health. To facilitate this discourse, the author proposes a novel framework called 'The Twelve Dimensions of Health Impacts of War' (or the 12-D framework). The framework is based on the concepts of social and environmental determinants of population health. It has 12 interconnected 'dimensions' beginning with the letter D, capturing the adverse impacts on health (n=5), its social (n=4) and environmental determinants (n=3). For health, the indices are Deaths, Disabilities, Diseases, Dependency and Deformities. For social determinants of health, there are Disparities in socioeconomic status, Displacements of populations, Disruptions to the social fabric and Development reversals. For environmental determinants, there is Destruction of infrastructure, Devastation of the environment and Depletion of natural resources. A relatively simple framework could help researchers and lay public to understand the magnitude and quantify the widespread health, social and environmental impacts of war, comprehensively. Further validation and development of this framework are necessary to establish it as a universal metric for quantifying the horrific impacts of war on the planet and garner support for initiatives to promote global peace.
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Affiliation(s)
- Saroj Jayasinghe
- Clinical Medicine, University of Colombo Faculty of Medicine, Colombo, Sri Lanka
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6
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Kokori E, Olatunji G, Yusuf IA, Isarinade T, Moradeyo Akanmu A, Olatunji D, Akinmoju O, Aderinto N. A mini-review on safeguarding global health amidst a "Pandemic" of armed conflicts. Medicine (Baltimore) 2024; 103:e37897. [PMID: 38758853 PMCID: PMC11098207 DOI: 10.1097/md.0000000000037897] [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: 11/25/2023] [Accepted: 03/22/2024] [Indexed: 05/19/2024] Open
Abstract
The year 2022 witnessed an alarming surge in state-based armed conflicts globally, reaching a staggering 56, with major hostilities in Ukraine, Myanmar, and Nigeria resulting in over 10,000 estimated conflict-related deaths. This trend continued with the onset of a significant conflict between Israel and Hamas in October 2023. The escalating frequency of armed conflicts, reaching the highest number since 1946, poses a critical threat to global health. This paper explores the multifaceted health impacts of armed conflicts, encompassing physical injuries, infectious diseases, malnutrition, and profound mental health consequences. Healthcare systems in conflict zones face severe strain, and achieving Sustainable Development Goals by 2030 becomes increasingly challenging. The surge in armed conflicts globally is characterized as a "pandemic," justifying urgent attention. The paper identifies and discusses strategies to safeguard public health in conflict zones, emphasizing humanitarian response, protecting healthcare workers and infrastructure, building preparedness and resilience, and promoting mental health support. In navigating this "pandemic" of armed conflicts, comprehensive strategies are imperative to address the intricate challenges and secure a healthier global future.
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Affiliation(s)
- Emmanuel Kokori
- Department of Medicine and Surgery, University of Ilorin, Ilorin, Nigeria
| | - Gbolahan Olatunji
- Department of Medicine and Surgery, University of Ilorin, Ilorin, Nigeria
| | - Ismaila Ajayi Yusuf
- Department of Medicine and Surgery, Obafemi Awolowo University Teaching Hospital, Ife, Nigeria
| | | | | | - Doyin Olatunji
- Department of Health Sciences, Western Illinois University, Macomb, IL
| | - Olumide Akinmoju
- Department of Medicine and Surgery, University of Ibadan, Ibadan, Nigeria
| | - Nicholas Aderinto
- Department of Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
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7
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Barsukova A, Shvab M, Puttkammer NH, Vitruk O, Ihnatiuk AP, Hetman LI, McDowell MR, Collins PY, Shapoval AY. Impact of war on HIV-related healthcare services and health workers in eastern Ukraine: a qualitative study. AIDS Care 2024:1-9. [PMID: 38530993 DOI: 10.1080/09540121.2024.2332445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 03/12/2024] [Indexed: 03/28/2024]
Abstract
The 2022 Russian invasion of Ukraine has caused serious challenges for healthcare workers (HCWs) and HIV-related healthcare services. This study assessed the effects of the invasion on HCWs wellbeing and on continuity of HIV services, using in-depth interviews with HCWs from facilities offering HIV antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) services in the Donetsk region of Eastern Ukraine. A directed content analysis, with both inductive and deductive approaches, was conducted. Ten HCWs (6 [60%] doctors, 4 [40%] nurses; 9 [90%] female) were interviewed. Six respondents were displaced from their homes and worksites, and all described stress and threats to emotional wellbeing. HCWs used online consultations, encrypted mobile communication, and multi-month dispensing to support continuity of ART and PrEP services. They noted immediate needs for psychological and financial support, and access to laptop computers and mobile communications to ensure continuity of HIV services. Priorities for restoration of services include repair of health facilities, restoration of laboratory services and supply chains, and return of personnel and patients. HCWs made innovative, rapid adaptations to HIV services to keep ART and PrEP services running, demonstrating the resolve of Ukrainian HCWs to maintain continuity of HIV services despite the disruptions of war.
