1
|
Wirtz AL, Stevenson M, Guillén JR, Ortiz J, Barriga Talero MÁ, Page KR, López JJ, Ramirez Correa JF, Martínez Porras D, Luque Núñez R, Fernández-Niño JA, Spiegel PB. Persistent Food Insecurity and Material Hardships: A Latent Class Analysis of Experiences among Venezuelan Refugees and Migrants in Urban Colombia. Nutrients 2024; 16:1060. [PMID: 38613093 PMCID: PMC11013044 DOI: 10.3390/nu16071060] [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: 02/28/2024] [Revised: 03/28/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
The causes and conditions of displacement often increase the vulnerability of migrant and refugee populations to food insecurity, alongside other material hardships. We aimed to examine the multidimensional aspects and patterns of food insecurity and other material hardships in a cross-sectional sample of 6221 Venezuelan refugees and migrants in urban Colombia using a latent class analysis. Using multinomial and logistic regression models, we investigated the demographic and migratory experiences associated with identified classes and how class membership is associated with multiple health outcomes among Venezuelan refugees and migrants, respectively. Approximately two thirds of the sample was comprised cisgender women, and the participants had a median age of 32 years (IQR: 26-41). Four heterogeneous classes of food insecurity and material hardships emerged: Class 1-low food insecurity and material hardship; Class 2-high food insecurity and material hardship; Class 3-high income hardship with insufficient food intake; and Class 4-income hardship with food affordability challenges. Class 2 reflected the most severe food insecurity and material hardships and had the highest class membership; Venezuelans with an irregular migration status were almost 1.5 times more likely to belong to this class. Food insecurity and material hardship class membership was independently associated with self-rated health, mental health symptoms, and recent violence victimization and marginally associated with infectious disease outcomes (laboratory-confirmed HIV and/or syphilis infection). Social safety nets, social protection, and other interventions that reduce and prevent material hardships and food insecurity among refugees and migrants, alongside the host community, may improve public health, support development, and reduce healthcare costs. In the long term, regularization and social policies for migrants aimed at enhancing refugees' and migrants' social and economic inclusion may contribute to improving food security in this population.
Collapse
Affiliation(s)
- Andrea L. Wirtz
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA; (M.S.); (K.R.P.)
- Department of International Health, Center for Humanitarian Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA;
| | - Megan Stevenson
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA; (M.S.); (K.R.P.)
| | - José Rafael Guillén
- Red Somos, Bogotá 111321, Colombia; (J.R.G.); (J.O.); (M.Á.B.T.); (J.J.L.); (J.F.R.C.); (D.M.P.)
| | - Jennifer Ortiz
- Red Somos, Bogotá 111321, Colombia; (J.R.G.); (J.O.); (M.Á.B.T.); (J.J.L.); (J.F.R.C.); (D.M.P.)
| | | | - Kathleen R. Page
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA; (M.S.); (K.R.P.)
- Department of International Health, Center for Humanitarian Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA;
- Department of Infectious Disease, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Jhon Jairo López
- Red Somos, Bogotá 111321, Colombia; (J.R.G.); (J.O.); (M.Á.B.T.); (J.J.L.); (J.F.R.C.); (D.M.P.)
| | | | - Damary Martínez Porras
- Red Somos, Bogotá 111321, Colombia; (J.R.G.); (J.O.); (M.Á.B.T.); (J.J.L.); (J.F.R.C.); (D.M.P.)
| | | | | | - Paul B. Spiegel
- Department of International Health, Center for Humanitarian Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA;
| |
Collapse
|
2
|
Cayreyre L, Korchia T, Loundou A, Jego M, Théry D, Berbis J, Gentile G, Auquier P, Khouani J. Lifetime sexual violence experienced by women asylum seekers and refugees hosted in high-income countries: Literature review and meta-analysis. J Forensic Leg Med 2024; 101:102622. [PMID: 38061112 DOI: 10.1016/j.jflm.2023.102622] [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: 08/03/2023] [Revised: 10/22/2023] [Accepted: 11/16/2023] [Indexed: 01/23/2024]
Abstract
Screening and care for victims of sexual violence (SV) among asylum seekers and refugees (ASRs) living in High-income host countries were prioritized by the WHO in 2020. The lack of stabilized prevalence findings on lifetime SV among ASRs in High-income countries hinders the development of adequate health management. The objective of this study was to determine the lifetime prevalence of SV experienced by ASRs living in High-income countries. We conducted a systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were included in the meta-analysis if the sample consisted exclusively of asylum seekers or refugees over the age of 16 living in High-income countries and if they reported a lifetime prevalence of experienced SV. The results of the meta-analysis were expressed with 95 % confidence intervals (CIs) as estimates of lifetime SV prevalence using a random-effects model. The estimated lifetime prevalence of SV among women ASRs was 44 % (95 % CI, 0.24-0.67) and 27 % (95 % CI, 0.18-0.38) for both sexes. This meta-analysis revealed a high prevalence of SV among ASRs hosted in High-income countries and suggest the importance of developing specific screening and care programs in these host countries.
