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Abaatyo J, Twakiire G, Favina A, Munaru G, Rukundo GZ. Body image, eating distress and emotional-behavioral difficulties among adolescents in Mbarara, Southwestern Uganda. BMC Public Health 2024; 24:1493. [PMID: 38835004 DOI: 10.1186/s12889-024-18973-1] [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: 08/15/2023] [Accepted: 05/27/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Adolescents frequently have emotional and behavioral difficulties as they struggle with the challenges of transition from childhood to adulthood. Many struggle with issues of body image and eating distress as they deal with the difficult and frequently perplexing changes that occur with puberty. Yet there is surprisingly little research on the emotional and behavioral challenges, as well as body image and eating distress among this sizable population in Uganda. This study sought to assess attitudes and behaviors related to body image and eating distress, as well as emotional and behavioral difficulties among adolescents in Mbarara, Southwestern Uganda. METHODS This was a cross-sectional study among 788 adolescents aged 13 to 19 years in secondary schools in Mbarara city and Mbarara district in south-western Uganda. The study employed the Body Image and Eating Distress scale to assess attitudes and behaviors about dieting and body shape and the extended version of the Strengths and Difficulties Questionnaire (SDQ) to assess for perceived emotional and behavioral difficulties. Logistic regression was used to identify the association between body image and eating distress and perceived difficulties. RESULTS The prevalence of high body image and eating distress was 10.8% while that of perceived emotional and behavioral difficulties was 45.8%. Some of the adolescents (16.1%) were dissatisfied with their body shape, 24.6% exercised a lot to avoid gaining weight, 15.0% were terrified to gain even a little weight, and 12.1% could not control their eating. More males reported eating large amounts of food at one time (p = < 0.001). Having emotional and behavioral difficulties (aOR: 1.89; 95% CI: 1.18 - 3.02; p = 0.019) and coming from a two-parent household (aOR: 1.79; 95% CI: 1.10 - 2.92; p = 0.019) increased the odds of high body image and eating distress. CONCLUSION High levels of body image and eating distress are linked to behavioral and emotional problems and adolescent's family structure. Clinicians who treat adolescents should use a holistic care strategy and be aware of the high prevalence and close association between emotional and behavioral difficulties, concerns about weight, and dieting. It is important to encourage parental involvement and support in providing information about mental health issues among adolescents.
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Affiliation(s)
- Joan Abaatyo
- School of medicine, King Ceasor University, Kampala, Uganda.
- Department of Psychiatry, Uganda Christian University, Kampala, Uganda.
| | - Godwin Twakiire
- African Center for Suicide Prevention and Research, Mbarara, Uganda
| | - Alain Favina
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Gideon Munaru
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Godfrey Zari Rukundo
- African Center for Suicide Prevention and Research, Mbarara, Uganda
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
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König A, Sappayabanphot J, Liang L, Fleßa S, Winkler V. The impact of the health microinsurance M-FUND on the utilization of health services among migrant workers and their dependents in Thailand: A case-control study. J Migr Health 2024; 9:100236. [PMID: 38799076 PMCID: PMC11127229 DOI: 10.1016/j.jmh.2024.100236] [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: 01/06/2024] [Revised: 04/23/2024] [Accepted: 05/12/2024] [Indexed: 05/29/2024] Open
Abstract
Background Even though Thailand has launched multiple migrant health policies, migrants still face various barriers in accessing health care. To some extent, these barriers may be reduced by health microinsurance. The M-FUND is a low-cost, not-for-profit health protection scheme for migrant workers in Thailand, created by Dreamlopments Social Enterprise and Foundation to support sustainable access to quality healthcare services for migrants. We aimed to investigate the impact of the M-FUND on utilization of health services. Methods Over a period of three months, we conducted quantitative face-to-face interviews with 408 M-FUND members, and 452 age, sex and location matched non-member controls in Tak Province, Thailand. We compared utilization of health services between members and non-members using logistic regression controlling for a number of socio-demographic variables and variables related to migration such as years in Thailand, legal status, etc. Findings M-FUND members were more likely to have utilized outpatient services (adjusted odds ratio: 1·74, 95 % confidence interval: 1·24-2·44), inpatient services (2·96, 1.11-7·92), and emergency care (1·89, 0·78-4·56), although the latter was not statistically significant. Members were more likely not to have purchased medicines over-the-counter (1·67, 1·22-2·27) than non-members. Members were also more likely to have utilized any additional specific service during a consultation (2·31, 1·49-3·58) including any type of imaging method (2·62, 1·29-5·29) and blood tests (1·64, 0·99-2·71). There were some differences between men and women, but most were not statistically significant. Interpretation The M-FUND health microinsurance was positively associated with the utilization of all major types of health services among migrant workers and their dependents in Thailand. For migrants, particularly vulnerable migrant workers and their dependents, the M-FUND appears to be a good approach to reducing barriers to health care. This study of the impact of health microinsurance for migrants provides important information for policy and program planners in the field of migrant health. However, more research is needed on health microinsurance schemes for migrants in different settings and for other underserved communities as well as the sex-specific impact on health service utilization.