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Affiliation(s)
- Alla Barsukova
- International Training and Education Center for Health (I-TECH), Kyiv, Ukraine
| | - Maria Shvab
- International Training and Education Center for Health (I-TECH), Kyiv, Ukraine
| | - Nancy H Puttkammer
- International Training and Education Center for Health (I-TECH), Department of Global Health, University of Washington, Seattle, WA, USA
| | - Olga Vitruk
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Alyona P Ihnatiuk
- International Training and Education Center for Health (I-TECH), Kyiv, Ukraine
| | - Larisa I Hetman
- Public Health Center (PHC) of the Ministry of Health (MoH) of Ukraine, Kyiv, Ukraine
| | - Misti R McDowell
- International Training and Education Center for Health (I-TECH), Department of Global Health, University of Washington, Seattle, WA, USA
| | - Pamela Y Collins
- International Training and Education Center for Health (I-TECH), Department of Global Health, University of Washington, Seattle, WA, USA
| | - Anna Y Shapoval
- International Training and Education Center for Health (I-TECH), Kyiv, Ukraine
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8
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Leslie S, Ververs M. Chemical and Biological Threats: Guidance for Breastfeeding Women, Infants, and Young Children. Health Secur 2024; 22:172-181. [PMID: 38416870 PMCID: PMC11044851 DOI: 10.1089/hs.2023.0096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024] Open
Affiliation(s)
- Sharon Leslie
- Sharon Leslie, DPT, MPH, was a Research Associate; at the Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Sharon Leslie is now a Global Health Consultant, Los Altos, CA
| | - Mija Ververs
- Mija Ververs, MMed, MPH, RD, is a Senior Associate; at the Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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9
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Hedström J, Herder T. Women's sexual and reproductive health in war and conflict: are we seeing the full picture? Glob Health Action 2023; 16:2188689. [PMID: 36927249 PMCID: PMC10026773 DOI: 10.1080/16549716.2023.2188689] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
It is well established that women's sexual and reproductive health (SRHR) is negatively affected by war. While global health research often emphasises infrastructure and systematic factors as key impediments to women's SRHR in war and postwar contexts, reports from different armed conflicts indicate that women's reproduction may be controlled both by state and other armed actors, limiting women's choices and access to maternal and reproductive health care even when these are available. In addition, it is important to examine and trace disparities in sexual reproductive health access and uptake within different types of wars, recognising gendered differences in war and postwar contexts. Adding feminist perspectives on war to global health research explanations of how war affects women's sexual and reproductive health might then contribute to further understanding the complexity of the different gendered effects war and armed conflicts have on women's sexual and reproductive health.
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Affiliation(s)
- Jenny Hedström
- Department of War Studies and Military History, Swedish Defence University, Stockholm, Sweden
| | - Tobias Herder
- Division of Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
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10
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Biset G, Goshiye D, Gedamu S, Tsehay M. The effect of conflict on child and adolescent health in Amhara region, Ethiopia: Cross-Sectional Study. BMC Pediatr 2023; 23:463. [PMID: 37710207 PMCID: PMC10500724 DOI: 10.1186/s12887-023-04282-w] [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: 09/21/2022] [Accepted: 08/31/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Currently, conflict become common phenomenon in the world affecting the lives of millions of children. Due the continued conflict in Ethiopia millions of children are suffering from extreme levels of violence, lack of basic humanitarian needs, and lack of health services. OBJECTIVE This study was designed to assess the effect of conflict on child and adolescent health in Amhara region, September 2022. METHODS A community-based cross-sectional study was employed among children agedd < 18 years in conflict affected areas of Amhara region. The sample size was determined using a single population proportion formula. Data was collected through face-to-face interviews of children or child legal guardians. Data was cleaned, verified, and entered into EpiData version 3.1 and analysis was done using SPSS version 24 statistical software. RESULT Seven hundred and ninety-eight children agedd less than 18 years were involved with a response rate of 94.33 percent. More than one thirds (276, 34.59%) of children were displaced due to the conflict. Three hundred and thirty one (41.48%) children get diseased with the majority didn't receive treatment. More than two thirds (557, 69.80%) of children had experienced violence of different types. One hundred and thirty four (41.23%) children had acute malnutrition with two third (66.42%) of them had severe acute malnutrition. CONCLUSION Conflict had deadly impacts on the lives of children and adolescents. It causes massive displacement, lack of basic humanitarian needs, extreme level of violence, hunger and malnutrition, and lack of health services. The government and other national and international humanitarian aids should give special attention to children living in war zone of Amhara region. In addition, rehabilitation services and resilience training should be designed and provided to children affected by the conflict.
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Affiliation(s)
- Gebeyaw Biset
- Department of Pediatric and Child Health Nursing, School of Nursing and Midwifery, College of Medicine and Health Sciences, Wollo University, PO. Box 1145, Dessie, Ethiopia.
| | - Debrnesh Goshiye
- Department of Pediatric and Child Health Nursing, School of Nursing and Midwifery, College of Medicine and Health Sciences, Wollo University, PO. Box 1145, Dessie, Ethiopia
| | - Sisay Gedamu
- Department of Adult Health Nursing, School of Nursing and Midwifery, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Mekonnen Tsehay
- Department of Psychiatry, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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11
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Vilhelmsson A, Baum SD. Public health and nuclear winter: addressing a catastrophic threat. J Public Health Policy 2023; 44:360-369. [PMID: 37322225 PMCID: PMC10484806 DOI: 10.1057/s41271-023-00416-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2023] [Indexed: 06/17/2023]
Abstract
Despite the end of the Cold War, the world still has thousands of nuclear weapons and adversarial relations between the countries that possess them. A nuclear war could cause large and abrupt global environmental change known as nuclear winter, with potentially devastating public health consequences. A significant line of natural science research characterizes nuclear winter and its potential effect on global food security, but less has been done on the human impacts and policy implications. Therefore, this Viewpoint proposes an interdisciplinary research and policy agenda to understand and address the public health implications of nuclear winter. Public health research can apply existing tools developed for the study of other environmental and military issues. Public health policy institutions can help build preparedness and community resilience to nuclear winter. Given the extreme potential severity of nuclear winter, it should be treated as a major global public health challenge to be addressed by public health institutions and researchers.