Collapse
Affiliation(s)
- Laura Cayreyre
- Department of General Practice, Aix Marseille University, Marseille, France
| | - Théo Korchia
- Department of Psychiatry, La Conception University Hospital, Marseille, France; Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montréal, Canada
| | - Anderson Loundou
- Aix Marseille University, CEReSS, UR3279, Marseille, France; APHM, Department of Public Health, Marseille, France
| | - Maeva Jego
- Department of General Practice, Aix Marseille University, Marseille, France; Aix Marseille University, CEReSS, UR3279, Marseille, France
| | - Didier Théry
- Department of General Practice, Aix Marseille University, Marseille, France
| | - Julie Berbis
- Aix Marseille University, CEReSS, UR3279, Marseille, France; APHM, Department of Public Health, Marseille, France
| | - Gaëtan Gentile
- Department of General Practice, Aix Marseille University, Marseille, France; Aix Marseille University, Institut des Neurosciences des Systèmes, INS UMR1106, France
| | - Pascal Auquier
- Aix Marseille University, CEReSS, UR3279, Marseille, France; APHM, Department of Public Health, Marseille, France
| | - Jérémy Khouani
- Department of General Practice, Aix Marseille University, Marseille, France; Aix Marseille University, CEReSS, UR3279, Marseille, France.
| |
Collapse
|
3
|
Green L, McHale T, Mishori R, Kaljee L, Akter Chowdhury S. “Most of the cases are very similar.”: Documenting and corroborating conflict-related sexual violence affecting Rohingya refugees. BMC Public Health 2022; 22:700. [PMID: 35397528 PMCID: PMC8994882 DOI: 10.1186/s12889-022-13038-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/09/2022] [Indexed: 11/10/2022] Open
Abstract
Background In August 2017, a large population of Rohingya from northern Rakhine state in Myanmar fled to Bangladesh due to “clearance operations” by the Myanmar security forces characterized by widespread and systematic violence, including extensive conflict-related sexual violence (CRSV). This study sought to document the patterns of injuries and conditions experienced by the Rohingya, with a specific focus on sexual violence. Methods Qualitative interviews were conducted with 26 health care professionals who cared for Rohingya refugees after their arrival in Bangladesh between November 2019 and August 2020. Results Health care workers universally reported hearing accounts and seeing evidence of sexual and gender-based violence committed against Rohingya people of all genders by the Myanmar military and security forces. They observed physical and psychological consequences of such acts against the Rohingya while patients were seeking care. Health care workers shared that patients faced pressure not to disclose their experiences of CRSV, likely resulted in an underreporting of the prevalence of sexual violence. Forced witnessing of sexual violence and observed increases in pregnancy and birth rates as a result of rape are two less-reported issues that emerged from these data. Conclusions Healthcare workers corroborated previous reports that the Rohingya experienced CRSV at the hands of the Myanmar military and security forces. Survivors often revealed their experiences of sexual violence while seeking care for a variety of physical and psychological conditions. Stigma, cultural pressure, and trauma created barriers to disclosing experiences of sexual violence and likely resulted in an underreporting of the prevalence of sexual violence. The findings of this research emphasize the importance of offering universal and comprehensive trauma-informed services to all refugees with the presumption of high rates of trauma in this population and many survivors who may never identify themselves as such.
Collapse
|
4
|
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: Protocol Integrating Respondent-Driven Sampling, Case Finding, and Medicolegal Services for Venezuelans Living in Colombia. JMIR Res Protoc 2022; 11:e36026. [PMID: 35258458 PMCID: PMC8941430 DOI: 10.2196/36026] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [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.
