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Kadio K, Ly A, Ouédraogo A, Ahmed MAA, Yaya S, Gagnon MP. Implementation of lockdown, quarantine, and isolation measures in the context of COVID-19 among internally displaced persons in Burkina Faso: a qualitative study. Confl Health 2024; 18:17. [PMID: 38429753 PMCID: PMC10908079 DOI: 10.1186/s13031-024-00579-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/25/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND The triple political, security, and health crisis in Burkina Faso has impacted the lives of Burkinabè people, resulting in massive internal displacement. These internally displaced persons (IDPs) are very vulnerable to epidemic diseases, which was exacerbated by the recent COVID-19 pandemic., The implementation of public health measures to curb the spread of COVID-19 represented a major concern among IDPs. The objective of this study was to document knowledge, difficulties, adjustments, and challenges faced by IDPs and humanitarian authorities/actors during implementation of lockdown, quarantine, and isolation measures in response to COVID-19. METHODS The study was conducted in Burkina Faso, in the north-central region Kaya, a commune which hosts the largest number of IDPs in the country. Qualitative research using semi-structured interviews collected discursive data from 18 authorities and/or humanitarian actors and 29 IDPs in June 2021. The transcribed interviews were coded with N'vivo 11 software and analyzed thematically. RESULTS Although respondents had a good knowledge of lockdown, isolation, and quarantine measures, the difference between these three concepts was not easily understood by either authorities/humanitarian actors or IDPs. Communication was one of the biggest challenges for humanitarian actors. The difficulties encountered by IDPs were economic (lack of financial resources), infrastructural (limited housing), and socio-cultural in the application of lockdown, isolation, and quarantine measures. As for adjustment measures, the health authorities developed a strategy for isolation and quarantine for the management of positive and suspected cases. The IDPs mentioned their commitment to compliance and awareness of lockdown measures as the main adjustment. CONCLUSION Although there were no known cases of COVID-19 among the IDPs at the time of the study, tailored response plans were developed to facilitate the application of these measures in emergencies. The involvement of IDPs in the communication and sensitization process was necessary to facilitate their adherence to these different measures.
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Affiliation(s)
- Kadidiatou Kadio
- Centre national de la recherche scientifique et technologique (CNRST)/Institut de recherche en sciences de la santé (IRSS), 03 BP 7047, Ouagadougou, Burkina Faso.
- Fellow Pilote African Postdoctrorat Academy - PAPA, Université Goethe de Francfort, Francfort, Hesse, Allemagne.
| | - Antarou Ly
- Centre national de la recherche scientifique et technologique (CNRST)/Institut de recherche en sciences de la santé (IRSS), 03 BP 7047, Ouagadougou, Burkina Faso
- Département de médecine sociale et préventive, Université Laval, Québec, QC, G1V 0A6, Canada
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC, G1S 4L8, Canada
| | - Adidjata Ouédraogo
- Centre national de la recherche scientifique et technologique (CNRST)/Institut de recherche en sciences de la santé (IRSS), 03 BP 7047, Ouagadougou, Burkina Faso
| | - Mohamed Ali Ag Ahmed
- Institut de médecine tropicale d'Anvers, Kronenburgstraat 43, Antwerpen, 2000, Belgique
| | - Sanni Yaya
- Faculty of Social Sciences, University of Ottawa, 120 University Private, Ottawa, ON, K1N 9A7, Canada
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Kadio K, Ly A, Ouédraogo A, Ahmed MAA, Yaya S, Gagnon MP. "if we don't regroup, hunger will kill us…": a qualitative study on measures of physical distancing during covid-19 among internally displaced persons in Burkina Faso. FRONTIERS IN SOCIOLOGY 2023; 8:1189235. [PMID: 38162932 PMCID: PMC10757600 DOI: 10.3389/fsoc.2023.1189235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024]
Abstract
This study contributes to the body of knowledge on IDPs in the context of security crisis related to terrorism. Very little research has been done on covid-19 amongst IDPs in Africa and this is one of the first studies in Burkina Faso. Our diversified sample allowed us to consider the discourses of humanitarian actors working with IDPs, but also the discourses of IDPs in a context of aggravated health and security crisis. The challenges encountered by IDPs in implementing physical distancing and the coping strategies have been documented. It showed some possible solutions that decision-makers could use in order to facilitate the appropriation of this measure by IDPs. This is a contribution to the field of applied human and social science research They will help to anticipate solutions in the event of a resurgence of covid-19 cases. In the current context, where the spread of the disease seems to be under control, concerted action should now be taken in the event of the detection of a case of covid-19 in the various IDP sites.
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Affiliation(s)
- Kadidiatou Kadio
- Département Biomédical et de Santé Publique, Institut de recherche en sciences de la santé (IRSS), du Centre National de la Recherche scientifique et Technologique (CNRST), Ouagadougou, Burkina Faso
- Fellow Pilote African Postdoctrorat Academy – PAPA, Goethe University Frankfurt, Frankfurt, Hesse, Germany
| | - Antarou Ly
- Département Biomédical et de Santé Publique, Institut de recherche en sciences de la santé (IRSS), du Centre National de la Recherche scientifique et Technologique (CNRST), Ouagadougou, Burkina Faso
- Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec, QC, Canada
- Centre de recherche du CHU de Québec, Laval University, Quebec, QC, Canada
| | - Adidjata Ouédraogo
- Département Biomédical et de Santé Publique, Institut de recherche en sciences de la santé (IRSS), du Centre National de la Recherche scientifique et Technologique (CNRST), Ouagadougou, Burkina Faso
| | | | - Sanni Yaya
- Faculté des sciences sociales, University of Ottawa, Ottawa, ON, Canada
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Omam LA, Jarman E, O'Laughlin KN, Parkes-Ratanshi R. Primary healthcare delivery models in African conflict-affected settings: a systematic review. Confl Health 2023; 17:34. [PMID: 37454133 DOI: 10.1186/s13031-023-00533-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/12/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND In conflict-affected settings, access to primary healthcare for displaced populations is constrained by multiple challenges. These include geographical, cultural, communication, logistical and financial barriers, as well as risks posed to health workers and the population by insecurity. Different models of care are used to provide primary healthcare to affected communities. However, there is a paucity of evidence on how these models are selected and implemented by organisations working in conflict and displacement-affected settings. Our aim was to explore the different primary healthcare delivery models used in conflict-affected settings to understand gaps in existing healthcare delivery models. METHODS We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The review protocol was registered with the International Prospective Register of Systematic Reviews. We searched six databases for manuscripts published from January 1992 to December 2020. Publications were included if they reported primary healthcare models of care in conflict-affected settings of Africa. Data was analyzed descriptively and thematically using tables, charts and text. RESULTS Forty-eight primary research articles were included for analysis from which thirty-three were rated as "high" quality. The results showed that the models of care in place in these conflict-affected settings include health facility-based, community-based, mobile clinics, outreach and home visits. Primary healthcare for internally displaced persons and refugees is provided by a wide range of actors including national and international organisations. A range of services is offered, most commonly nutrition, mental health and sexual/reproductive health. Some organisations offer vertical (stand-alone) services, while others use an integrated service delivery model. Multiple cadres of healthcare workers provide services, frequently lay healthcare workers such as Community Health Workers. CONCLUSION Understanding the different modalities of primary healthcare delivery in conflict-affected settings is important to identify existing practices and gaps in service delivery. Service delivery using community health workers in conflict-affected settings is a low-cost primary care delivery strategy that may help optimize contributions of existing personnel through task shifting.