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Affiliation(s)
- Andreas Vilhelmsson
- Division of Occupational and Environmental Medicine, Lund University, Medicon Village (Building 402a), Scheelevägen 8, SE-223 81, Lund, Sweden.
| | - Seth D Baum
- Global Catastrophic Risk Institute, PO Box 40364, Washington, DC, 20016, USA
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12
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Alhaffar M, Basaleem H, Othman F, Alsakkaf K, Naji SMM, Kolaise H, Babattah AK, Salem YAM, Brindle H, Yahya N, Pepe P, Checchi F. Adult mortality before and during the first wave of COVID-19 pandemic in nine communities of Yemen: a key informant study. Confl Health 2022; 16:63. [PMID: 36510241 PMCID: PMC9743127 DOI: 10.1186/s13031-022-00497-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Widespread armed conflict has affected Yemen since 2014. To date, the mortality toll of seven years of crisis, and any excess due to the COVID-19 pandemic, are not well quantified. We attempted to estimate population mortality during the pre-pandemic and pandemic periods in nine purposively selected urban and rural communities of southern and central Yemen (Aden and Ta'iz governorates), totalling > 100,000 people. METHODS Within each study site, we collected lists of decedents between January 2014-March 2021 by interviewing different categories of key community informants, including community leaders, imams, healthcare workers, senior citizens and others. After linking records across lists based on key variables, we applied two-, three- or four-list capture-recapture analysis to estimate total death tolls. We also computed death rates by combining these estimates with population denominators, themselves subject to estimation. RESULTS After interviewing 138 disproportionately (74.6%) male informants, we identified 2445 unique decedents. While informants recalled deaths throughout the study period, reported deaths among children were sparse: we thus restricted analysis to persons aged ≥ 15 years old. We noted a peak in reported deaths during May-July 2020, plausibly coinciding with the first COVID-19 wave. Death rate estimates featured uninformatively large confidence intervals, but appeared elevated compared to the non-crisis baseline, particularly in two sites where a large proportion of deaths were attributed to war injuries. There was no clear-cut evidence of excess mortality during the pandemic period. CONCLUSIONS We found some evidence of a peak in mortality during the early phase of the pandemic, but death rate estimates were otherwise too imprecise to enable strong inference on trends. Estimates suggested substantial mortality elevations from baseline during the crisis period, but are subject to serious potential biases. The study highlighted challenges of data collection in this insecure, politically contested environment.
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Affiliation(s)
- Mervat Alhaffar
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
| | - Huda Basaleem
- Department of Community Medicine and Public Health, Faculty of Medicine and Health Science, University of Aden, Aden, Yemen
| | - Fouad Othman
- Faculty of Medicine and Health Science, Ta'iz University, Ta'iz, Yemen
| | - Khaled Alsakkaf
- Department of Community Medicine and Public Health, Faculty of Medicine and Health Science, University of Aden, Aden, Yemen
| | | | - Hussein Kolaise
- Department of Internal Medicine, Faculty of Medicine and Health Science, University of Aden, Aden, Yemen
| | - Abdullah K Babattah
- Primary Health Care Program, Health Sector, HUMAN ACCESS for Partnership and Development, Aden, Yemen
| | | | - Hannah Brindle
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Pasquale Pepe
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Francesco Checchi
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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13
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Talbot A, Connor SG, Austin K, Hannon T, Gabbay E, Clay TD. The impact of the 2022 Ukraine/Russian conflict on cancer clinical trials. J Int Med Res 2022; 50:3000605221143284. [PMID: 36510451 DOI: 10.1177/03000605221143284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Since the invasion of Ukraine in February 2022, clinical trial conduct has become extremely challenging due to damage to the healthcare infrastructure and patient displacement. This current study aimed to estimate the number of cancer clinical trials at risk of impact from the conflict. A descriptive analysis and narrative review were completed using data from cancer clinical trials with sites in Russia or Ukraine using the 'clinical trials.gov' online database between February 2022 and May 2022. There were 508 clinical trials involving sites in Ukraine or Russia. Most were multinational studies (470 of 508; 93%). The majority of studies were phase 3 (344 of 508; 68%) and these also had the largest sample sizes (median 624, range 12-5637). The most common tumour types were lung (128 of 508; 25%), urogenital (94 of 508; 19%) and breast (78 of 508; 15%). A meaningful number of trials had curative intent (129 of 508; 25%). The most common intervention was immunotherapy-related (218 of 508; 43%), followed by other targeted therapy (185 of 508; 36%). Ukraine and Russia are both large centres for global clinical trial activity. The invasion of Ukraine may result in underpowering of international clinical trial results with loss of future recruitment sites for both countries.