Collapse
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
| |
Collapse
|
5
|
Bukuluki P, Kisaakye P, Etti B, Ocircan M, Bev RR. Tolerance of Violence against Women and the Risk of Psychosocial Distress in Humanitarian Settings in Northern Uganda. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8103. [PMID: 34360397 PMCID: PMC8345785 DOI: 10.3390/ijerph18158103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 07/05/2021] [Accepted: 07/19/2021] [Indexed: 12/02/2022]
Abstract
BACKGROUND Violence against women (VAW) remains a public health concern, which can sometimes lead to mental or psychological stress among other negative consequences. DATA AND METHODS we fitted a binary logistic regression model on 657 respondents from host and refugee settings in three humanitarian districts (Adjumani, Obongi, and Lamwo) to examine the determinants of psychosocial stress. RESULTS experience of psychosocial distress is higher among refugees than host populations. Results indicate a higher proportion of respondents who ever experienced psychosocial stress in the 6 months preceding the survey among those who believed that a woman should tolerate violence (59% vs. 53%). Respondents who believed that a woman should tolerate violence had higher odds of experiencing psychosocial stress than their counterparts who believed a woman should not tolerate violence (OR = 6.86; 95%CI = 1.23-38.22). The likelihood to experience psychosocial stress was higher among females (OR = 6.94; 95%CI = 1.76-27.32), those with primary education (OR = 4.73; 95%CI = 1.24-18.00), and respondents with less than USD 2.7 as personal income one month before the survey (OR = 3.37; 95%CI = 1.32-8.62). Respondents who said that women should engage in income generation activities had higher odds to experience psychosocial stress (OR = 0.39; 95%CI = 0.17-0.89). CONCLUSION results suggest that income and positive attitudes toward female-led income generating activities act as protective measures against psychosocial distress. Given the associations between VAW and psychosocial distress, efforts aimed at prevention and response to VAW in humanitarian settings should integrate mental health and psychosocial support interventions.
Collapse
Affiliation(s)
- Paul Bukuluki
- School of Social Sciences, Makerere University, Kampala 7062, Uganda
| | - Peter Kisaakye
- School of Statistics and Planning, Makerere University, Kampala 7062, Uganda;
| | - Bonny Etti
- Save the Children, Kampala 12018, Uganda; (B.E.); (M.O.); (R.-R.B.)
| | - Micheal Ocircan
- Save the Children, Kampala 12018, Uganda; (B.E.); (M.O.); (R.-R.B.)
| | | |
Collapse
|
6
|
Munyuzangabo M, Khalifa DS, Gaffey MF, Kamali M, Siddiqui FJ, Meteke S, Shah S, Jain RP, Als D, Radhakrishnan A, Ataullahjan A, Bhutta ZA. Delivery of sexual and reproductive health interventions in conflict settings: a systematic review. BMJ Glob Health 2021; 5:bmjgh-2019-002206. [PMID: 32694131 PMCID: PMC7375437 DOI: 10.1136/bmjgh-2019-002206] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 03/28/2020] [Accepted: 04/07/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND It is essential to provide comprehensive sexual and reproductive health (SRH) interventions to women affected by armed conflict, but there is a lack of evidence on effective approaches to delivering such interventions in conflict settings. This review synthesised the available literature on SRH intervention delivery in conflict settings to inform potential priorities for further research and additional guidance development. METHODS We searched MEDLINE, Embase, CINAHL and PsycINFO databases using terms related to conflict, women and children, and SRH. We searched websites of 10 humanitarian organisations for relevant grey literature. Publications reporting on conflict-affected populations in low-income and middle-income countries and describing an SRH intervention delivered during or within 5 years after the end of a conflict were included. Information on population, intervention and delivery characteristics were extracted and narratively synthesised. Quantitative data on intervention coverage and effectiveness were tabulated, but no meta-analysis was undertaken. RESULTS 110 publications met our eligibility criteria. Most focused on sub-Saharan Africa and displaced populations based in camps. Reported interventions targeted family planning, HIV/STIs, gender-based violence and general SRH. Most interventions were delivered in hospitals and clinics by doctors and nurses. Delivery barriers included security, population movement and lack of skilled health staff. Multistakeholder collaboration, community engagement and use of community and outreach workers were delivery facilitators. Reporting of intervention coverage or effectiveness data was limited. DISCUSSION There is limited relevant literature on adolescents or out-of-camp populations and few publications reported on the use of existing guidance such as the Minimal Initial Services Package. More interventions for gender-based violence were reported in the grey than the indexed literature, suggesting limited formal research in this area. Engaging affected communities and using community-based sites and personnel are important, but more research is needed on how best to reach underserved populations and to implement community-based approaches. PROSPERO REGISTRATION NUMBER CRD42019125221.