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Affiliation(s)
- Andrea König
- Epidemiology of Transition, Heidelberg Institute of Global Health, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, Heidelberg 69120, Germany
| | | | - Li Liang
- Faculty of Public Health, Thammasat University, Pathum Thani, Thailand
| | - Steffen Fleßa
- Faculty of Law and Economics, University of Greifswald, Germany
| | - Volker Winkler
- Epidemiology of Transition, Heidelberg Institute of Global Health, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, Heidelberg 69120, Germany
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Al-Hajj S, Moustafa M, El Hechi M, Chahrour MA, Nasrallah AA, Kaafarani H. Physical injuries and burns among refugees in Lebanon: implications for programs and policies. Confl Health 2023; 17:42. [PMID: 37749592 PMCID: PMC10518957 DOI: 10.1186/s13031-023-00539-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 08/29/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Refugees are prone to higher risks of injury due to often austere living conditions, social and economic disadvantages, and limited access to health care services in host countries. This study aims to systematically quantify the prevalence of physical injuries and burns among the refugee community in Western Lebanon and to examine injury characteristics, risk factors, and outcomes. METHODS We conducted a cluster-based population survey across 21 camps in the Beqaa region of Lebanon from February to April 2019. A modified version of the 'Surgeons Overseas Assessment of Surgical Need (SOSAS)' tool (Version 3.0) was administered to the head of the refugee households and documented all injuries sustained by family members over the last 12 months. Descriptive and univariate regression analyses were performed to understand the association between variables. RESULTS 750 heads of households were surveyed. 112 (14.9%) households sustained injuries in the past 12 months, 39 of which (34.9%) reported disabling injuries that affected their work and daily living. Injuries primarily occurred inside the tent (29.9%). Burns were sustained by at least one household member in 136 (18.1%) households in total. The majority (63.7%) of burns affected children under 5 years and were mainly due to boiling liquid (50%). Significantly more burns were reported in households where caregivers cannot lock children outside the kitchen while cooking (25.6% vs 14.9%, p-value = 0.001). Similarly, households with unemployed heads had significantly more reported burns (19.7% vs. 13.3%, p value = 0.05). Nearly 16.1% of the injured refugees were unable to seek health care due to the lack of health insurance coverage and financial liability. CONCLUSIONS Refugees severely suffer from injuries and burns, causing substantial human and economic repercussions on the affected individuals, their families, and the host healthcare system. Resources should be allocated toward designing safe camps as well as implementing educational awareness campaigns specifically focusing on teaching about heating and cooking safety practices.
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Affiliation(s)
- Samar Al-Hajj
- Faculty of Health Sciences, American University of Beirut, Van Dyck Hall, Riad El-Solh, PO Box 11-0236, Beirut, 1107 2020, Lebanon.
| | | | - Majed El Hechi
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mohamad A Chahrour
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali A Nasrallah
- Division of Urology, Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Haytham Kaafarani
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Mourtada R, Melnikas AJ. Syrian refugee women's access to family planning services and modern contraception during overlapping crises in Bekaa, Lebanon. BMC Womens Health 2023; 23:475. [PMID: 37674178 PMCID: PMC10481481 DOI: 10.1186/s12905-023-02613-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/22/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Political, financial, and pandemic crises in Lebanon have affected both provision of reproductive health services including family planning and modern contraception methods as well as women's interest and ability to seek those services. This study aims to explore the impact of the compounding crises on the provision and use of family planning services including modern contraception methods for Syrian refugees in Lebanon focusing on the perspectives of Syrian refugee women. METHODS We carried out 12 Focus Group Discussions (FGDs) with 119 Syrian refugee women recruited from two cities in West Bekaa, Lebanon from inside and outside the informal tented settlements. We used Skype video calls to moderate the FGDs due to the limited mobility at the time of the study because of Covid-19. We used thematic analyses to analyse the data. RESULTS The crises seemed to exacerbate supply side barriers, which influenced provision of family planning services and women's demand for them. These included Covid-19 regulations and maltreatment by staff at public health facilities, disruption of outreach reproductive health services that provide family planning and modern contraception, and reduced supply of modern contraception methods. On the demand side, women reported financial limitations in accessing and paying for services, concern over being infected with Covid-19, and concerns about insecurity. CONCLUSIONS We suggest possible interventions to address these challenges and better reach these populations. These include using mobile health technology (mHealth) that may provide contraceptive counselling and/or can inform refugee women about where they may receive family planning and modern contraception. These services may also support Syrian refugees to access care they are entitled to receive and may also address disruptions in service provision due to overlapping crises, including availability and rising costs of contraceptives. These can be coupled with mobile outreach reproductive health services that provide family planning. We also suggest considering the provision of Long Acting Reversible Contraception (LARC) for Syrian refugee women, which would reduce a barrier of needing to revisit health facilities to obtain an additional supply of contraception pills.