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Affiliation(s)
- Alice Talbot
- Clinical Trials Unit, St John of God Hospital, Subiaco, Western Australia.,Bendat Respiratory Research and Development Fund, St John of God Hospital, Subiaco, Western Australia
| | - Sophia G Connor
- Clinical Trials Unit, St John of God Hospital, Subiaco, Western Australia.,Bendat Respiratory Research and Development Fund, St John of God Hospital, Subiaco, Western Australia
| | - Kate Austin
- Clinical Trials Unit, St John of God Hospital, Subiaco, Western Australia.,Bendat Respiratory Research and Development Fund, St John of God Hospital, Subiaco, Western Australia
| | - Tara Hannon
- Bendat Respiratory Research and Development Fund, St John of God Hospital, Subiaco, Western Australia
| | - Eli Gabbay
- Clinical Trials Unit, St John of God Hospital, Subiaco, Western Australia.,Bendat Respiratory Research and Development Fund, St John of God Hospital, Subiaco, Western Australia.,Department of Medicine, University of Notre Dame, Perth, Western Australia
| | - Timothy D Clay
- Clinical Trials Unit, St John of God Hospital, Subiaco, Western Australia.,Bendat Respiratory Research and Development Fund, St John of God Hospital, Subiaco, Western Australia.,Department of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia
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14
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Khanyk N, Hromovyk B, Levytska O, Agh T, Wettermark B, Kardas P. The impact of the war on maintenance of long-term therapies in Ukraine. Front Pharmacol 2022; 13:1024046. [PMID: 36506505 PMCID: PMC9731218 DOI: 10.3389/fphar.2022.1024046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 11/03/2022] [Indexed: 11/26/2022] Open
Abstract
Due to the Russian invasion, which started on 24 February 2022, the Ukrainian healthcare system is facing multiple challenges. A great number of healthcare facilities have been destroyed, while availability of other ones is often limited due to a lack of qualified medical staff. Certain services, e.g. cancer therapies, have been seriously disrupted. Moreover, millions of Ukrainians with chronic conditions are also suffering as due to war-related problems with execution of their long-term therapies. Availability of drugs is particularly limited in the occupied regions. According to the national statistics, as of 18 August 2022, about 505 pharmacies were damaged in Eastern Ukraine and 47 completely ruined. Moreover, the invaders have been blocking humanitarian aid provided to these territories by the Ukrainian government or other countries. Fortunately, in the areas controlled by the Government of Ukraine, the acute shortage of medicines, observed at the beginning of the war, has already been eliminated. Nevertheless, not all drugs are now fully available, even in the areas where no military attacks occur. The economic availability of drugs is also profoundly influenced by the significant increase in the cost of medications and the fall in average salaries. The Government of Ukraine is trying to minimise the impact of these war-related challenges by adopting a new legislation. This includes, among others, simplification of procedures for licensing, quality control and import of medicinal products to Ukraine. Other measures involve securing displaced people with the option of benefiting from local healthcare facilities, broadening the scope of the ePrescription system, authorizing primary care doctors to issue prescriptions to refugees, increasing the number of drugs reimbursed for long-term therapies, etc. These solutions, however, cannot balance all the harmful consequences the war in Ukraine brings in terms of maintenance of long-term therapies. Therefore, in order to minimise this negative impact, Ukraine still needs urgent international support in this area.
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Affiliation(s)
- Nataliia Khanyk
- Uppsala Universitet, Uppsala, Sweden,Danylo Halytsky Lviv, National Medical University, Lviv, Ukraine
| | - Bohdan Hromovyk
- Danylo Halytsky Lviv, National Medical University, Lviv, Ukraine
| | - Oksana Levytska
- Danylo Halytsky Lviv, National Medical University, Lviv, Ukraine
| | - Tamas Agh
- Syreon Research Institute, Budapest, Hungary
| | | | - Przemyslaw Kardas
- Department of Family Medicine, Medication Adherence Research Centre, Medical University of Lodz, Lodz, Poland,*Correspondence: Przemyslaw Kardas,
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15
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Wren SM, Wild H. Armed Conflicts Destroy Civilian Health Systems: Cancer Screening in Ukraine the Newest Casualty of World Conflict. World J Surg 2022; 46:2487-2488. [PMID: 35948827 DOI: 10.1007/s00268-022-06700-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2022] [Indexed: 10/15/2022]
Affiliation(s)
- Sherry M Wren
- Department of Surgery, Stanford University School of Medicine Stanford, G112 3801 Miranda Avenue, Palo Alto, CA, USA.
| | - Hannah Wild
- Department of Surgery, University of Washington, Seattle, WA, USA
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16
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Ogbu TJ, Rodriguez-Llanes JM, Moitinho de Almeida M, Speybroeck N, Guha-Sapir D. Human insecurity and child deaths in conflict: evidence for improved response in Yemen. Int J Epidemiol 2022; 51:847-857. [DOI: 10.1093/ije/dyac038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 02/24/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Since the beginning of the ongoing conflict in Yemen, >23 000 air strikes and >100 000 fatalities have been recorded. Data from Yemen Data Project linked >1300 child fatalities and >900 child injuries to air raids. However, there is little literature on the effect of the protracted armed conflict on the pattern of child mortality using data from small-scale surveys. We aimed to identify the pattern of the death rate for children aged <5 years (‘under-5’) and its relationship with human insecurity in Yemen.