Collapse
Affiliation(s)
- Mariella Munyuzangabo
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Dina Sami Khalifa
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michelle F Gaffey
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mahdis Kamali
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Fahad J Siddiqui
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada.,Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore
| | - Sarah Meteke
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Shailja Shah
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Reena P Jain
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Daina Als
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Amruta Radhakrishnan
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Anushka Ataullahjan
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada .,Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| |
Collapse
|
7
|
Rodella Sapia MD, Wangmo T, Dagron S, Elger BS. Understanding access to professional healthcare among asylum seekers facing gender-based violence: a qualitative study from a stakeholder perspective. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2020; 20:25. [PMID: 32957996 PMCID: PMC7507652 DOI: 10.1186/s12914-020-00244-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 09/06/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND When it comes to gender-based violence (GBV), migrant women and girls represent the most vulnerable group. GBV can happen at any stage of migrants' flight and/or during the asylum process. It has severe consequences on their life and health. Victims therefore need timely access to healthcare. This study explores the context GBV victims face when they seek refuge in Switzerland. METHODS Qualitative methodology was used where we conducted five semi-structured focus groups and three interviews. A total of sixteen stakeholders participated in the study. They were either involved in the asylum process or provided healthcare to asylum seekers. We analyzed the data using framework analysis. RESULTS Study participants noted lack of confidence of the GBV victims in the legal and in the healthcare systems as major barriers to disclosure of GBV. Since only GBV exerted before fleeing the home country gives the right to asylum, they pointed out that victims do not disclose GBV that took place after they left their home country. Language was identified as a barrier to disclosure of GBV as well as to healthcare access. Continuity of care at the moment of transfer from federal to cantonal (i.e. state) accommodations is another issue that was deemed critical. Study participants felt that health professionals must be trained to identify GBV victims. The first-contact caregiver available to these victims was deemed as the most competent professional that could act as a "GBV coordinator". CONCLUSION In Switzerland, access to healthcare is guaranteed to all asylum seekers on a legal and structural level. Yet, health seeking by GBV survivors is hindered by factors such as lack of confidence in the legal system, trust in health providers, and continuity of care during the asylum process. Building trust in legal institutions, health structures, and professionals should be enhanced to facilitate disclosure and to strengthen resilience. This includes a healthcare system with competent professionals, support with language and cultural needs, as well as seamless continuity of care beyond cantonal borders.
Collapse
Affiliation(s)
- Mirjam D Rodella Sapia
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland. .,University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland.
| | - Tenzin Wangmo
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Stéphanie Dagron
- Global Studies Institute / Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Bernice S Elger
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland.,Center of Legal Medicine, University of Geneva, Geneva, Switzerland
| |
Collapse
|
8
|
Knapp AP, Rehmus W, Chang AY. Skin diseases in displaced populations: a review of contributing factors, challenges, and approaches to care. Int J Dermatol 2020; 59:1299-1311. [PMID: 32686140 DOI: 10.1111/ijd.15063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/11/2020] [Accepted: 06/19/2020] [Indexed: 01/14/2023]
Abstract
There are 70.8 million persons displaced worldwide due to war, persecution, and violence. Eighty percent of displaced persons reside in low- and middle-income countries with limited healthcare resources. Cutaneous diseases are commonly reported among displaced persons owing to numerous interrelated factors such as inadequate housing, overcrowding, food insecurity, environmental exposures, violence including torture, and breakdown of healthcare infrastructure. Diagnosis and management of these conditions, as well as an understanding of the context in which they present, is crucial to providing dermatologic care for displaced populations worldwide. Herein, we define displaced populations and, within this context, review the epidemiology of skin diseases, discuss pertinent skin conditions, examine challenges to care provision, and present approaches for improving dermatologic care. Inflammatory and communicable infectious disorders are the most common skin diseases seen in displaced populations. Other relevant conditions include skin manifestations of heat injuries, cold injuries, immersion foot syndromes, macronutrient and micronutrient deficiencies, torture, and sexual and gender-based violence. Provision of dermatologic care to displaced populations is hampered by limited diagnostic and therapeutic resources and specialist expertise. Medical screening for cutaneous disorders, context-relevant dermatology training, and telemedicine are potential tools to improve diagnosis and management of skin diseases in displaced populations.