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Affiliation(s)
- Rima Mourtada
- Population Council. One Dag Hammarskjold Plaza, New York, NY, 10017, USA.
| | - Andrea J Melnikas
- Population Council. One Dag Hammarskjold Plaza, New York, NY, 10017, USA
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van de Pas R, Mans L, Koutsoumpa M. An exploratory review of investments by development actors in health workforce programmes and job creation. HUMAN RESOURCES FOR HEALTH 2023; 21:54. [PMID: 37420237 DOI: 10.1186/s12960-023-00835-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 06/14/2023] [Indexed: 07/09/2023]
Abstract
The World Health Organization's Global Strategy on Human Resources for Health: Workforce 2030 identified a projected shortfall of 18 million health workers by 2030, primarily in low- and middle-income countries. The need for investment was re-enforced by the 2016 report and recommendations of the United Nations High-Level Commission on Health Employment and Economic Growth. This exploratory policy tracing study has as objective to map and analyse investments by bilateral, multilateral and other development actors in human resources for health actions, programmes and health jobs more broadly since 2016. This analysis will contribute to the accountability of global human resources for health actions and its commitment by the international community. It provides insights in gaps, priorities and future policies' needs. The study follows an exploratory rapid review methodology, mapping and analysing the actions of four categories of development actors in implementing the ten recommendations of the United Nations High-Level Commission on Health Employment and Economic Growth. These four categories of actors include (A) bilateral agencies, (B) multilateral initiatives, (C) international financial institutions and (D) non-state actors. Analysing the data generated via this review, three trends can be observed. Firstly, while a broad range of human resources for health actions and outputs have been identified, data on programme outcomes and especially on their impacts are limited. Secondly, many of the programmatic human resources for health actions, often funded via bilateral or philanthropic grants and implemented by non-governmental organisations, seemed to be rather short-term in nature, focusing on in-service training, health security, technical and service delivery needs. Despite the strategic guidance and norms developed by multilateral initiatives, such as the International Labour Organization-Organisation for Economic Co-operation and Development-World Health Organization Working for Health programme, has it been for several development projects difficult to assess how their activities actually contributed to national human resources for health strategic development and health system reforms. Lastly, governance, monitoring and accountability between development actors and across the policy recommendations from the United Nations High-Level Commission on Health Employment and Economic Growth could be improved. There has been limited actionable progress made for the enablers required to transform the workforce, including in the domain of generating fiscal space for health that would strengthen jobs in the health sector, the development of health workforce partnerships and its global agenda, and the governance of international health workforce migration. In conclusion, one can observe that global health workforce needs are much recognised, especially given the impact of the Covid-19 pandemic. However, 20 years after the Joint Learning Initiative on Human Resources for Health, there is still an urgent need to take shared responsibility for international cooperative action for overcoming and addressing persistent underinvestment in the health workforce. Specific policy recommendations are provided to this end.
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Affiliation(s)
- Remco van de Pas
- Institute of Tropical Medicine, Department of Public Health, Nationalestraat 155, 2000, Antwerp, Belgium.
- Centre for Planetary Health Policy, Cuvrystrasse 1, 10997, Berlin, Germany.
| | - Linda Mans
- Manskracht, Van den Havestraat 42, 6521 JS, Nijmegen, The Netherlands
| | - Myria Koutsoumpa
- Wemos, Plantage Middenlaan 14, 1018 DD, Amsterdam, The Netherlands
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Workie K, Tinsae T, Salelew E, Asrat B. Gender-based violence and its associated factors among internally displaced women in Northwest Ethiopia: a cross-sectional study. BMC Womens Health 2023; 23:166. [PMID: 37024889 PMCID: PMC10080783 DOI: 10.1186/s12905-023-02306-2] [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: 01/09/2023] [Accepted: 03/24/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Gender-based violence (GBV) is a common human right violence in conflict-affected communities. Women with GBV are prone to experience mental health problems such as post-traumatic stress disorder, depression, and anxiety. However, there is a paucity of evidence as to what extent the problem is affecting internally displaced women (IDW) in Ethiopia. This study aimed to assess the prevalence of GBV and its associated factors among IDW in Northwest Ethiopia. METHODS A cross-sectional study was conducted among IDW residing at three humanitarian sites from May to June 2022 in Northwest Ethiopia. Study participants were selected using a stratified simple random sampling technique from the three sites. GBV was assessed using a 6-item Assessment Screen to Identify Survivors Toolkit questionnaire for Gender-based violence (ASIST-GBV). Data were analyzed using binary logistic regression. All variables with a p-value of ≤ 0.05 in the multivariable analysis were defined to have a statistically significant association with GBV at a 95% confidence interval (CI). RESULTS Of 424 approached candidates, 412 (97.2%) of them participated in the study. A one-year prevalence of GBV was 37.9% (95%CI = 33.2-42.6) among IDW in Northwest Ethiopia. The mean age of the participants was 31.3 (± 7.6) years. Young women, 18-24 years old (AOR = 3.52, 95%CI = 2.15-5.34, p ≤ 0.001) and 25-29 years old (AOR = 2.41, 95%CI = 1.57-3.24, p ≤ 0.001) had a statistically significant association with GBV. Moreover, having no social protection (AOR = 3.18, 95%CI = 2.65-6.22, p ≤ 0.001), being current alcohol user (AOR = 2.54, 95%CI = 1.22-4.78, p ≤ 0.001) and being single in marital status (AOR = 1.69, 95%CI = 1.18-2.87, p < 0.01) showed a statistical association with GBV. CONCLUSION We found a high prevalence of GBV among IDW in Northwest Ethiopia which indicates that IDW are prone to GBV. We call for immediate action and special attention to young women in conflict-affected parts of Ethiopia. It is crucial to establish a system that ensures the safety, security, and well-being of women in humanitarian settings.