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Affiliation(s)
- Lundi-Anne Omam
- Department of Public Health and Primary Care, University of Cambridge, Cambridgeshire, UK.
- Department of Psychiatry, University of Cambridge, Cambridgeshire, UK.
| | | | - Kelli N O'Laughlin
- Departments of Emergency Medicine and Global Health, University of Washington, Seattle, USA
| | - Rosalind Parkes-Ratanshi
- Department of Psychiatry, University of Cambridge, Cambridgeshire, UK
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
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Lin CY, Meagher K, Bricknell M, Patel P, El Achi N, Kutluk T, Harding R, Kienzler H, Giacaman R, Mukherji D, Shamieh O, Sullivan R. The challenges of international collaboration in conflict and health research: experience from the Research for Health in Conflict-Middle East and North Africa (R4HC-MENA) partnership. Confl Health 2023; 17:29. [PMID: 37316903 DOI: 10.1186/s13031-023-00527-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/26/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Healthcare is a basic human right extending across all humanitarian contexts, including conflict. Globally, two billion people are living under conditions of insecurity and violent armed conflict with a consequent impact on public health. Health research in conflict-affected regions has been recognised as important to gain more understanding of the actual needs of such populations, to optimise healthcare delivery, as well as to inform advocacy and policy change. International collaborative research maximises the resources and skills available for dealing with global health issues, builds capacity and endeavours to ensure the research reflects real needs of the populations. Under the UK's Global Challenge Research Fund in 2017 a number of such international programs were created including the Research for Health in Conflict-Middle East and North Africa (R4HC-MENA) partnership to build capacity in conflict and health research as well as study specific areas, namely noncommunicable diseases in conflict (cancer & mental health) and the political economy of health in conflict. METHODS A qualitative study using semi-structured online interviews was conducted to explore researchers' and stakeholders' perspectives on the R4HC-MENA programme over its lifetime from 2017 to 2021. It aimed to understand the factors that influenced and accelerated international collaboration within the R4HC-MENA programme on conflict and health research, and to provide deeper insights into the implementation of the programme. Data collection was conducted from March 2022 to June 2022. Purposive and snowball sampling techniques were used for participant recruitment. Thematic analysis was applied for data analysis. RESULTS Twelve researchers/stakeholders participated in this study: four men and eight women. Four main themes were generated: Theme 1: Network building (personal and institutional levels); Theme 2: Hierarchies and power dynamics (power imbalance between different academic status, genders and institutions); Theme 3: Communication challenges; Theme 4: Career development (management, leadership, research, and teaching skills). CONCLUSIONS This study provided preliminary insights into perspectives on international collaboration in a major international programme of research on conflict and health. Several key challenges and outputs were generated by the researchers in this study. The findings are important for further developing effective strategies to tackle the challenge of power imbalance and ineffective communication in international research collaborations.
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Affiliation(s)
- Chiu-Yi Lin
- Centre for Conflict and Health Research, King's College London, London, UK.
| | - Kristen Meagher
- Centre for Conflict and Health Research, King's College London, London, UK
| | - Martin Bricknell
- Centre for Conflict and Health Research, King's College London, London, UK
| | - Preeti Patel
- Centre for Conflict and Health Research, King's College London, London, UK
| | - Nassim El Achi
- Centre for Conflict and Health Research, King's College London, London, UK
| | - Tezer Kutluk
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine and Cancer Institute, Ankara, Turkey
| | - Richard Harding
- Florence Nightingale Faculty of Nursing Midwifery & Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Hanna Kienzler
- Department of Global Health & Social Medicine, School of Global Affairs, King's College London, London, UK
| | - Rita Giacaman
- Institute of Community and Public Health, Birzeit University, West Bank, Birzeit, Occupied Palestinian Territory
| | - Deborah Mukherji
- Department of Internal Medicine, Division of Hematology-Oncology, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
| | - Omar Shamieh
- Center for Palliative & Cancer Care in Conflict, King Hussein Cancer Center, Amman, Jordan
| | - Richard Sullivan
- Centre for Conflict and Health Research, King's College London, London, UK
- King's Institute Cancer Policy, King's College London, London, UK
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Semaan J, Farah C, Harb RA, Bardus M, Germani A, Elhajj IH. Tackling the COVID-19 infodemic among Syrian refugees in Lebanon: Development and evaluation of the "Wikaytek" tool. Digit Health 2023; 9:20552076231205280. [PMID: 37915792 PMCID: PMC10617281 DOI: 10.1177/20552076231205280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 11/03/2023] Open
Abstract
Objective The COVID-19 infodemic has been a global public health challenge, especially affecting vulnerable populations such as Syrian refugees with limited internet access and functional, health, digital, and media literacies. To address this problem, we developed Wikaytek, a software to diffuse reliable COVID-19 information using WhatsApp, the preferred communication channel among Syrian refugees. In this paper, we describe the systematic development of the tool. Methods We undertook a pilot study guided by the Humanitarian Engineering Initiative (HEI)'s user-centered design framework, comprising five stages: (a) user research, including needs assessment and desk review of interventions with target users; (b) concept design based on platform and source selection, message format, concept testing, and architecture design; (c) prototyping and implementation, encompassing software development and system operation; (d) user testing (alpha and beta); and (e) evaluation through software analytics and user interviews. We reported a qualitative process evaluation. Results Wikaytek scrapes validated and reliable COVID-19-related information from reputable sources on Twitter, automatically translates it into Arabic, attaches relevant media (images/video), and generates an audio format using Google text-to-speech. Then, messages are broadcast to WhatsApp. Our evaluation shows that users appreciate receiving "push" information from reliable sources they can trust and prefer the audio format over text. Conclusions Wikaytek is a useful and well-received software for diffusing credible information on COVID-19 among Syrian refugees with limited literacy, as it complements the texts with audio messages. The tool can be adapted to diffuse messages about other public health issues among vulnerable communities, extending its scope and reach in humanitarian settings.