Collapse
Affiliation(s)
- Alexia P Knapp
- Department of Dermatology, International Foundation for Dermatology Migrant Health Dermatology Working Group, HealthPartners Institute, Saint Paul, Minnesota, USA
| | - Wingfield Rehmus
- Departments of Pediatrics and Dermatology, University of British Columbia, Vancouver, BC, Canada
| | - Aileen Y Chang
- Department of Dermatology, International Foundation for Dermatology Migrant Health Dermatology Working Group, University of California, San Francisco, USA
| |
Collapse
|
9
|
Araujo JDO, de Souza FM, Proença R, Bastos ML, Trajman A, Faerstein E. Prevalence of sexual violence among refugees: a systematic review. Rev Saude Publica 2019; 53:78. [PMID: 31553381 PMCID: PMC6752644 DOI: 10.11606/s1518-8787.2019053001081] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 12/04/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To synthesize data about the prevalence of sexual violence (SV) among refugees around the world. METHODS A systematic review was conducted from the search in seven bibliographic databases. Studies on the prevalence of SV among refugees and asylum seekers of any country, sex or age, whether in English, French, Spanish and Portuguese, were eligible. RESULTS Of the 2,906 titles found, 60 articles were selected. The reported prevalence of SV was largely variable (0% to 99.8%). Reports of SV were collected in all continents, with 42% of the articles mentioning it in refugees from Africa (prevalence from 1.3% to 100%). The rape was the most reported SV in 65% of the studies (prevalence from 0% to 90.9%). The main victims were women in 89% of the studies, all the way, especially when still in the countries of origin. The SV was perpetrated particularly by intimate partners, but also by agents of supposed protection. Few studies have reported SV in men and children; the prevalence reached up to 39.3% and 90.9%, respectively. Approximately one-third of the studies (32%) were carried out in refugee camps and more than half (52%) in health services using mental health assessment tools. No study has addressed the most recent migratory crisis. Meta-analysis was not performed due to the methodological heterogeneity of the studies. CONCLUSIONS SV is a prevalent problem affecting refugees of both sexes, of all ages, throughout the migratory journey, particularly those from Africa. Protection measures are urgently needed, and further studies, with more appropriate tools, may better measure the current magnitude of the problem.
Collapse
Affiliation(s)
- Juliana de Oliveira Araujo
- Universidade do Estado do Rio de Janeiro
Instituto de Medicina Social
Programa de Pós-Graduação em Saúde Coletiva
Universidade do Estado do Rio de Janeiro. Instituto de Medicina Social. Programa de Pós-Graduação em Saúde Coletiva. Rio de Janeiro, RJ, Brasil
| | - Fernanda Mattos de Souza
- Universidade do Estado do Rio de Janeiro
Instituto de Medicina Social
Programa de Pós-Graduação em Saúde Coletiva
Universidade do Estado do Rio de Janeiro. Instituto de Medicina Social. Programa de Pós-Graduação em Saúde Coletiva. Rio de Janeiro, RJ, Brasil
| | - Raquel Proença
- Universidade do Estado do Rio de Janeiro
Instituto de Medicina Social
Programa de Pós-Graduação em Saúde Coletiva
Universidade do Estado do Rio de Janeiro. Instituto de Medicina Social. Programa de Pós-Graduação em Saúde Coletiva. Rio de Janeiro, RJ, Brasil
| | - Mayara Lisboa Bastos
- Universidade do Estado do Rio de Janeiro
Instituto de Medicina Social
Programa de Pós-Graduação em Saúde Coletiva
Universidade do Estado do Rio de Janeiro. Instituto de Medicina Social. Programa de Pós-Graduação em Saúde Coletiva. Rio de Janeiro, RJ, Brasil
| | - Anete Trajman
- Universidade Federal do Rio de Janeiro. Faculdade de Medicina. Programa de pós-Graduação em Clínica médica. Rio de Janeiro, RJ, Brasil
- McGill University. Montreal, QC, Canadá
| | - Eduardo Faerstein
- Universidade do Estado do Rio de Janeiro. Instituto de Medicina Social. Departamento de Epidemiologia. Rio de Janeiro, RJ, Brasil
| |
Collapse
|
10
|
Glass N, Perrin N, Marsh M, Clough A, Desgroppes A, Kaburu F, Ross B, Read-Hamilton S. Effectiveness of the Communities Care programme on change in social norms associated with gender-based violence (GBV) with residents in intervention compared with control districts in Mogadishu, Somalia. BMJ Open 2019; 9:e023819. [PMID: 30872541 PMCID: PMC6429733 DOI: 10.1136/bmjopen-2018-023819] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE Determine the effectiveness of the Communities Care programme (CCP) on change in harmful social norms associated with gender-based violence (GBV) and confidence in provision of services with residents in intervention compared with control district. We hypothesised that residents in the intervention district would report a decrease in support for harmful social norms and increase in