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Affiliation(s)
- Keralem Workie
- Department of Psychiatry, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Techilo Tinsae
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, P.o.Box: 196, Gondar, Ethiopia
| | - Endalamaw Salelew
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, P.o.Box: 196, Gondar, Ethiopia
| | - Biksegn Asrat
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, P.o.Box: 196, Gondar, Ethiopia.
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Ramos AA. Considerations in designing trauma-focused interventions for displaced Afghan women. Front Glob Womens Health 2023; 3:893957. [PMID: 36909736 PMCID: PMC9996057 DOI: 10.3389/fgwh.2022.893957] [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: 03/11/2022] [Accepted: 12/21/2022] [Indexed: 02/25/2023] Open
Abstract
In light of the 2021 United States military withdrawal from Afghanistan, as well as the humanitarian crises of mass displacement and subsequent health system strain that have ensued, practitioners worldwide will need to develop a more nuanced understanding of the adverse life experiences that women from Afghanistan frequently endorse. As they bear a disproportionate impact of constraints within Afghan society, and as patriarchal systems affect most of their life domains, women from Afghanistan may present with high levels of baseline trauma upon resettlement, and health systems may seek to attenuate this distress; However, the nature of these traumatogenic events may shape women's receptivity to psychosocial interventions, particularly those which are at least partially rooted in Western modalities. In the absence of sufficient literature on evidence-based interventions for this population, a diversity of ethnographic and clinical literature is synthesized, including literature on interventions alleged to be compatible with Afghan norms. As it will be essential to support Afghan women's mental health following social reorganization on a massive scale, considerations arising from the interdisciplinary literature are offered so that they may inform the development of structured, trauma-focused interventions and so that the health systems with which they interface may be better prepared to serve them.
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Ndungu J, Ngcobo-Sithole M, Gibbs A. Learners' viewpoints on the possibilities and limitations imposed by social contexts on online group-based participatory interventions to address violence. Glob Public Health 2022; 17:3894-3911. [PMID: 35748787 DOI: 10.1080/17441692.2022.2092182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Intimate partner violence (IPV) is a global public health concern amongst young people. Consequently, prevention efforts in the form of participatory interventions have been implemented, mainly in face-to-face settings. However, in recent years, there has been a growing interest to deliver participatory IPV prevention interventions online, and this has been exacerbated by COVID-19 imposed limitations. There remain concerns, however, about the impact social contexts may have on transformative communication in participatory interventions online. We conducted semi-structured interviews with 18 learners (14-19 years) from Eastern Cape province, South Africa, to understand the possibilities and limitations that social contexts impose on online participatory IPV prevention interventions. Access to devices, reliable internet, and privacy in homes provided opportunities for online IPV prevention interventions, while limited privacy, safety, concentration, and familiarity with some apps online challenged young people's interest in online IPV prevention interventions. We also found that young people's greatest concern was around achieving trust, privacy and safety online. More evidence is needed on how trust, privacy, and safety, supportive of transformative communication, can be achieved online. Further, young people are active and strategic in their engagements online and their potential to generate creative relevant solutions to address these challenges is highlighted.
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Affiliation(s)
- Jane Ndungu
- School of Behavioural Sciences, Nelson Mandela University, Port Elizabeth, South Africa
| | | | - Andrew Gibbs
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa.,Centre for Rural Health, School of Nursing and Public Health, University of Kwa-Zulu Natal, Durban, South Africa.,Institute for Global Health, University College London, London, UK
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Ismail SA, Lam ST, Bell S, Fouad FM, Blanchet K, Borghi J. Strengthening vaccination delivery system resilience in the context of protracted humanitarian crisis: a realist-informed systematic review. BMC Health Serv Res 2022; 22:1277. [DOI: 10.1186/s12913-022-08653-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 10/09/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Childhood vaccination is among the most effective public health interventions available for the prevention of communicable disease, but coverage in many humanitarian settings is sub-optimal. This systematic review critically evaluated peer-review and grey literature evidence on the effectiveness of system-level interventions for improving vaccination coverage in protracted crises, focusing on how they work, and for whom, to better inform preparedness and response for future crises.
Methods
Realist-informed systematic review of peer-reviewed and grey literature. Keyword-structured searches were performed in MEDLINE, EMBASE and Global Health, CINAHL, the Cochrane Collaboration and WHOLIS, and grey literature searches performed through the websites of UNICEF, the Global Polio Eradication Initiative (GPEI) and Technical Network for Strengthening Immunization Services. Results were independently double-screened for inclusion on title and abstract, and full text. Data were extracted using a pre-developed template, capturing information on the operating contexts in which interventions were implemented, intervention mechanisms, and vaccination-related outcomes. Study quality was assessed using the MMAT tool. Findings were narratively synthesised.