Methods
We created a human insecurity index (i.e. severely insecure vs insecure) for the 22 governorates in Yemen from 2015 to 2019, using data from the Armed Conflict Location and Event Database. We matched this insecurity index with the corresponding under-5 mortality data from the Complex Emergency Database. We analysed the relationship between the under-5 death rate (U5DR) and the insecurity level using a Bayesian finite mixture model in order to account for unobserved heterogeneity in clustered finite subsets of a population.
Results
We extracted 72 surveys and 77.8% (n = 56) were included in this study. The mean of the recall period for mortality was 106 days with a standard deviation of 93 days. We identified two subpopulations: Subpopulation I—high average number of child deaths and Subpopulation II—low average number of child deaths. The log posterior mean of the U5DR is 1.10 (95% credible intervals: 0.36, 1.82) in the severely insecure group in Subpopulation I and 3-fold the estimate in Subpopulation II. However, in Subpopulation II, we found no association between the insecurity level and the U5DR.
Conclusion
The pattern of child deaths is crucial in understanding the relationship between human insecurity and the U5DR.
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Affiliation(s)
- Thomas Jideofor Ogbu
- Institut de Recherche Santé et Société (IRSS), Université Catholique de Louvain, Brussels, Belgium
- Center for Research on the Epidemiology of Disaster (CRED), Brussels, Belgium
| | | | - Maria Moitinho de Almeida
- Institut de Recherche Santé et Société (IRSS), Université Catholique de Louvain, Brussels, Belgium
- Center for Research on the Epidemiology of Disaster (CRED), Brussels, Belgium
| | - Niko Speybroeck
- Institut de Recherche Santé et Société (IRSS), Université Catholique de Louvain, Brussels, Belgium
| | - Debarati Guha-Sapir
- Institut de Recherche Santé et Société (IRSS), Université Catholique de Louvain, Brussels, Belgium
- Center for Research on the Epidemiology of Disaster (CRED), Brussels, Belgium
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17
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Guha Sapir D, Ogbu JT, Scales SE, de Almeida MM, Donneau AF, Diep A, Bernstein R, Al-Masnai A, Rodriguez-Llanes JM, Burnham G. Civil war and death in Yemen: Analysis of SMART survey and ACLED data, 2012-2019. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000581. [PMID: 36962390 PMCID: PMC10022117 DOI: 10.1371/journal.pgph.0000581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 06/07/2022] [Indexed: 05/04/2023]
Abstract
Conflict in Yemen has displaced millions and destroyed health infrastructure, resulting in the world's largest humanitarian disaster. The objective of this paper is to examine mortality in Yemen to determine whether it has increased significantly since the conflict began in 2015 compared to the preceding period. We analysed 91 household surveys using the Standardized Monitoring and Assessment of Relief and Transitions methodology, covering 2,864 clusters undertaken from 2012-2019, and deaths from Armed Conflict Location & Event Data Project database covering the conflict period 2015-2019. We used a Poisson-Gamma model to estimate pre-conflict (μp, baseline value) and conflict period (μc) mean death rates using household survey data from 2012-2019. To analyse changes in the distribution of deaths and estimate nationwide excess deaths, we applied pre- and post-conflict death rates to total population numbers. Further, we tested for association between excess death and security levels by governorate. The national estimated crude death rate/10,000 in the conflict period was 0.20 (95% CI: 0.17, 0.24), which is meaningfully higher than the estimated baseline rate of 0.19 (95% CI: 0.17, 0.22). Applying the conflict period rate to the Yemeni population, we estimated 168,212 excess deaths that occurred between 2015 and 2019. There was an 17.8% increase in overall deaths above the baseline during the conflict period. A large share (67.2%) of the excess deaths were due to combat-related violence. At the governorate level, posterior crude death rate varied across the country, ranging from 0.03 to 0.63 per 10,000 per day. Hajjah, Ibb, and Al Jawf governorates presented the highest total excess deaths. Insecurity level was not statistically associated with excess deaths. The health situation in Yemen was poor before the crisis in 2015. During the conflict, intentional violence from air and ground strikes were responsible for more deaths than indirect or non-violent causes. The provision of humanitarian aid by foreign agencies may have helped contain increases in indirect deaths from the conflict.
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Affiliation(s)
- Debarati Guha Sapir
- Centre for Research on the Epidemiology of Disasters, Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Jideofor Thomas Ogbu
- Centre for Research on the Epidemiology of Disasters, Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
| | - Sarah Elizabeth Scales
- Epidemiology Program, College of Health Sciences, University of Delaware, Newark, Delaware, United States of America
| | - Maria Moitinho de Almeida
- Centre for Research on the Epidemiology of Disasters, Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
| | | | - Anh Diep
- Public Health Department, Biostatistics Unit, University of Liege, Liege, Belgium
| | | | | | | | - Gilbert Burnham
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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18
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Ottolini M, Cirks B, Madden KB, Rajnik M. Pediatric Infectious Diseases Encountered During Wartime-Part 1: Experiences and Lessons Learned From Armed Conflict in the Modern Era. Curr Infect Dis Rep 2021; 23:27. [PMID: 34903952 PMCID: PMC8656442 DOI: 10.1007/s11908-021-00770-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE OF REVIEW Armed conflicts occur globally, with some regions experiencing heightened instability for many years. A better understanding of the infectious disease impact on children in armed conflict will allow aid organizations to anticipate and mitigate the most serious problems. RECENT FINDINGS Armed conflicts are estimated to have caused approximately 30 million civilian deaths during the past 27 years, with two-thirds occurring in women and children. Children are extremely vulnerable to the mass population displacements, experiencing a combined loss of safety, nutrition, shelter, hygiene, and health care. Under these circumstances, the emergence and prevalence of multiple infectious diseases can result in heightened morbidity and mortality long after active conflict ceases. SUMMARY Factors leading to increased infectious diseases in populations in crisis due to armed conflict and lessons learned from recent outbreaks are discussed in detail. Acute respiratory infections, diphtheria, measles, varicella, and cholera are a few of the more common infectious diseases that take advantage of populations displaced or disrupted by conflict. Key issues include the ability of countries or non-governmental organizations (NGOs) to keep up with basic childhood immunizations, and how rapidly disease outbreaks are recognized and addressed with disease-specific interventions.