confidence in services in comparison with control district. SETTING The study was conducted in Mogadishu, Somalia. PARTICIPANTS In the intervention district, 192 community members (50% women) completed baseline surveys with 163 (84.9%) retained at endline. In the control district, 195 community members (50% women) completed baseline surveys with 167 (85.6%) retained at endline. INTERVENTION CCP uses facilitated dialogues with community members to catalyse GBV prevention actions and provides training to diverse sectors to strengthen response services for GBV survivors. RESULTS Residents in the intervention district had significantly greater improvement in change in social norms: (1) response to sexual violence (b=-0.214, p=0.041); (2) protecting family honour (b=-0.558, p<0.001); and (3) husband's right to use violence (b=-0.309, p=0.003) compared with control district participants. The greatest change was seen in the norm of 'protecting family honour' with a Cohen's d effect size (ES) of 0.70, followed by the norm 'husband's right to use violence' (ES=0.38), and then the norm of 'response to sexual violence' (ES=0.28). Residents in intervention district had a significantly greater increase in confidence in provision of GBV services across diverse sectors than the control district (b=0.318, p<0.001) with an associated effect size of 0.67. There were no significant differences between residents in intervention and control districts on change in personal beliefs on the norms. CONCLUSION The evaluation showed the promise of CCP in changing harmful social norms associated with GBV and increasing confidence in provision of services in a complex humanitarian setting.
Collapse
Affiliation(s)
- Nancy Glass
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Nancy Perrin
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Amber Clough
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Amelie Desgroppes
- Comitato Internazionale per lo Sviluppo dei Popoli (CISP) Somalia, Nairobi, Kenya
| | - Francesco Kaburu
- Comitato Internazionale per lo Sviluppo dei Popoli (CISP) Somalia, Nairobi, Kenya
| | | | | |
Collapse
|
11
|
Perrin N, Marsh M, Clough A, Desgroppes A, Yope Phanuel C, Abdi A, Kaburu F, Heitmann S, Yamashina M, Ross B, Read-Hamilton S, Turner R, Heise L, Glass N. Social norms and beliefs about gender based violence scale: a measure for use with gender based violence prevention programs in low-resource and humanitarian settings. Confl Health 2019; 13:6. [PMID: 30899324 PMCID: PMC6408811 DOI: 10.1186/s13031-019-0189-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 02/20/2019] [Indexed: 11/22/2022] Open
Abstract
Background Gender-based violence (GBV) primary prevention programs seek to facilitate change by addressing the underlying causes and drivers of violence against women and girls at a population level. Social norms are contextually and socially derived collective expectations of appropriate behaviors. Harmful social norms that sustain GBV include women’s sexual purity, protecting family honor over women’s safety, and men’s authority to discipline women and children. To evaluate the impact of GBV prevention programs, our team sought to develop a brief, valid, and reliable measure to examine change over time in harmful social norms and personal beliefs that maintain and tolerate sexual violence and other forms of GBV against women and girls in low resource and complex humanitarian settings. Methods The development and testing of the scale was conducted in two phases: 1) formative phase of qualitative inquiry to identify social norms and personal beliefs that sustain and justify GBV perpetration against women and girls; and 2) testing phase using quantitative methods to conduct a psychometric evaluation of the new scale in targeted areas of Somalia and South Sudan. Results The Social Norms and Beliefs about GBV Scale was administered to 602 randomly selected men (N = 301) and women (N = 301) community members age 15 years and older across Mogadishu, Somalia and Yei and Warrup, South Sudan. The psychometric properties of the 30-item scale are strong. Each of the three subscales, “Response to Sexual Violence,” “Protecting Family Honor,” and “Husband’s Right to Use Violence” within the two domains, personal beliefs and injunctive social norms, illustrate good factor structure, acceptable internal consistency, reliability, and are supported by the significance of the hypothesized group differences. Conclusions We encourage and recommend that researchers and practitioners apply the Social Norms and Beliefs about GBV Scale in different humanitarian and global LMIC settings and collect parallel data on a range of GBV outcomes. This will allow us to further validate the scale by triangulating its findings with GBV experiences and perpetration and assess its generalizability across diverse settings. Electronic supplementary material The online version of this article (10.1186/s13031-019-0189-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Nancy Perrin