Results
50 studies were included, most describing interventions applied in conflict or near-post conflict settings in sub-Saharan Africa, and complex humanitarian emergencies. Vaccination campaigns were the most commonly addressed adaptive mechanism (n = 17). Almost all campaigns operated using multi-modal approaches combining service delivery through multiple pathways (fixed and roving), health worker recruitment and training and community engagement to address both vaccination supply and demand. Creation of collaterals through service integration showed generally positive evidence of impact on routine vaccination uptake by bringing services closer to target populations and leveraging trust that had already been built with communities. Robust community engagement emerged as a key unifying mechanism for outcome improvement across almost all of the intervention classes, in building awareness and trust among crisis-affected populations. Some potentially transformative mechanisms for strengthening resilience in vaccination delivery were identified, but evidence for these remains limited.
Conclusion
A number of interventions to support adaptations to routine immunisation delivery in the face of protracted crisis are identifiable, as are key unifying mechanisms (multi-level community engagement) apparently irrespective of context, but evidence remains piecemeal. Adapting these approaches for local system resilience-building remains a key challenge.
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Tan SE, Kuschminder K. Migrant experiences of sexual and gender based violence: a critical interpretative synthesis. Global Health 2022; 18:68. [PMID: 35765002 PMCID: PMC9241205 DOI: 10.1186/s12992-022-00860-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gender based violence (GBV) is a critical issue and migrants are at higher risk of experiencing and being victimized by GBV. This critical interpretative synthesis (CIS) examines migrants experiences of GBV with a focus on different migrant groups and experiences at different stages of the migrant journey. METHOD The guiding question of this review is: "how do migrants experience gender-based violence?" A total of 84 studies were included in the CIS, of which 67 peer-reviewed academic articles were selected from 2356 studies found on WebofScience, MedLINE, and ProQuest, and 17 relevant studies from the grey literature were selected from the time period 2011 to 2020. All final studies were reviewed and synthesized using a critical inductive approach to formulate the key results. RESULTS The results demonstrate a high prevalence of GBV amongst migrants, and in particular among vulnerable migrant groups such as forced migrants and irregular migrants, with an emerging focus on male victims. Findings of the CIS revealed three key themes: 1) Most GBV occurrences are rooted in unequal power dynamics; 2) Victims often live with long-lasting consequences that are worsened by their fear of disclosure and stigmatization; 3) There are differential understandings of victimhood across organizations, communities, and victims themselves. In order to support access, sampling, and methodological challenges in this field of research, this article also reports its findings on common risk-factors identified, consequences and coping mechanisms reported, protection policies targeting GBV, and finally, available databases and data collection methods. CONCLUSION Further directions for research should be encouraged to move beyond prevalence reporting into identifying risk-factors and possible prevention in both sexes. In addition, more research on GBV experiences throughout migrants' journeys, and coping mechanisms should be encouraged.
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Affiliation(s)
- Sze Eng Tan
- UNU-MERIT / Maastricht University, Boschstraat 24, 6211, AX, Maastricht, The Netherlands
| | - Katie Kuschminder
- Department of Political Science, University of Amsterdam, Nieuwe Achtergracht 166, 1018, Amsterdam, WV, Netherlands.
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Wirtz AL, Page KR, Stevenson M, Guillén JR, Ortíz J, López JJ, Ramírez JF, Quijano C, Vela A, Moreno Y, Rigual F, Case J, Hakim AJ, Hladik W, Spiegel PB. HIV surveillance and research for migrant populations: a protocol integrating respondent-driven sampling, case finding, and medicolegal services for Venezuelans living in Colombia (Preprint). JMIR Res Protoc 2021; 11:e36026. [PMID: 35258458 PMCID: PMC8941430 DOI: 10.2196/36026] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 01/05/2022] [Indexed: 11/17/2022] Open
Abstract
Background Epidemiologic research among migrant populations is limited by logistical, methodological, and ethical challenges, but it is necessary for informing public health and humanitarian programming. Objective We describe a methodology to estimate HIV prevalence among Venezuelan migrants in Colombia. Methods Respondent-driven sampling, a nonprobability sampling method, was selected for attributes of reaching highly networked populations without sampling frames and analytic methods that permit estimation of population parameters. Respondent-driven sampling was modified to permit electronic referral of peers via SMS text messaging and WhatsApp. Participants complete sociobehavioral surveys and rapid HIV and syphilis screening tests with confirmatory testing. HIV treatment is not available for migrants who have entered Colombia through irregular pathways; thus, medicolegal services integrated into posttest counseling provide staff lawyers and legal assistance to participants diagnosed with HIV or syphilis for sustained access to treatment through the national health system. Case finding is integrated into respondent-driven sampling to allow partner referral. This study is implemented by a local community-based organization providing HIV support services and related legal services for Venezuelans in Colombia. Results Data collection was launched in 4 cities in July and August 2021. As of November 2021, 3105 of the target 6100 participants were enrolled, with enrollment expected to end by February/March 2022. Conclusions Tailored methods that combine community-led efforts with innovations in sampling and linkage to care can aid in advancing health research for migrant and displaced populations. Worldwide trends in displacement and migration underscore the value of improved methods for translation to humanitarian and public health programming. International Registered Report Identifier (IRRID) DERR1-10.2196/36026