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Affiliation(s)
- Martin Ottolini
- Departments of Pediatrics and Academic Affairs, The Uniformed Services University of the Health Sciences, Bethesda, MD USA
| | - Blake Cirks
- Departments of Pediatrics and Academic Affairs, The Uniformed Services University of the Health Sciences, Bethesda, MD USA
| | - Kathleen B. Madden
- Departments of Pediatrics and Academic Affairs, The Uniformed Services University of the Health Sciences, Bethesda, MD USA
| | - Michael Rajnik
- Departments of Pediatrics and Academic Affairs, The Uniformed Services University of the Health Sciences, Bethesda, MD USA
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19
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Implications of armed conflict for maternal and child health: A regression analysis of data from 181 countries for 2000-2019. PLoS Med 2021; 18:e1003810. [PMID: 34582455 PMCID: PMC8478221 DOI: 10.1371/journal.pmed.1003810] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 09/13/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Armed conflicts have major indirect health impacts in addition to the direct harms from violence. They create enduring political instability, destabilise health systems, and foster negative socioeconomic and environmental conditions-all of which constrain efforts to reduce maternal and child mortality. The detrimental impacts of conflict on global maternal and child health are not robustly quantified. This study assesses the association between conflict and maternal and child health globally. METHODS AND FINDINGS Data for 181 countries (2000-2019) from the Uppsala Conflict Data Program and World Bank were analysed using panel regression models. Primary outcomes were maternal, under-5, infant, and neonatal mortality rates. Secondary outcomes were delivery by a skilled birth attendant and diphtheria, pertussis, and tetanus (DPT) and measles vaccination coverage. Models were adjusted for 10 confounders, country and year fixed effects, and conflict lagged by 1 year. Further lagged associations up to 10 years post-conflict were tested. The number of excess deaths due to conflict was estimated. Out of 3,718 country-year observations, 522 (14.0%) had minor conflicts and 148 (4.0%) had wars. In adjusted models, conflicts classified as wars were associated with an increase in maternal mortality of 36.9 maternal deaths per 100,000 live births (95% CI 1.9-72.0; 0.3 million excess deaths [95% CI 0.2 million-0.4 million] over the study period), an increase in infant mortality of 2.8 per 1,000 live births (95% CI 0.1-5.5; 2.0 million excess deaths [95% CI 1.6 million-2.5 million]), a decrease in DPT vaccination coverage of 4.9% (95% CI 1.5%-8.3%), and a decrease in measles vaccination coverage of 7.3% (95% CI 2.7%-11.8%). The long-term impacts of war were demonstrated by associated increases in maternal mortality observed for up to 7 years, in under-5 mortality for 3-5 years, in infant mortality for up to 8 years, in DPT vaccination coverage for up to 3 years, and in measles vaccination coverage for up to 2 years. No evidence of association between armed conflict and neonatal mortality or delivery by a skilled birth attendant was found. Study limitations include the ecological study design, which may mask sub-national variation in conflict intensity, and the quality of the underlying data. CONCLUSIONS Our analysis indicates that armed conflict is associated with substantial and persistent excess maternal and child deaths globally, and with reductions in key measures that indicate reduced availability of organised healthcare. These findings highlight the importance of protecting women and children from the indirect harms of conflict, including those relating to health system deterioration and worsening socioeconomic conditions.
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20
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Alves LC, Sanchez MN, Hone T, Pinto LF, Nery JS, Tauil PL, Barreto ML, Penna GO. The association between a conditional cash transfer programme and malaria incidence: a longitudinal ecological study in the Brazilian Amazon between 2004 and 2015. BMC Public Health 2021; 21:1253. [PMID: 34187454 PMCID: PMC8243887 DOI: 10.1186/s12889-021-11255-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 06/09/2021] [Indexed: 11/25/2022] Open
Abstract
Background Malaria causes 400 thousand deaths worldwide annually. In 2018, 25% (187,693) of the total malaria cases in the Americas were in Brazil, with nearly all (99%) Brazilian cases in the Amazon region. The Bolsa Família Programme (BFP) is a conditional cash transfer (CCT) programme launched in 2003 to reduce poverty and has led to improvements in health outcomes. CCT programmes may reduce the burden of malaria by alleviating poverty and by promoting access to healthcare, however this relationship is underexplored. This study investigated the association between BFP coverage and malaria incidence in Brazil. Methods A longitudinal panel study was conducted of 807 municipalities in the Brazilian Amazon between 2004 and 2015. Negative binomial regression models adjusted for demographic and socioeconomic covariates and time trends were employed with fixed effects specifications. Results A one percentage point increase in municipal BFP coverage was associated with a 0.3% decrease in the incidence of malaria (RR = 0.997; 95% CI = 0.994–0.998). The average municipal BFP coverage increased 24 percentage points over the period 2004–2015 corresponding to be a reduction of 7.2% in the malaria incidence. Conclusions Higher coverage of the BFP was associated with a reduction in the incidence of malaria. CCT programmes should be encouraged in endemic regions for malaria in order to mitigate the impact of disease and poverty itself in these settings. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11255-0.