- Johns Hopkins School of Nursing, 525 North Wolfe Street, Baltimore, MD 21205 USA
| | | | - Amber Clough
- Johns Hopkins School of Nursing, 525 North Wolfe Street, Baltimore, MD 21205 USA
| | - Amelie Desgroppes
- Comitato Internazionale per lo Sviluppo dei Popoli (CISP) Somalia, Nairobi, Kenya
| | | | - Ali Abdi
- Comitato Internazionale per lo Sviluppo dei Popoli (CISP) Somalia, Nairobi, Kenya
| | - Francesco Kaburu
- Comitato Internazionale per lo Sviluppo dei Popoli (CISP) Somalia, Nairobi, Kenya
| | | | | | | | | | - Rachael Turner
- Johns Hopkins School of Nursing, 525 North Wolfe Street, Baltimore, MD 21205 USA
| | - Lori Heise
- Johns Hopkins School of Nursing, 525 North Wolfe Street, Baltimore, MD 21205 USA.,9Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Nancy Glass
- Johns Hopkins School of Nursing, 525 North Wolfe Street, Baltimore, MD 21205 USA
| |
Collapse
|
12
|
Glass N, Perrin N, Clough A, Desgroppes A, Kaburu FN, Melton J, Rink A, Read-Hamilton S, Marsh M. Evaluating the communities care program: best practice for rigorous research to evaluate gender based violence prevention and response programs in humanitarian settings. Confl Health 2018; 12:5. [PMID: 29422946 PMCID: PMC5791214 DOI: 10.1186/s13031-018-0138-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 01/12/2018] [Indexed: 11/10/2022] Open
Abstract
Background Gender-based violence (GBV) is a significant issue for women and girls in humanitarian settings. Innovative primary prevention programs are being developed and implemented with existing response programs to change harmful social norms that sustain GBV in humanitarian settings. Social norms are expectations of how women, men, girls and boys should behave, who should have power and control over behavior, and how families and communities value women and girls and support their rights and opportunities. Methods The United Nations Children’s Fund (UNICEF) led Communities Care program is a primary prevention and response program designed from the understanding that within the context of conflict and displacement, there is an opportunity for positive change in social norms that support gender equity, and decrease GBV. The goal is to support communities in humanitarian settings to create healthy, safe and peaceful environments with quality response services for women and girls by transforming harmful social norms that uphold violence into norms that promote dignity, equity, and non-violence. Conclusion This manuscript will highlight the use of best practices in GBV research to rigorously evaluate the Communities Care program in two diverse in humanitarian settings, Somalia and South Sudan.
Collapse
Affiliation(s)
- N Glass
- 1Johns Hopkins University School of Nursing, 525 North Wolfe Street, Unit 435, Baltimore, MD 21205 USA
| | - N Perrin
- 1Johns Hopkins University School of Nursing, 525 North Wolfe Street, Unit 435, Baltimore, MD 21205 USA
| | - A Clough
- 1Johns Hopkins University School of Nursing, 525 North Wolfe Street, Unit 435, Baltimore, MD 21205 USA
| | - A Desgroppes
- Comitato Internazionale per lo Sviluppo dei Popoli (CISP) Somalia, Nairobi, Kenya
| | - F N Kaburu
- Comitato Internazionale per lo Sviluppo dei Popoli (CISP) Somalia, Nairobi, Kenya
| | | | - A Rink
- UNICEF, Juba, South Sudan
| | - S Read-Hamilton
- Consultant, Gender based violence in Emergencies, Sydney, Australia
| | | |
Collapse
|
13
|
Flores RJ, Campo-Arias A, Stimpson JP, Chalela CM, Reyes-Ortiz CA. The Association Between Past Sexual Abuse and Depression in Older Adults From Colombia. J Geriatr Psychiatry Neurol 2018; 31:13-18. [PMID: 29172904 DOI: 10.1177/0891988717743588] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To explore the association between past sexual abuse and depression in elders living in Bogotá, Colombia, we used data from the SABE (Salud, Bienestar y Envejecimiento [Health, Well-being, and Aging]) Bogotá Study. Participants were 2000 community-dwelling adults aged 60 years and older in 2012. Sexual abuse was assessed by self-report. Depression was measured by the Geriatric Depression Scale. The weighted prevalence estimate was 2.6% for past sexual abuse and 23.4% for depression. Multivariate data analyses showed significantly higher odds of depression for past sexual abuse (odds ratio [OR] = 3.91, 95% confidence interval [CI]: 2.13-7.16). Other characteristics associated with depression were history of being displaced by violence (OR = 1.77, 95% CI: 1.30-2.40), low socioeconomic status, low education, poor self-rated health status, and poor self-rated memory. Thus, past sexual abuse and history of being displaced by violence were strongly associated with depression among Colombian elderly individuals.