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Affiliation(s)
- Andrea L Wirtz
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Center for Humanitarian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Kathleen R Page
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Center for Humanitarian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Division of Infectious Diseases, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Megan Stevenson
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | | | | | | | | | | | | | | | | | - James Case
- Johns Hopkins School of Nursing, Baltimore, MD, United States
| | - Avi J Hakim
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Wolfgang Hladik
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Paul B Spiegel
- Center for Humanitarian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Moustafa MK, Al-Hajj S, El-Hechi M, El Moheb M, Chamseddine Z, Kaafarani HMA. The Burden of Surgical Disease and Access to Care in a Vulnerable Syrian Refugee Population in Lebanon. World J Surg 2021; 45:3019-3026. [PMID: 34312694 PMCID: PMC8313117 DOI: 10.1007/s00268-021-06242-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2021] [Indexed: 11/27/2022]
Abstract
Background The Syrian conflict has produced one of the largest refugee crises in modern times. Lebanon has taken in more Syrian refugees per capita than any other nation. We aimed to study the burden of surgical disease and access to surgical care among Syrian refugees in Lebanon. Methods This study was designed as a convenient cross-sectional cluster-based population survey of all refugee camps throughout the Bekaa region of Lebanon. We used a modified version of the Surgeons OverSeas Assessment of Surgical Need to identify surgical conditions and barriers to care access. The head of household of each informal tented settlement provided demographic information after which two household members were randomly chosen and administered the survey. Results A total of 1,500 individuals from 750 households representing 21 camps were surveyed. Respondents had a mean age of 36.6 (15.0) years, 54.6% were female, and 59% were illiterate. Nearly 25% of respondents reported at least one surgical condition within the past year, most commonly involving the face, head, and neck region (32%) and extremities (22%). Less than 20% of patients with a surgical condition reported seeing any healthcare provider, > 75% due to financial hardship. Conclusions The prevalence of surgical disease among Syrian refugees is very high with a fourth of refugees suffering from one or more surgical conditions over the past year. The surgical needs of this vulnerable population are largely unmet as financial reasons prevent patients from seeking care. Local and humanitarian efforts need to include increased access to surgical care.
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Affiliation(s)
| | - Samar Al-Hajj
- Faculty of Health Sciences, Health Management and Policy Department, American University in Beirut, Bliss Street, Beirut, Lebanon.
| | - Majed El-Hechi
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA
| | - Mohamad El Moheb
- Department of Surgery, University of Virginia, Charlottesville, VA, USA
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA
| | - Zahraa Chamseddine
- Faculty of Health Sciences, Health Management and Policy Department, American University in Beirut, Bliss Street, Beirut, Lebanon
| | - Haytham M A Kaafarani
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA.
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Naal H, Nabulsi D, El Arnaout N, Abdouni L, Dimassi H, Harb R, Saleh S. Prevalence of depression symptoms and associated sociodemographic and clinical correlates among Syrian refugees in Lebanon. BMC Public Health 2021; 21:217. [PMID: 33499834 PMCID: PMC7836044 DOI: 10.1186/s12889-021-10266-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 01/19/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Since the outbreak of the Syrian war in 2011, close to 6 million Syrian refugees have escaped to Syria's neighbouring countries, including Lebanon. Evidence suggests rising levels of mental health disorders among Syrian refugee populations. Yet, to the best of our knowledge, large-scale studies addressing the mental health of adult Syrian refugees in Lebanon are lacking. We examined the prevalence of depression symptoms, which represent a common and debilitating mental health disorder among Syrian refugee populations in Lebanon, along with their sociodemographic and clinical correlates. METHODS A cross-sectional survey design was conducted as part of a collaborative project-"Sijilli"- led by the Global Health Institute at the American University of Beirut (Beirut, Lebanon) across 4 informal tented settlements for refugees (Beirut, Bekaa, North, South) in Lebanon among adult Syrian refugees (≥18), over a period extending from 2018 to 2020. The survey inquired about participants' sociodemographic and clinical characteristics, and screened participants for symptoms of depression through sequential methodology using the Patient Health Questionnaire (PHQ-2 and PHQ-9). RESULTS A total of 3255 adult Syrian refugees were enrolled in the study. Of those refugees, 46.73% (n = 1521) screened positive on the PHQ-2 and were therefore eligible to complete the PHQ-9. In the entire sample (n = 3255), the prevalence of moderate to severe depression symptoms (PHQ-2 ≥ 2 and then PHQ-9 ≥ 10) was 22% (n = 706). Further analyses indicate that being ≥45 years of age (OR 1.61, 95% CI 1.13-2.30), a woman (OR 1.34, 95% CI 1.06-1.70), widowed (OR 2.88, 95% CI 1.31-6.32), reporting a neurological (OR 1.73, 95% CI 1.15-2.60) or a mental health condition (OR 3.98, 95% CI 1.76-8.97) are major risk factors for depression. CONCLUSION Our study suggests that an estimated one in four Syrian refugees in Lebanon shows moderate to severe depression symptoms, and our findings have important public health and clinical implications on refugee health. There is a need to enhance screening efforts, to improve access and referral to mental health services, and to improve post-migration factors among Syrian refugees in Lebanon.