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Affiliation(s)
- Juliette Semaan
- Humanitarian Engineering Initiative, Faculty of Health Sciences and Maroun Semaan Faculty of Engineering and Architecture, American University of Beirut, Beirut, Lebanon
| | - Christopher Farah
- Department of Electrical and Computer Engineering, Maroun Semaan Faculty of Engineering and Architecture (MSFEA), American University of Beirut, Beirut, Lebanon
| | - Reem Abou Harb
- Humanitarian Engineering Initiative, Faculty of Health Sciences and Maroun Semaan Faculty of Engineering and Architecture, American University of Beirut, Beirut, Lebanon
- Department of Health Promotion and Community Health (HPCH), Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Marco Bardus
- Humanitarian Engineering Initiative, Faculty of Health Sciences and Maroun Semaan Faculty of Engineering and Architecture, American University of Beirut, Beirut, Lebanon
- Department of Health Promotion and Community Health (HPCH), Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, UK
| | - Aline Germani
- Humanitarian Engineering Initiative, Faculty of Health Sciences and Maroun Semaan Faculty of Engineering and Architecture, American University of Beirut, Beirut, Lebanon
- Center for Public Health Practice, Faculty of Health Sciences (FHS), American University of Beirut, Beirut, Lebanon
| | - Imad H Elhajj
- Humanitarian Engineering Initiative, Faculty of Health Sciences and Maroun Semaan Faculty of Engineering and Architecture, American University of Beirut, Beirut, Lebanon
- Department of Electrical and Computer Engineering, Maroun Semaan Faculty of Engineering and Architecture (MSFEA), American University of Beirut, Beirut, Lebanon
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Krishnan S, Zaman S, Ferdaus M, Kabir MH, Khatun H, Rahman SMS, Marzouk M, Durrance-Bagale A, Howard N. How can humanitarian services provision during mass displacement better support health systems? An exploratory qualitative study of humanitarian service provider perspectives in Cox's Bazar, Bangladesh. J Migr Health 2022; 6:100132. [PMID: 36158594 PMCID: PMC9489749 DOI: 10.1016/j.jmh.2022.100132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/30/2022] [Accepted: 09/12/2022] [Indexed: 12/30/2022] Open
Abstract
Health services provision in mass displacement settings is a humanitarian imperative and essential to promoting international and regional security. Internationally displaced populations experience a range of issues pre-, peri-, post-displacement and residing in host countries that affect their health and well-being. This study examined links between humanitarian and government health services provision for forcibly displaced Myanmar nationals (FDMN) in Cox's Bazar to consider how improved knowledge sharing and collaboration might better support health systems during mass displacement. We conducted a qualitative descriptive study, interviewing 25 humanitarian service providers in-person in Bangladesh in early 2021 and analysing data thematically. We found that government restricted what essential services humanitarian health actors could provide and FDMN had to undergo stringent screening and referral to receive tertiary healthcare. Concurrently, the government health system was challenged by accessibility, affordability and availability of medicines, equipment, and trained staff. Humanitarian health service providers augmented government responses by working with community groups, recruiting and training Rohingya volunteers, and involving religious leaders. Findings suggest that easing barriers to a fuller range of health services, allowing access to digital devices, and hiring FDMN to support their communities would improve health system responsiveness to the legitimate needs of FDMN displaced around Cox's Bazar. It is imperative to amplify and listen to the voices of FDMN and collaborate in addressing structural and social barriers constraining their access to effective health services, both to increase trust in and responsiveness of the health system.
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Affiliation(s)
- Sneha Krishnan
- Jindal School of Environment and Sustainability, Jindal Global University, Haryana and Environment, Technology and Community Health Consultancy Services, Mumbai, Maharashtra, India
| | - Samia Zaman
- BRAC University, UB04–66 Bir Uttam AK Khandakar Road, Dhaka 1212, Bangladesh
| | - Muhammad Ferdaus
- BRAC University, UB04–66 Bir Uttam AK Khandakar Road, Dhaka 1212, Bangladesh
| | - Md Humayun Kabir
- University of Dhaka, Department of Geography & Environment, Nilkhet Road, Dhaka 1000, Bangladesh
| | - Hafiza Khatun
- University of Dhaka, Department of Geography & Environment, Nilkhet Road, Dhaka 1000, Bangladesh
| | - SM Safiqur Rahman
- BRAC University, UB04–66 Bir Uttam AK Khandakar Road, Dhaka 1212, Bangladesh
| | - Manar Marzouk
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, Singapore 117549, Singapore
| | - Anna Durrance-Bagale
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, Singapore 117549, Singapore,London School of Hygiene & Tropical Medicine, Department of Global Health & Development, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom,Corresponding author at: London School of Hygiene & Tropical Medicine, Department of Global Health & Development, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom.
| | - Natasha Howard
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, Singapore 117549, Singapore,London School of Hygiene & Tropical Medicine, Department of Global Health & Development, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom
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Oyekale AS. Indicators of Mental Health Disorder, COVID-19 Prevention Compliance and Vaccination Intentions among Refugees in Kenya. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1032. [PMID: 36013499 PMCID: PMC9413478 DOI: 10.3390/medicina58081032] [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: 06/20/2022] [Revised: 07/19/2022] [Accepted: 07/27/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: COVID-19 remains a major development challenge in many developing countries. This study analysed the effect of mental health disorder and indicators of COVID-19 preventive practices on vaccination intentions among refugees in Kenya. Materials and Methods: The data were the fourth and fifth waves of the High Frequency Phone Surveys on the impacts of COVID-19 that were collected by the Kenyan National Bureau of Statistics (KNBS) between May 2020 and June 2021. The data were collected from Kakuma, Kalobeyei, Dadaab and Shona camps using the stratified random sampling method. The data were analysed with random effects instrumental variable Probit regression model. Results: The results showed that 69.32% and 93.16% of the refugees were willing to be vaccinated during the 4th and 5th waves, respectively. The fear of dying was reported by 85.89% and 74.19% during the 4th and 5th waves, respectively. COVID-19 contact prevention and immune boosting indicators were differently influenced by some demographic and anxiety index variables, while being endogenous influenced vaccine hesitancy along with urban residence, age, knowing infected persons, days of depression, days of anxiety, days of physical reactions, members losing job, searching for jobs, accepting job offers and being employed. Conclusions: It was concluded that efforts to promote COVID-19 vaccination should address mental health disorder and compliance with existing COVID-19 contact and immune boosting behaviour with a focus on urban residents and youths.
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Affiliation(s)
- Abayomi Samuel Oyekale
- Department of Agricultural Economics and Extension, North-West University Mafikeng Campus, Mmabatho 2735, South Africa
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History Repeating-How Pandemics Collide with Health Disparities in the United States. J Racial Ethn Health Disparities 2022; 10:1455-1465. [PMID: 35595916 PMCID: PMC9122254 DOI: 10.1007/s40615-022-01331-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/25/2022] [Accepted: 05/13/2022] [Indexed: 11/24/2022]
Abstract
Across the United States, public health responses to the COVID-19 pandemic have fallen short. COVID-19 has exacerbated longstanding public health shortfalls in disadvantaged communities. Was this predestined? Understanding where we are today requires reflection on our longer journey. Disparities cataloged during COVID-19 reflect the same unequal host exposure and susceptibility risks that shaped previous pandemics. In this review, we provide historical context to better understand current events and to showcase forgotten lessons which may motivate future action to protect our most vulnerable citizens.
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Mansaray B, Dean L, Tubb P, Josyula KL, Okoth L, Chumo I, Waritu J, Klingel A, Manzoor F, Aktar B, Garimella S, Murthy S, Tolhurst R, Whittaker L, Gray L, Forsyth R, Elsey H, Waldman L, Theobald S. Implications of COVID-19 for safeguarding in international development research: learning, action and reflection from a research hub. BMJ Glob Health 2022; 7:e008122. [PMID: 35606015 PMCID: PMC9125381 DOI: 10.1136/bmjgh-2021-008122] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 04/13/2022] [Indexed: 12/02/2022] Open
Abstract
COVID-19 brings uncertainties and new precarities for communities and researchers, altering and amplifying relational vulnerabilities (vulnerabilities which emerge from relationships of unequal power and place those less powerful at risk of abuse and violence). Research approaches have changed too, with increasing use of remote data collection methods. These multiple changes necessitate new or adapted safeguarding responses. This practice piece shares practical learnings and resources on safeguarding from the Accountability for Informal Urban Equity hub, which uses participatory action research, aiming to catalyse change in approaches to enhancing accountability and improving the health and well-being of marginalised people living and working in informal urban spaces in Bangladesh, India, Kenya and Sierra Leone. We outline three new challenges that emerged in the context of the pandemic (1): exacerbated relational vulnerabilities and dilemmas for researchers in responding to increased reports of different forms of violence coupled with support services that were limited prior to the pandemic becoming barely functional or non-existent in some research sites, (2) the increased use of virtual and remote research methods, with implications for safeguarding and (3) new stress, anxiety and vulnerabilities experienced by researchers. We then outline our learning and recommended action points for addressing emerging challenges, linking practice to the mnemonic 'the four Rs: recognise, respond, report, refer'. COVID-19 has intensified safeguarding risks. We stress the importance of communities, researchers and co-researchers engaging in dialogue and ongoing discussions of power and positionality, which are important to foster co-learning and co-production of safeguarding processes.