Collapse
Affiliation(s)
- Renee J Flores
- 1 Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Adalberto Campo-Arias
- 2 Programa de Medicina, Facultad de Ciencias de la Salud, Universidad del Magdalena, Santa Marta, Colombia
| | - Jim P Stimpson
- 3 City University of New York, Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Claudia M Chalela
- 4 Programa de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Carlos A Reyes-Ortiz
- 1 Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA
| |
Collapse
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
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.
Collapse
|
16
|
Vu A, Wirtz A, Pham K, Singh S, Rubenstein L, Glass N, Perrin N. Psychometric properties and reliability of the Assessment Screen to Identify Survivors Toolkit for Gender Based Violence (ASIST-GBV): results from humanitarian settings in Ethiopia and Colombia. Confl Health 2016; 10:1. [PMID: 26865857 PMCID: PMC4748528 DOI: 10.1186/s13031-016-0068-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 02/01/2016] [Indexed: 11/10/2022] Open
Abstract
Background Refugees and internally displaced persons who are affected by armed-conflict are at increased vulnerability to some forms of sexual violence or other types of gender-based violence. A validated, brief and easy-to-administer screening tool will help service providers identify GBV survivors and refer them to appropriate GBV services. To date, no such GBV screening tool exists. We developed the 7-item ASIST-GBV screening tool from qualitative research that included individual interviews and focus groups with GBV refugee and IDP survivors. This study presents the psychometric properties of the ASIST-GBV with female refugees living in Ethiopia and IDPs in Colombia. Methods Several strategies were used to validate ASIST-GBV, including a 3 month implementation to validate the brief screening tool with women/girls seeking health services, aged ≥15 years in Ethiopia (N = 487) and female IDPs aged ≥ 18 years in Colombia (N = 511). Results High proportions of women screened positive for past-year GBV according to the ASIST-GBV: 50.6 % in Ethiopia and 63.4 % in Colombia. The factor analysis identified a single dimension, meaning that all items loaded on the single factor. Cronbach’s α = 0.77. A 2-parameter logistic IRT model was used for estimating the precision and discriminating power of each item. Item difficulty varied across the continuum of GBV experiences in the following order (lowest to highest): threats of violence (0.690), physical violence (1.28), forced sex (2.49), coercive sex for survival (2.25), forced marriage (3.51), and forced pregnancy (6.33). Discrimination results showed that forced pregnancy was the item with the strongest ability to discriminate between different levels of GBV. Physical violence and forced sex also have higher levels of discrimination with threats of violence discriminating among women at the low end of the GBV continuum and coercive sex for survival among women at the mid-range of the continuum. Conclusion The findings demonstrate that the ASIST-GBV has strong psychometric properties and good reliability. The tool can be used to screen and identify female GBV survivors confidentially and efficiently among IDPs in Colombia and refugees in Ethiopia. Early identification of GBV survivors can enable safety planning, early referral for treatment, and psychosocial support to prevent long-term harmful consequence of GBV.
Collapse
Affiliation(s)
- Alexander Vu
- Department of Emergency Medicine, Johns Hopkins University, School of Medicine, Baltimore, USA ; Department of International Health, Center for Refugee and Disaster Response, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, USA
| | - Andrea Wirtz
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, USA
| | - Kiemanh Pham
- Department of Emergency Medicine, Johns Hopkins University, School of Medicine, Baltimore, USA
| | - Sonal Singh
- Department of Medicine, Johns Hopkins University, Johns Hopkins Medical Institutions, Baltimore, USA
| | - Leonard Rubenstein
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, USA
| | - Nancy Glass
- Johns Hopkins University, School of Nursing , Baltimore, USA
| | - Nancy Perrin
- Johns Hopkins University, School of Nursing , Baltimore, USA ; Center for Health Research Kaiser Permanente Northwest, Portland, OR USA
| |
Collapse
|