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Affiliation(s)
- Hady Naal
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Dana Nabulsi
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Nour El Arnaout
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Lina Abdouni
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Hani Dimassi
- School of Pharmacy, Lebanese American University, Beirut, Lebanon
| | - Ranime Harb
- School of Pharmacy, Lebanese American University, 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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Durrance-Bagale A, Salman OM, Omar M, Alhaffar M, Ferdaus M, Newaz S, Krishnan S, Howard N. Lessons from humanitarian clusters to strengthen health system responses to mass displacement in low and middle-income countries: A scoping review. J Migr Health 2020; 1-2:100028. [PMID: 33458716 PMCID: PMC7790453 DOI: 10.1016/j.jmh.2020.100028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/03/2020] [Accepted: 12/03/2020] [Indexed: 11/17/2022] Open
Abstract
Potential scope for health-system learning from cluster responses to mass displacement. Non-health clusters can contribute to health improvements during mass displacement. Cluster approaches are often siloed with insufficient cross-cluster learning. Equitable power dynamics between displaced people, humanitarian actors, and governments are still needed.
The humanitarian cluster approach was established in 2005 but clarity on how lessons from humanitarian clusters can inform and strengthen health system responses to mass displacement in low and middle-income countries (LMIC) is lacking. We conducted a scoping review to examine the extent and nature of existing research and identify relevant lessons. We used Arksey and O'Malley's scoping framework with Levac's 2010 revisions and Khalil's 2016 refinements, focussing on identifying lessons from discrete humanitarian clusters that could strengthen health system responses to mass population displacement. We summarised thematically by cluster. Of 186 sources included, 56% were peer-reviewed research articles. Most related to health (37%), protection (18%), or nutrition (13%) clusters. Key lessons for health system responses included the necessity of empowering women; ensuring communities are engaged in decision-making processes (e.g. planning and construction of camps and housing) to strengthen trust and bonds between and within communities; and involving potential end-users in technological innovations development (e.g. geographical information systems) to ensure relevance and applicability. Our review provided evidence that non-health clusters can contribute to improving health outcomes using focussed interventions for implementation by government or humanitarian partners to inform LMIC health system responses to mass displacement.
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Affiliation(s)
- Anna Durrance-Bagale
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom
| | - Omar Mukhtar Salman
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom
| | - Maryam Omar
- Bart's Health NHS Trust, The Royal London Hospital, Whitechapel Road, London E1 1BB, United Kingdom
| | - Mervat Alhaffar
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom
| | - Muhammad Ferdaus
- BRAC University, UB04 - 66 Bir Uttam AK Khandakar Road, Dhaka 1212, Bangladesh
| | - Sanjida Newaz
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, 750 Bannatyne Ave, Winnipeg MB R3E 0W2, Canada
| | - Sneha Krishnan
- Environment, Technology and Community Health (ETCH) Consultancy Services, Mumbai, India
| | - Natasha Howard
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom.,National University of Singapore, Saw Swee Hock School of Public Health, 12 Science Drive 2, 117549, Singapore
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Robbers GML, Morgan A. Programme potential for the prevention of and response to sexual violence among female refugees: a literature review. REPRODUCTIVE HEALTH MATTERS 2017; 25:69-89. [PMID: 29214917 DOI: 10.1080/09688080.2017.1401893] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Continuing international conflict has resulted in several million people seeking asylum in other countries each year, over half of whom are women. Their reception and security in overburdened camps, combined with limited information and protection, increases their risk and exposure to sexual violence (SV). This literature review explores the opportunities to address SV against female refugees, with a particular focus on low-resource settings. A systematic literature review of articles published between 2000 and 2016 was conducted following PRISMA guidelines. Databases including Medline (Ovid), PubMed, Scopus, PsychINFO, CINAHL and the Cochrane Library. Grey literature from key refugee websites were searched. Studies were reviewed for quality and analysed according to the framework outlined in the UNHCR Guidelines on Prevention and Response of Sexual Violence against Refugees. Twenty-nine studies met the inclusion criteria, of which 7 studies addressed prevention, 14 studies response and 8 addressed both. There are limited numbers of rigorously evaluated SV prevention and response interventions available, especially in the context of displacement. However, emerging evidence shows that placing a stronger emphasis on programmes in the category of engagement/participation and training/education has the potential to target underlying causes of SV. SV against female refugees is caused by factors including lack of information and gender inequality. This review suggests that SV interventions that engage community members in their design and delivery, address harmful gender norms through education and advocacy, and facilitate strong cooperation between stakeholders, could maximise the efficient use of limited resources.