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Affiliation(s)
- Bintu Mansaray
- Department of Health Systems Research, COMAHS, Freetown, Western Area, Sierra Leone
- Pediatrics, King Harman Road Maternal and Child Health Hospital, Freetown, Western Area, Sierra Leone
| | - Laura Dean
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Phil Tubb
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | | | - Ivy Chumo
- Research Division, APHRC, Nairobi, Kenya
| | - Jane Waritu
- Slum Dwellers International, Cape Town, South Africa
| | - Andrea Klingel
- Sierra Leone Urban Research Centre, Freetown, Sierra Leone
| | - Farzana Manzoor
- BRAC University James P Grant School of Public Health, Dhaka, Bangladesh
| | - Bachera Aktar
- BRAC University James P Grant School of Public Health, Dhaka, Bangladesh
| | | | | | | | | | | | | | - Helen Elsey
- Health Sciences, University of York, York, UK
| | | | - Sally Theobald
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Nair S, Attal-Juncqua A, Reddy A, Sorrell EM, Standley CJ. Assessing barriers, opportunities and future directions in health information sharing in humanitarian contexts: a mixed-method study. BMJ Open 2022; 12:e053042. [PMID: 35379617 PMCID: PMC8981313 DOI: 10.1136/bmjopen-2021-053042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 03/12/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Health information sharing continues to play a crucial yet underappreciated role in humanitarian settings, to guide evidence-based disease prevention, detection and response. We conducted a mixed-methods study to investigate and analyse existing approaches and practices to health information sharing across humanitarian settings over the past 20 years. SETTING We sought to identify studies from any self-described humanitarian setting worldwide, and also targeted experts familiar with refugee settings, specifically long-term camps in Kenya, Jordan and Bangladesh, for key informant interviews. PARTICIPANTS The systematic review did not directly involve participants. The identified reports were largely retrospective and observational, and focused on populations affected by humanitarian crises worldwide. Participants in the key informant interviews were experts with either broad geographical expertise or direct experience in refugee camp settings. PRIMARY AND SECONDARY OUTCOME MEASURES Our study was qualitative, and both the systematic review and analysis of key informant interview responses focused on identifying themes related to barriers, tools and recommendations used between stakeholders to share health information, with a particular emphasis on infectious disease and surveillance data. RESULTS We identified logistical challenges, difficulties with data collection and a lack of health information sharing frameworks as the most significant barriers to health information sharing. The most important tools to health information sharing included the use of third-party technologies for data collection and standardisation, formalised health information sharing frameworks, establishment of multilevel coordination mechanisms and leadership initiatives which prioritised the sharing of health information. CONCLUSIONS We conclude that health information sharing can be strengthened in humanitarian settings with improvements to existing frameworks, coordination and leadership tools, in addition to promotion of health information communication. Furthermore, specific recommendations for improving health information sharing should be pursued according to the nature of the humanitarian setting and the efficacy of the health system present.
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Affiliation(s)
- Shuait Nair
- Walsh School of Foreign Service, Georgetown University, Washington, District of Columbia, USA
| | - Aurelia Attal-Juncqua
- Center for Global Health Science and Security, Georgetown University, Washington, District of Columbia, USA
| | - Aashna Reddy
- School of Nursing and Health Studies, Georgetown University, Washington, District of Columbia, USA
| | - Erin M Sorrell
- Center for Global Health Science and Security, Georgetown University, Washington, District of Columbia, USA
- Department of Microbiology & Immunology, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Claire J Standley
- Center for Global Health Science and Security, Georgetown University, Washington, District of Columbia, USA
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11
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Polonsky JA, Bhatia S, Fraser K, Hamlet A, Skarp J, Stopard IJ, Hugonnet S, Kaiser L, Lengeler C, Blanchet K, Spiegel P. Feasibility, acceptability, and effectiveness of non-pharmaceutical interventions against infectious diseases among crisis-affected populations: a scoping review. Infect Dis Poverty 2022; 11:14. [PMID: 35090570 PMCID: PMC8796190 DOI: 10.1186/s40249-022-00935-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 01/03/2022] [Indexed: 12/23/2022] Open
Abstract
Background Non-pharmaceutical interventions (NPIs) are a crucial suite of measures to prevent and control infectious disease outbreaks. Despite being particularly important for crisis-affected populations and those living in informal settlements, who typically reside in overcrowded and resource limited settings with inadequate access to healthcare, guidance on NPI implementation rarely takes the specific needs of such populations into account. We therefore conducted a systematic scoping review of the published evidence to describe the landscape of research and identify evidence gaps concerning the acceptability, feasibility, and effectiveness of NPIs among crisis-affected populations and informal settlements. Methods We systematically reviewed peer-reviewed articles published between 1970 and 2020 to collate available evidence on the feasibility, acceptability, and effectiveness of NPIs in crisis-affected populations and informal settlements. We performed quality assessments of each study using a standardised questionnaire. We analysed the data to produce descriptive summaries according to a number of categories: date of publication; geographical region of intervention; typology of crisis, shelter, modes of transmission, NPI, research design; study design; and study quality. Results Our review included 158 studies published in 85 peer-reviewed articles. Most research used low quality study designs. The acceptability, feasibility, and effectiveness of NPIs was highly context dependent. In general, simple and cost-effective interventions such as community-level environmental cleaning and provision of water, sanitation and hygiene services, and distribution of items for personal protection such as insecticide-treated nets, were both highly feasible and acceptable. Logistical, financial, and human resource constraints affected both the implementation and sustainability of measures. Community engagement emerged as a strong factor contributing to the effectiveness of NPIs. Conversely, measures that involve potential restriction on personal liberty such as case isolation and patient care and burial restrictions were found to be less acceptable, despite apparent effectiveness. Conclusions Overall, the evidence base was variable, with substantial knowledge gaps which varied between settings and pathogens. Based on the current landscape, robust evidence-based guidance is not possible, and a research agenda is urgently required that focusses on these specific vulnerable populations. Although implementation of NPIs presents unique practical challenges in these settings, it is critical that such an agenda is put in place, and that the lessons learned from historical and present experiences are documented to build a firm evidence base. Graphical Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s40249-022-00935-7.