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Affiliation(s)
- Layana Costa Alves
- Fiocruz School of Government, Oswaldo Cruz Foundation, EFG/FIOCRUZ, Avenida L3 Norte, s/n, Campus Universitário Darcy Ribeiro, Gleba A, Brasília/DF, CEP: 70.904-130, Brazil. .,Institute of Collective Health, Federal University of Bahia, UFBA, Rua Basílio da Gama, s/n, Campus Universitário Canela, Salvador/BA, CEP: 40.110-040, Brazil.
| | - Mauro Niskier Sanchez
- Department of Collective Health, University of Brasília, UNB, Campus Universitário Darcy Ribeiro, s/n, Asa Norte, Brasília/DF, CEP: 70910-900, Brazil.,Tropical Medicine Centre, University of Brasília, UNB, Campus Universitário Darcy Ribeiro, s/n, Asa Norte, Brasília/DF, CEP: 70.904.970, Brazil
| | - Thomas Hone
- Public Health Policy Evaluation Unit, Imperial College, Imperial College London, Charing Cross Hospital, London, W6 8RP, UK
| | - Luiz Felipe Pinto
- Department of Medicine in Primary Health Care, School of Medicine, Federal University of Rio de Janeiro, UFRJ, Rua Laura de Araújo, 36 - 2 andar. Cidade Nova, Rio de Janeiro/RJ, CEP: 20211-170, Brazil.,Postdoctoral Fellow in the Institute of Hygiene and Tropical Medicine at Nova Medical School, R. da Junqueira 100, 1349-008, Lisbon, Portugal
| | - Joilda Silva Nery
- Institute of Collective Health, Federal University of Bahia, UFBA, Rua Basílio da Gama, s/n, Campus Universitário Canela, Salvador/BA, CEP: 40.110-040, Brazil.,Department of Collective Health, Federal University of Vale do São Francisco, UNIVASF, Rua da Aurora, s/n, General Dutra, Paulo Afonso/BA, CEP: 48607-190, Brazil
| | - Pedro Luiz Tauil
- Tropical Medicine Centre, University of Brasília, UNB, Campus Universitário Darcy Ribeiro, s/n, Asa Norte, Brasília/DF, CEP: 70.904.970, Brazil
| | - Maurício Lima Barreto
- Center for Data and Knowledge Integration for Health, CIDACS, Oswaldo Cruz Foundation, FIOCRUZ, Rua Mundo, 121, Trobogy, Salvador/BA, CEP: 41745-715, Brazil
| | - Gerson Oliveira Penna
- Fiocruz School of Government, Oswaldo Cruz Foundation, EFG/FIOCRUZ, Avenida L3 Norte, s/n, Campus Universitário Darcy Ribeiro, Gleba A, Brasília/DF, CEP: 70.904-130, Brazil.,Tropical Medicine Centre, University of Brasília, UNB, Campus Universitário Darcy Ribeiro, s/n, Asa Norte, Brasília/DF, CEP: 70.904.970, Brazil
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21
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Canning D. Inappropriate use of global health metrics for analysis of the determinants of health. Lancet 2021; 397:2048. [PMID: 34062141 DOI: 10.1016/s0140-6736(21)01111-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 05/07/2021] [Indexed: 11/22/2022]
Affiliation(s)
- David Canning
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA 02155, USA.
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22
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Parham GP, Mathieu KM, YouYou TG, Hicks ML, Henry-Tillman R, Mutombo A, Anaclet MM, Sylvain MK, Pinder L, Hicks MM, Kanda L, Kanda M. Establishing women's cancer care services in a fragile, conflict and violence affected ecosystem in Africa. Ecancermedicalscience 2021; 15:1231. [PMID: 34221114 PMCID: PMC8225336 DOI: 10.3332/ecancer.2021.1231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The majority of the world's poorest women (income < $1.90/day) reside in fragile, conflict and violence (FCV)-affected countries, like the Democratic Republic of the Congo. Health services in these settings have traditionally focused on immediate relief efforts, communicable diseases and malnutrition. Recent data suggests there is need to widen the focus to include cancer, as its incidence and mortality rates are rising. METHODS Employing competency-based learning strategies, Congolese health professionals were trained to perform same-day cervical cancer screening and treatment of precancerous lesions of the cervix; same-day clinical breast examination and breast ultrasound diagnostics; surgical treatment of invasive cancers of the breast and cervix; and infusion of cytotoxic chemotherapy. Outpatient breast and cervical cancer care clinics, a chemotherapy suite and surgical theatres were outfitted with equipment and supplies. RESULTS Combining local and regional hands-on training seminars with wise infrastructure investments, a team of US and Zambian oncology experts successfully implemented a clinical service platform for women's cancers in a private sector health facility in the Democratic Republic of the Congo. CONCLUSION We forged a novel partnership between oncology health professionals from Africa and its Diaspora, international philanthropic organisations, a cancer medicine access initiative and an established African cancer centre to build women's cancer services in a FVC-affected African setting.