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Affiliation(s)
- Gianna Maxi Leila Robbers
- a MPH Graduate of the University of Melbourne, Nossal Institute for Global Health, University of Melbourne , Melbourne , VIC , Australia
| | - Alison Morgan
- b Senior Technical Advisor, Maternal Health, Nossal Institute for Global Health, University of Melbourne , Melbourne , VIC , Australia
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Feasibility and acceptability of a universal screening and referral protocol for gender-based violence with women seeking care in health clinics in Dadaab refugee camps in Kenya. Glob Ment Health (Camb) 2017; 4:e21. [PMID: 29230317 PMCID: PMC5719473 DOI: 10.1017/gmh.2017.18] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 08/02/2017] [Accepted: 08/04/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Gender-based violence (GBV) is both a global public health problem and violation of human rights. Refugees and internally displaced persons experience an increased risk of GBV and health outcomes associated with GBV are often exacerbated in conflict settings. METHODS A mixed methods study to examine the feasibility and acceptability of universal screening for GBV in a refugee population in the Dadaab refugee camp of Kenya, using the ASIST-GBV from January to July 2015. RESULTS Of 9366 women offered screening at International Rescue Committee health clinics, about 89% (n = 8369) female refugees consented to participate. Only 15% of the potentially eligible population could participate in GBV screening because of the ongoing struggle to identify private space in the clinics. Over 85% of women reported being 'willing' or 'very willing' to participate in GBV screening; 96% felt they had a good or very good experience with the screening protocol. Qualitative findings stressed the importance of securing a room/space in the busy clinic is critical to universal screening with referral to safe and confidential services for survivors. CONCLUSIONS The findings suggest that the evidence-based ASIST-GBV is both feasible to implement and acceptable to both providers and women seeking care. Universal GBV screening and referral is an effective way for health care and service providers in humanitarian settings to assist survivors of GBV.
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Wirtz AL, Glass N, Pham K, Perrin N, Rubenstein LS, Singh S, Vu A. Comprehensive development and testing of the ASIST-GBV, a screening tool for responding to gender-based violence among women in humanitarian settings. Confl Health 2016; 10:7. [PMID: 27099617 PMCID: PMC4837612 DOI: 10.1186/s13031-016-0071-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 02/08/2016] [Indexed: 11/10/2022] Open
Abstract
Background Conflict affected refugees and internally displaced persons (IDPs) are at increased vulnerability to gender-based violence (GBV). Health, psychosocial, and protection services have been implemented in humanitarian settings, but GBV remains under-reported and available services under-utilized. To improve access to existing GBV services and facilitate reporting, the ASIST-GBV screening tool was developed and tested for use in humanitarian settings. This process was completed in four phases: 1) systematic literature review, 2) qualitative research that included individual interviews and focus groups with GBV survivors and service providers, respectively, 3) pilot testing of the developed screening tool, and 4) 3-month implementation testing of the screening tool. Research was conducted among female refugees, aged ≥15 years in Ethiopia, and female IDPs, aged ≥18 years in Colombia. Results The systematic review and meta-analysis identified a range of GBV experiences and estimated a 21.4 % prevalence of sexual violence (95 % CI:14.9-28.7) among conflict-affected populations. No existing screening tools for GBV in humanitarian settings were identified. Qualitative research with GBV survivors in Ethiopia and Colombia found multiple forms of GBV experienced by refugees and IDPs that occurred during conflict, in transit, and in displaced settings. Identified forms of violence were combined into seven key items on the screening tool: threats of violence, physical violence, forced sex, sexual exploitation, forced pregnancy, forced abortion, and early or forced marriage. Cognitive testing further refined the tool. Pilot testing in both sites demonstrated preliminary feasibility where 64.8 % of participants in Ethiopia and 44.9 % of participants in Colombia were identified with recent (last 12 months) cases of GBV. Implementation testing of the screening tool, conducted as a routine service in camp/district hospitals, allowed for identification of GBV cases and referrals to services. In this phase, 50.6 % of participants in Ethiopia and 63.4 % in Colombia screened positive for recent experiences of GBV. Psychometric testing demonstrated appropriate internal consistency of the tool (Cronbach’s α = 0.77) and item response theory demonstrated appropriate discrimination and difficulty of the tool. Conclusion The ASIST-GBV screening tool has demonstrated utility and validity for use in confidential identification and referral of refugees and IDPs who experience GBV.
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Affiliation(s)
- A L Wirtz
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, USA
| | - N Glass
- Johns Hopkins School of Nursing, Baltimore, USA
| | - K Pham
- Department of Emergency Medicine, Johns Hopkins Medical Institute, Baltimore, USA ; Department of International Health, Johns Hopkins School of Public Health, Baltimore, USA
| | - N Perrin
- Johns Hopkins School of Nursing, Baltimore, USA ; Center for Health Research, Kaiser Permanente Northwest, Portland, USA
| | - L S Rubenstein
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, USA
| | - S Singh
- Department of Internal Medicine, Johns Hopkins Medical Institute, Baltimore, USA
| | - A Vu
- Department of Emergency Medicine, Johns Hopkins Medical Institute, Baltimore, USA ; Department of International Health, Johns Hopkins School of Public Health, Baltimore, USA
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