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12
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Lowe H, Woodd S, Lange IL, Janjanin S, Barnett J, Graham W. Challenges and opportunities for infection prevention and control in hospitals in conflict-affected settings: a qualitative study. Confl Health 2021; 15:94. [PMID: 34930364 PMCID: PMC8686079 DOI: 10.1186/s13031-021-00428-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 11/29/2021] [Indexed: 12/13/2022] Open
Abstract
Background Healthcare associated infections (HAIs) are the most frequent adverse outcome in healthcare delivery worldwide. In conflict-affected settings HAIs, in particular surgical site infections, are prevalent. Effective infection prevention and control (IPC) is crucial to ending avoidable HAIs and an integral part of safe, effective, high quality health service delivery. However, armed conflict and widespread violence can negatively affect the quality of health care through workforce shortages, supply chain disruptions and attacks on health facilities and staff. To improve IPC in these settings it is necessary to understand the specific barriers and facilitators experienced locally. Methods In January and February of 2020, we conducted semi-structured interviews with hospital staff working for the International Committee of the Red Cross across eight conflict-affected countries (Central African Republic, South Sudan, Democratic Republic of the Congo, Mali, Nigeria, Lebanon, Yemen and Afghanistan). We explored barriers and facilitators to IPC, as well as the direct impact of conflict on the hospital and its’ IPC programme. Data was analysed thematically. Results We found that inadequate hospital infrastructure, resource and workforce shortages, education of staff, inadequate in-service IPC training and supervision and large visitor numbers are barriers to IPC in hospitals in this study, similar to barriers seen in other resource-limited settings. High patient numbers, supply chain disruptions, high infection rates and attacks on healthcare infrastructures, all as a direct result of conflict, exacerbated existing challenges and imposed an additional burden on hospitals and their IPC programmes. We also found examples of local strategies for improving IPC in the face of limited resources, including departmental IPC champions and illustrated guidelines for in-service training. Conclusions Hospitals included in this study demonstrated how they overcame certain challenges in the face of limited resources and funding. These strategies present opportunities for learning and knowledge exchange across contexts, particularly in the face of the current global coronavirus pandemic. The findings are increasingly relevant today as they provide evidence of the fragility of IPC programmes in these settings. More research is required on tailoring IPC programmes so that they can be feasible and sustainable in unstable settings.
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Affiliation(s)
- Hattie Lowe
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, The London School of Hygiene and Tropical Medicine, London, UK. .,Institute for Global Health, Univeristy College London, London, UK.
| | - Susannah Woodd
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, The London School of Hygiene and Tropical Medicine, London, UK
| | - Isabelle L Lange
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, The London School of Hygiene and Tropical Medicine, London, UK
| | - Sanja Janjanin
- Health Unit, International Committee of the Red Cross, Geneva, Switzerland
| | - Julie Barnett
- Health Unit, International Committee of the Red Cross, Geneva, Switzerland
| | - Wendy Graham
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, The London School of Hygiene and Tropical Medicine, London, UK
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13
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Tan MKI. COVID-19 in an inequitable world: the last, the lost and the least. Int Health 2021; 13:493-496. [PMID: 34528090 PMCID: PMC8499981 DOI: 10.1093/inthealth/ihab057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 09/13/2021] [Indexed: 01/09/2023] Open
Affiliation(s)
- Mark K I Tan
- London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT
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14
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Yamey G, McDade KK, Brennan RJ, Abubakar A, Khan W. Preventing pandemics in the world's most vulnerable settings. BMJ 2021; 375:n2897. [PMID: 34824126 DOI: 10.1136/bmj.n2897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Gavin Yamey
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Kaci Kennedy McDade
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Richard J Brennan
- WHO Health Emergencies Programme, World Health Organization Regional Office for the Eastern Mediterranean, Nasr City, Cairo, Egypt
| | - Abdinasir Abubakar
- WHO Health Emergencies Programme, World Health Organization Regional Office for the Eastern Mediterranean, Nasr City, Cairo, Egypt
| | - Wasiq Khan
- WHO Health Emergencies Programme, World Health Organization Regional Office for the Eastern Mediterranean, Nasr City, Cairo, Egypt
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15
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Odlum A, James R, Mahieu A, Blanchet K, Altare C, Singh N, Spiegel P. Use of COVID-19 evidence in humanitarian settings: the need for dynamic guidance adapted to changing humanitarian crisis contexts. Confl Health 2021; 15:83. [PMID: 34798877 PMCID: PMC8602975 DOI: 10.1186/s13031-021-00418-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 10/29/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND For humanitarian organisations to respond effectively to complex crises, they require access to up-to-date evidence-based guidance. The COVID-19 crisis has highlighted the importance of updating global guidance to context-specific and evolving needs in humanitarian settings. Our study aimed to understand the use of evidence-based guidance in humanitarian responses during COVID-19. Primary data collected during the rapidly evolving pandemic sheds new light on evidence-use processes in humanitarian response. METHODS We collected and analysed COVID-19 guidance documents, and conducted semi-structured interviews remotely with a variety of humanitarian organisations responding and adapting to the COVID-19 pandemic. We used the COVID-19 Humanitarian platform, a website established by three universities in March 2020, to solicit, collate and document these experiences and knowledge. RESULTS We analysed 131 guidance documents and conducted 80 interviews with humanitarian organisations, generating 61 published field experiences. Although COVID-19 guidance was quickly developed and disseminated in the initial phases of the crisis (from January to May 2020), updates or ongoing revision of the guidance has been limited. Interviews conducted between April and September 2020 showed that humanitarian organisations have responded to COVID-19 in innovative and context-specific ways, but have often had to adapt existing guidance to inform their operations in complex humanitarian settings. CONCLUSIONS Experiences from the field indicate that humanitarian organisations consulted guidance to respond and adapt to COVID-19, but whether referring to available guidance indicates evidence use depends on its accessibility, coherence, contextual relevance and trustworthiness. Feedback loops through online platforms like the COVID-19 Humanitarian platform that relay details of these evidence-use processes to global guidance setters could improve future humanitarian response.
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Affiliation(s)
- Alex Odlum
- Geneva Centre of Humanitarian Studies, Boulevard du Pont-d'Arve 28, 1205, Geneva, Switzerland.
| | - Rosemary James
- Geneva Centre of Humanitarian Studies, Boulevard du Pont-d'Arve 28, 1205, Geneva, Switzerland
| | - Audrey Mahieu
- Geneva Centre of Humanitarian Studies, Boulevard du Pont-d'Arve 28, 1205, Geneva, Switzerland
| | - Karl Blanchet
- Geneva Centre of Humanitarian Studies, Boulevard du Pont-d'Arve 28, 1205, Geneva, Switzerland
| | - Chiara Altare
- Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Neha Singh
- Health in Humanitarian Crises Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Paul Spiegel
- Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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16
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Sserwanja Q, Adam MB, Kawuki J, Olal E. COVID-19 in conflict border regions: a case of South Kordofan, Sudan. Confl Health 2021; 15:34. [PMID: 33947451 PMCID: PMC8094973 DOI: 10.1186/s13031-021-00370-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/21/2021] [Indexed: 11/21/2022] Open
Abstract
The novel coronavirus disease (COVID-19) was first reported in Sudan on 13 March 2020. Since then, Sudan has experienced one of the highest rates of COVID-19 spread and fatalities in Africa. One year later, as per 22 March 2021, Sudan had registered 29,661 confirmed cases and 2,028 deaths with a case fatality rate (CFR) of 6.8 %. By 12 December 2020, of the 18 states in Sudan, South Kordofan had the fifth highest CFR of 17.4 %, only surpassed by the other conflict affected North (57.5 %), Central (50.0 %) and East (31.8 %) Darfur States. By late March 2021, just three months from December 2020, the number of cases in South Kordofan increased by 100 %, but with a significant decline in the CFR from 17.4 to 8.5 %. South Kordofan is home to over 200,000 poor and displaced people from years of destructive civil unrests. To date, several localities such as the Nubba mountains region remain under rebel control and are not accessible. South Kordofan State Ministry of Health in collaboration with the federal government and non-governmental organizations set up four isolation centres with 40 total bed capacity, but with only two mechanical ventilators and no testing centre. There is still need for further multi-sectoral coalition and equitable allocation of resources to strengthen the health systems of rural and conflict affected regions. This article aims at providing insight into the current state of COVID-19 in South Kordofan amidst the second wave to address the dearth of COVID-19 information in rural and conflict affected regions.