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Affiliation(s)
- Groesbeck Preer Parham
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, 101 Manning Dr, Chapel Hill, NC 27514, USA
- Department of Obstetrics and Gynecology, University Teaching Hospital – Women and Newborn Hospital, 10101 Nationalist Way, Lusaka, Zambia
- https://orcid.org/0000-0001-5922-5990
| | - Kabongo Mukuta Mathieu
- Biamba Marie Mutombo Hospital, No. 9777, Boulevard Lumumba, Commune de Masina, Kinshasa, Democratic Republic of the Congo
| | - Tankoy Gombo YouYou
- Biamba Marie Mutombo Hospital, No. 9777, Boulevard Lumumba, Commune de Masina, Kinshasa, Democratic Republic of the Congo
| | - Michael L Hicks
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, 101 Manning Dr, Chapel Hill, NC 27514, USA
- Department of Obstetrics and Gynecology, University Teaching Hospital – Women and Newborn Hospital, 10101 Nationalist Way, Lusaka, Zambia
- St Mary Mercy Cancer Center, 36475 Five Mile Rd, Livonia, MI 48154, USA
- St Joseph Mercy Oakland Cancer Center, 44405 Woodward Ave, Suite 202, Pontiac, MI 48324, USA
- McLaren Macomb Medical Center, 1000 Harrington Blvd, Mount Clemens, MI 48043, USA
- https://orcid.org/0000-0002-1819-155X
| | - Ronda Henry-Tillman
- Winthrop P Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, 4301 West Markham St, Slot #725, Little Rock, AR 72205, USA
- https://orcid.org/0000-0002-1782-9523
| | - Alex Mutombo
- Biamba Marie Mutombo Hospital, No. 9777, Boulevard Lumumba, Commune de Masina, Kinshasa, Democratic Republic of the Congo
| | - Mukanya Mpalata Anaclet
- Biamba Marie Mutombo Hospital, No. 9777, Boulevard Lumumba, Commune de Masina, Kinshasa, Democratic Republic of the Congo
| | - Mulumba Kapuku Sylvain
- Biamba Marie Mutombo Hospital, No. 9777, Boulevard Lumumba, Commune de Masina, Kinshasa, Democratic Republic of the Congo
| | - Leeya Pinder
- Department of Obstetrics and Gynecology, University Teaching Hospital – Women and Newborn Hospital, 10101 Nationalist Way, Lusaka, Zambia
- Department of Oncology, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA
- https://orcid.org/0000-0002-8929-7810
| | - Maya M Hicks
- Howard University College of Medicine, 520 W St NW, Washington, DC 20059, USA
- https://orcid.org/0000-0002-1993-3367
| | - Louis Kanda
- Dikembe Mutombo Foundation, 400 Interstate N Pkwy, Suite 1040, Atlanta, GA 30339, USA
| | - Mirielle Kanda
- Dikembe Mutombo Foundation, 400 Interstate N Pkwy, Suite 1040, Atlanta, GA 30339, USA
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Severo PP, Furstenau LB, Sott MK, Cossul D, Bender MS, Bragazzi NL. Thirty Years of Human Rights Study in the Web of Science Database (1990-2020). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2131. [PMID: 33671671 PMCID: PMC7926733 DOI: 10.3390/ijerph18042131] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/09/2021] [Accepted: 02/09/2021] [Indexed: 12/22/2022]
Abstract
The study of human rights (HR) is vital in order to enhance the development of human beings, but this field of study still needs to be better depicted and understood because violations of its core principles still frequently occur worldwide. In this study, our goal was to perform a bibliometric performance and network analysis (BPNA) to investigate the strategic themes, thematic evolution structure, and trends of HR found in the Web of Science (WoS) database from 1990 to June 2020. To do this, we included 25,542 articles in the SciMAT software for bibliometric analysis. The strategic diagram produced shows 23 themes, 12 of which are motor themes, the most important of which are discussed in this article. The thematic evolution structure presented the 21 most relevant themes of the 2011-2020 period. Our findings show that HR research is directly related to health issues, such as mental health, HIV, and reproductive health. We believe that the presented results and HR panorama presented have the potential to be used as a basis on which researchers in future works may enhance their decision making related to this field of study.
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Affiliation(s)
- Priscilla Paola Severo
- Graduate Program in Law, University of Santa Cruz do Sul, Santa Cruz do Sul 96816-501, Brazil;
| | - Leonardo B. Furstenau
- Graduate Program of Industrial Systems and Processes, University of Santa Cruz do Sul, Santa Cruz do Sul 96816-501, Brazil;
| | - Michele Kremer Sott
- Graduate Program of Industrial Systems and Processes, University of Santa Cruz do Sul, Santa Cruz do Sul 96816-501, Brazil;
| | - Danielli Cossul
- Department of Psychology, University of Santa Cruz do Sul, Santa Cruz do Sul 96816-501, Brazil;
| | - Mariluza Sott Bender
- Multiprofessional Residency Program in Urgency and Emergency, Santa Cruz Hospital, Santa Cruz do Sul 96810-072, Brazil;
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON M3J 1P3, Canada
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