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Affiliation(s)
- Quraish Sserwanja
- Programmes Department, GOAL Global, Khartoum, Sudan. .,Global Health Uganda, Mawanda Road, Plot 667, P.0 Box 33842, Kampala, Uganda.
| | | | - Joseph Kawuki
- Centre for Health Behaviors Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong- SAR, China
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Cueto LJ, Agaton CB. Pandemic and Typhoon: Positive Impacts of a Double Disaster on Mental Health of Female Students in the Philippines. Behav Sci (Basel) 2021; 11:64. [PMID: 33946801 PMCID: PMC8147095 DOI: 10.3390/bs11050064] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/24/2021] [Accepted: 04/25/2021] [Indexed: 12/12/2022] Open
Abstract
Humanitarian emergencies pose a great challenge to how all sectors perform their functions in society. In several countries, these emergencies combined the pandemic and other man-made and natural disasters: "double disaster", which affected the health, safety, and well-being of both individuals and communities. Students are a particularly vulnerable population for mental health problems considering the challenges with their transitions to adulthood. Using narrative analysis, this study explored the impacts of a double disaster on the mental health of students and how they cope up with these emergencies. The results showed that the occurrence of natural disasters during the lockdowns from pandemic brought stress to students in adjusting to distance education, completing academic requirements, and accessing technology for online learning. Participants expressed their anxieties about the spread of the virus in the community, particularly in the disaster evacuation centers with less strictly observed social distancing, insufficient hygiene and sanitation facilities, and lack of basic needs. Participants described their learnings and coping strategies that included helping one another, following the government protocols, finding additional sources of income, using energy for important purposes only, and leaning on faith. The findings of this study would be instrumental in formulating policies and strategic measures that best complement the needs of community members during a double disaster, particularly in addressing the mental health impacts of humanitarian emergencies.
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Affiliation(s)
- Lavinia Javier Cueto
- Junior High School Department, Parang National High School, Calapan City 5200, Philippines;
| | - Casper Boongaling Agaton
- Utrecht School of Economics, Utrecht University, Kriekenpitplein 21-22, 3584 EC Utrecht, The Netherlands
- Copernicus Institute of Sustainable Development, Utrecht University, Princetonlaan 8a, 3584 CB Utrecht, The Netherlands
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18
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Hayward SE, Deal A, Cheng C, Crawshaw A, Orcutt M, Vandrevala TF, Norredam M, Carballo M, Ciftci Y, Requena-Méndez A, Greenaway C, Carter J, Knights F, Mehrotra A, Seedat F, Bozorgmehr K, Veizis A, Campos-Matos I, Wurie F, McKee M, Kumar B, Hargreaves S. Clinical outcomes and risk factors for COVID-19 among migrant populations in high-income countries: A systematic review. J Migr Health 2021; 3:100041. [PMID: 33903857 PMCID: PMC8061095 DOI: 10.1016/j.jmh.2021.100041] [Citation(s) in RCA: 153] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 04/07/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Migrants in high-income countries may be at increased risk of COVID-19 due to their health and social circumstances, yet the extent to which they are affected and their predisposing risk factors are not clearly understood. We did a systematic review to assess clinical outcomes of COVID-19 in migrant populations, indirect health and social impacts, and to determine key risk factors. METHODS We did a systematic review following PRISMA guidelines (PROSPERO CRD42020222135). We searched multiple databases to 18/11/2020 for peer-reviewed and grey literature on migrants (foreign-born) and COVID-19 in 82 high-income countries. We used our international networks to source national datasets and grey literature. Data were extracted on primary outcomes (cases, hospitalisations, deaths) and we evaluated secondary outcomes on indirect health and social impacts and risk factors using narrative synthesis. RESULTS 3016 data sources were screened with 158 from 15 countries included in the analysis (35 data sources for primary outcomes: cases [21], hospitalisations [4]; deaths [15]; 123 for secondary outcomes). We found that migrants are at increased risk of infection and are disproportionately represented among COVID-19 cases. Available datasets suggest a similarly disproportionate representation of migrants in reported COVID-19 deaths, as well as increased all-cause mortality in migrants in some countries in 2020. Undocumented migrants, migrant health and care workers, and migrants housed in camps have been especially affected. Migrants experience risk factors including high-risk occupations, overcrowded accommodation, and barriers to healthcare including inadequate information, language barriers, and reduced entitlement. CONCLUSIONS Migrants in high-income countries are at high risk of exposure to, and infection with, COVID-19. These data are of immediate relevance to national public health and policy responses to the pandemic. Robust data on testing uptake and clinical outcomes in migrants, and barriers and facilitators to COVID-19 vaccination, are urgently needed, alongside strengthening engagement with diverse migrant groups.
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Affiliation(s)
- Sally E Hayward
- Institute for Infection and Immunity, St George's University of London, London, UK
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Anna Deal
- Institute for Infection and Immunity, St George's University of London, London, UK
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Cherie Cheng
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - Alison Crawshaw
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - Miriam Orcutt
- Institute for Global Health, University College London, London, UK
| | | | - Marie Norredam
- Danish Research Centre for Migration, Ethnicity and Health, University of Copenhagen; Department of Infectious Diseases at Copenhagen University Hospital, Amager and Hvidovre, Copenhagen, Denmark
| | - Manuel Carballo
- International Centre for Migration, Health, and Development, Geneva, Switzerland
| | | | - Ana Requena-Méndez
- Department of Medicine, Karolinska Insitutet, Solna, Sweden; and Barcelona Insitute for Global Health (ISGlobal), University of Barcelona, Barcelona, Spain
| | | | - Jessica Carter
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - Felicity Knights
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - Anushka Mehrotra
- Institute for Infection and Immunity, St George's University of London, London, UK
| | | | - Kayvan Bozorgmehr
- Department of Population Medicine and Health and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany; Section for Health Equity Studies & Migration, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Ines Campos-Matos
- Public Health England; and UCL Collaborative Centre for Inclusion Health, London, UK
| | - Fatima Wurie
- Public Health England; and UCL Research Department of Epidemiology and Public Health, London, UK
| | - Martin McKee
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Sally Hargreaves
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - on behalf of the ESCMID Study Group for Infections in Travellers and Migrants (ESGITM)
- Institute for Infection and Immunity, St George's University of London, London, UK
- Institute for Global Health, University College London, London, UK
- Faculty of Business and Social Sciences, Kingston University, London, UK
- Danish Research Centre for Migration, Ethnicity and Health, University of Copenhagen; Department of Infectious Diseases at Copenhagen University Hospital, Amager and Hvidovre, Copenhagen, Denmark
- International Centre for Migration, Health, and Development, Geneva, Switzerland
- Doctors of the World UK, London, UK
- Department of Medicine, Karolinska Insitutet, Solna, Sweden; and Barcelona Insitute for Global Health (ISGlobal), University of Barcelona, Barcelona, Spain
- Department of Medicine, McGill University, Montreal, Canada
- Department of Population Medicine and Health and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany; Section for Health Equity Studies & Migration, Heidelberg University Hospital, Heidelberg, Germany
- Medecins Sans Frontieres Greece, Athens, Greece
- Public Health England, London, UK
- Public Health England; and UCL Collaborative Centre for Inclusion Health, London, UK
- Public Health England; and UCL Research Department of Epidemiology and Public Health, London, UK
- Norwegian Institute of Public Health, Oslo, Norway
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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19
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Guo P, Chukwusa E, Asad M, Nimri O, Arqoub K, Alajarmeh S, Mansour A, Sullivan R, Shamieh O, Harding R. Changing Mortality and Place of Death in Response to Refugee Influx: A Population-Based Cross-Sectional Study in Jordan, 2005-2016. J Palliat Med 2021; 24:1616-1625. [PMID: 33826858 DOI: 10.1089/jpm.2020.0476] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Jordan faces complex health care challenges due to refugee influx and an aging population. Palliative care planning and delivery require data to ensure services respond to changing population needs. Objectives: To determine the trend in mortality and place of death in Jordan. Design: Population-based study. Setting/Subjects: Death registry data of adult decedents (n = 143,215), 2005-2016. Measurements: Descriptive statistics examined change in demographic and place of death (categorized as hospital and nonhospital). Binomial logistic regression compared the association between hospital deaths and demographic characteristics in 2008-2010, 2011-2013, and 2014-2016, with 2005-2007. Results: The annual number of deaths increased from 6792 in 2005 to 17,018 in 2016 (151% increase). Hospital was the most common place of death (93.7% of all deaths) in Jordan, and percentage of hospital deaths increased for Jordanian (82.6%-98.8%) and non-Jordanian decedents (88.1%-98.7%). There was an increased likelihood of hospital death among Jordanian decedents who died from nonischemic heart disease (odd ratio [OR]: 1.11, 95% confidence interval [CI]: 1.09-1.13, p < 0.001), atherosclerosis (OR: 1.10, 95% CI: 1.08-1.13, p < 0.001), renal failure (OR: 1.05, 95% CI: 1.02-1.08, p < 0.001), hemorrhagic fevers (OR: 1.09, 95% CI: 1.06-1.13, p < 0.001), and injury (OR: 1.18, 95% CI: 1.06-1.33, p < 0.001) in the period 2014-2016, compared with 2005-2007. There were similar increases in the likelihood of hospital death among non-Jordanians in 2014-2016 for the following conditions: malignant neoplasms (except leukemia), nonischemic heart disease, atherosclerosis, injury, and HIV, compared with 2005-2007. Conclusions: Country-level palliative care development must respond to both internal (aging) and external (refugee influx) population trends. Universal Health Coverage requires palliative care to move beyond cancer and meet population-specific needs. Community-based services should be prioritized and expanded to care for the patients with nonischemic heart disease, atherosclerosis, renal failure, hemorrhagic fevers, and injury.
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Affiliation(s)
- Ping Guo
- School of Nursing, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom.,Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Emeka Chukwusa
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Majed Asad
- Non-Communicable Diseases, Jordan Cancer Registry, The Ministry of Health, Amman, Jordan
| | - Omar Nimri
- Non-Communicable Diseases, Jordan Cancer Registry, The Ministry of Health, Amman, Jordan
| | - Kamal Arqoub
- Non-Communicable Diseases, Jordan Cancer Registry, The Ministry of Health, Amman, Jordan
| | - Sawsan Alajarmeh
- Center for Palliative and Cancer Care in Conflict, King Hussein Cancer Center, Amman, Jordan
| | | | - Richard Sullivan
- Institute of Cancer Policy, King's College London, London, United Kingdom
| | - Omar Shamieh
- Department of Palliative Care, Center for Palliative and Cancer Care in Conflict, King Hussein Cancer Centre, Amman, Jordan.,College of Medicine, University of Jordan, Amman, Jordan
| | - Richard Harding
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
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Lupieri S. Refugee Health During the Covid-19 Pandemic: A Review of Global Policy Responses. Risk Manag Healthc Policy 2021; 14:1373-1378. [PMID: 33854386 PMCID: PMC8039842 DOI: 10.2147/rmhp.s259680] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/22/2021] [Indexed: 11/23/2022] Open
Abstract
Refugees and displaced persons have been severely affected by the Covid-19 pandemic. Yet findings from this narrative review reveal that the health needs of refugees have been largely neglected within global healthcare responses. Such gaps include: (1) responding to the needs of refugees in camps and detention centers; (2) providing adequate public health information; (3) providing access to healthcare and mental health services; (4) and including refugees as decision-makers within health responses. More research is urgently needed to investigate why these gaps exists and to provide recommendations for improving the inclusiveness of healthcare policies during a pandemic.
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Affiliation(s)
- Sigrid Lupieri
- Department of Politics and International Studies, Centre of Development Studies, University of Cambridge, Cambridge, UK
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21
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Fouad FM, McCall SJ, Ayoub H, Abu-Raddad LJ, Mumtaz GR. Vulnerability of Syrian refugees in Lebanon to COVID-19: quantitative insights. Confl Health 2021; 15:13. [PMID: 33673855 PMCID: PMC7934989 DOI: 10.1186/s13031-021-00349-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 02/26/2021] [Indexed: 12/13/2022] Open
Abstract
Lebanon, a middle-income country with ongoing political turmoil, unstable economic situation, and a fragmented and under-resourced health system, hosts about one million Syrian refugees since 2011. While the country is currently experiencing substantial COVID-19 epidemic spread, no outbreaks have been reported yet among Syrian refugees. However, testing of this population remains limited and exposure levels are high given dire living conditions and close interaction with the host community. Here, we use quantitative insights of transmission dynamics to outline risk and contextual factors that may modulate vulnerability of Syrian refugees in Lebanon to potentially large COVID-19 epidemics. Syrian refugees live in close contact with the host community, and their living conditions are favorable for epidemic spread. We found that the high levels of crowding within Syrian refugee households and among those in informal tented settlements, the inadequate water supply and sanitation, limited use of masks, inadequate access to health care, and inadequate community awareness levels are vulnerability factors that directly impact important parameters of transmission dynamics, leading to larger epidemic scale. Poverty, stigma, and fear of legal consequences are contextual factors that further exacerbate this vulnerability. The relatively high prevalence of non-communicable diseases in this population could also affect the severity of the disease among those infected. Mathematical modeling simulations we conducted illustrated that even modest increases in transmission among Syrian refugees could result in a large increase in the incidence and cumulative total number of infections in the absence of interventions. In conclusion, while the young age structure of the Syrian refugee population might play a protective role against the scale and disease-burden severity of a potential COVID-19 epidemic, the epidemic potential due to several vulnerability factors warrants an immediate response in this population group. Local and international actors are required to mobilize and coordinate efforts to prevent the transmission of COVID-19, and to mitigate its impact amongst the vulnerable refugee populations globally.
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Affiliation(s)
- Fouad M Fouad
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, P.O.Box 11-0236, Riad El Solh, Beirut, 1107 2020, Lebanon
| | - Stephen J McCall
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Houssein Ayoub
- Department of Mathematics, Statistics, and Physics, Qatar University, Doha, Qatar
| | - Laith J Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medical College - Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar.,Department of Healthcare Policy and Research, Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Ghina R Mumtaz
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, P.O.Box 11-0236, Riad El Solh, Beirut, 1107 2020, Lebanon.
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Logie CH, Okumu M, Latif M, Musoke DK, Odong Lukone S, Mwima S, Kyambadde P. Exploring resource scarcity and contextual influences on wellbeing among young refugees in Bidi Bidi refugee settlement, Uganda: findings from a qualitative study. Confl Health 2021; 15:3. [PMID: 33413546 PMCID: PMC7790031 DOI: 10.1186/s13031-020-00336-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 12/17/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Contextual factors including poverty and inequitable gender norms harm refugee adolescent and youths' wellbeing. Our study focused on Bidi Bidi refugee settlement that hosts more than 230,000 of Uganda's 1.4 million refugees. We explored contextual factors associated with wellbeing among refugee adolescents and youth aged 16-24 in Bidi Bidi refugee settlement. METHODS We conducted 6 focus groups (n = 3: women, n = 3: men) and 10 individual interviews with young refugees aged 16-24 living in Bidi Bidi. We used physical distancing practices in a private outdoor space. Focus groups and individual interviews explored socio-environmental factors associated with refugee youth wellbeing. Focus groups were digitally recorded, transcribed verbatim, and coded by two investigators using thematic analysis. Analysis was informed by a social contextual theoretical approach that considers the interplay between material (resource access), symbolic (cultural norms and values), and relational (social relationships) contextual factors that can enable or constrain health promotion. RESULTS Participants included 58 youth (29 men; 29 women), mean age was 20.9 (range 16-24). Most participants (82.8%, n = 48) were from South Sudan and the remaining from the Democratic Republic of Congo (17.2% [n = 10]). Participant narratives revealed the complex interrelationships between material, symbolic and relational contexts that shaped wellbeing. Resource constraints of poverty, food insecurity, and unemployment (material contexts) produced stress and increased sexual and gender-based violence (SGBV) targeting adolescent girls and women. These economic insecurities exacerbated inequitable gender norms (symbolic contexts) to increase early marriage and transactional sex (relational context) among adolescent girls and young women. Gendered tasks such as collecting water and firewood also increased SGBV exposure among girls and young women, and this was exacerbated by deforestation. Participants reported negative community impacts (relational context) of COVID-19 that were associated with fear and panic, alongside increased social isolation due to business, school and church closures. CONCLUSIONS Resource scarcity produced pervasive stressors among refugee adolescents and youth. Findings signal the importance of gender transformative approaches to SGBV prevention that integrate attention to resource scarcity. These may be particularly relevant in the COVID-19 pandemic. Findings signal the importance of developing health enabling social contexts with and for refugee adolescents and youth.
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Affiliation(s)
- Carmen H Logie
- Factor Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada. .,Women's College Research Institute, Women's College Hospital, 76 Grenville St, Toronto, ON, M5G 1N8, Canada.
| | - Moses Okumu
- School of Social Work, University of North Carolina, Chapel Hill, 325 Pittsboro St, Chapel Hill, NC, 27599-3550, USA
| | - Maya Latif
- Factor Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | | | | | - Simon Mwima
- AIDS Control Program, Ministry of Health, Plot 6, Lourdel Road, Nakasero, Kampala, Uganda
| | - Peter Kyambadde
- Most At Risk Population Initiative Clinic, Mulago Hospital, Kampala, Uganda
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Munajed DA, Ekren E. Exploring the impact of multidimensional refugee vulnerability on distancing as a protective measure against COVID-19: The case of Syrian refugees in Lebanon and Turkey. J Migr Health 2020; 1-2:100023. [PMID: 34405174 PMCID: PMC8352139 DOI: 10.1016/j.jmh.2020.100023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The unequal physiological and socioeconomic consequences of the COVID-19 pandemic across the world are revealing the multidimensional components of health and vulnerability. As governments have pushed physical and social distancing as protective strategies, this study explores the extent to which this approach is relevant for Syrian refugees living in Lebanon and Turkey. METHODS This qualitative study draws on 11 interviews with refugee experts and development practitioners (3) and Syrian refugee families (4 from Turkey, 4 from Lebanon) during the COVID-19 pandemic, as well as a review of recent literature. In addition, it draws on 71 semi-structured interviews with staff at NGOs supporting refugees (48 from Turkey, 23 from Lebanon) collected in 2018. Qualitative data analysis software ATLAS.ti 8 was used to perform content-based thematic analysis using both deductive and inductive coding. FINDINGS The study finds that distancing-physically and socially-can be ineffective as a disease protection strategy in Syrian refugee communities. This is influenced by six major interconnected dimensions of refugee vulnerability-political, material, spatial, physiological, psychological and sociocultural-which collectively form an interdisciplinary framework to guide more relevant COVID-19 interventions in refugee communities. The inability to distance is not necessarily rooted in lack of knowledge. Rather, when the inside conditions of living are crowded and unhygienic, but also include cultural expectations of familial care, and the outside conditions of survival-necessitated work are perpetuated through precarious political protections, distancing becomes impractical in application, despite the sense of internalized responsibility to keep one another safe. CONCLUSIONS The findings suggest that more relevant COVID-19 interventions and protection measures must consider the non-physiological manifestations of disease across multiple dimensions of vulnerability to mitigate decreased distancing abilities in settings of refugee life.
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Affiliation(s)
- Dima Al Munajed
- Center for Development Studies, University of Bonn, Genscherallee 3, 53113 Bonn, Germany
| | - Elizabeth Ekren
- Center for Development Studies, University of Bonn, Genscherallee 3, 53113 Bonn, Germany
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Singh NS, Abrahim O, Altare C, Blanchet K, Favas C, Odlum A, Spiegel PB. COVID-19 in humanitarian settings: documenting and sharing context-specific programmatic experiences. Confl Health 2020; 14:79. [PMID: 33292392 PMCID: PMC7676860 DOI: 10.1186/s13031-020-00321-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/04/2020] [Indexed: 11/10/2022] Open
Abstract
Humanitarian organizations have developed innovative and context specific interventions in response to the COVID-19 pandemic as guidance has been normative in nature and most are not humanitarian specific. In April 2020, three universities developed a COVID-19 humanitarian-specific website (www.covid19humanitarian.com) to allow humanitarians from the field to upload their experiences or be interviewed by academics to share their creative responses adapted to their specific country challenges in a standardised manner. These field experiences are reviewed by the three universities together with various guidance documents and uploaded to the website using an operational framework. The website currently hosts 135 guidance documents developed by 65 different organizations, and 65 field experiences shared by 29 organizations from 27 countries covering 38 thematic areas. Examples of challenges and innovative solutions from humanitarian settings are provided for triage and sexual and gender-based violence. Offering open access resources on a neutral platform by academics can provide a space for constructive dialogue among humanitarians at the country, regional and global levels, allowing humanitarian actors at the country level to have a strong and central voice. We believe that this neutral and openly accessible platform can serve as an example for future large-scale emergencies and epidemics.
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Affiliation(s)
- Neha S Singh
- Health in Humanitarian Crises Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Orit Abrahim
- Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Chiara Altare
- Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Karl Blanchet
- Geneva Centre of Humanitarian Studies, University of Geneva and the Graduate Institute, Geneva, Switzerland
| | - Caroline Favas
- Health in Humanitarian Crises Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Alex Odlum
- Geneva Centre of Humanitarian Studies, University of Geneva and the Graduate Institute, Geneva, Switzerland
| | - Paul B Spiegel
- Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
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