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Ugwu OPC, Alum EU, Ugwu JN, Eze VHU, Ugwu CN, Ogenyi FC, Okon MB. Harnessing technology for infectious disease response in conflict zones: Challenges, innovations, and policy implications. Medicine (Baltimore) 2024; 103:e38834. [PMID: 38996110 PMCID: PMC11245197 DOI: 10.1097/md.0000000000038834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 06/14/2024] [Indexed: 07/14/2024] Open
Abstract
Epidemic outbreaks of infectious diseases in conflict zones are complex threats to public health and humanitarian activities that require creativity approaches of reducing their damage. This narrative review focuses on the technology intersection with infectious disease response in conflict zones, and complexity of healthcare infrastructure, population displacement, and security risks. This narrative review explores how conflict-related destruction is harmful towards healthcare systems and the impediments to disease surveillance and response activities. In this regards, the review also considered the contributions of technological innovations, such as the improvement of epidemiological surveillance, mobile health (mHealth) technologies, genomic sequencing, and surveillance technologies, in strengthening infectious disease management in conflict settings. Ethical issues related to data privacy, security and fairness are also covered. By advisement on policy that focuses on investment in surveillance systems, diagnostic capacity, capacity building, collaboration, and even ethical governance, stakeholders can leverage technology to enhance the response to infectious disease in conflict settings and, thus, protect the global health security. This review is full of information for researchers, policymakers, and practitioners who are dealing with the issues of infectious disease outbreaks in conflicts worn areas.
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Affiliation(s)
| | - Esther Ugo Alum
- Department of Publication and Extension, Kampala International University, Uganda, Kampala, Uganda
| | - Jovita Nnenna Ugwu
- Department of Publication and Extension, Kampala International University, Uganda, Kampala, Uganda
| | - Val Hyginus Udoka Eze
- Department of Publication and Extension, Kampala International University, Uganda, Kampala, Uganda
| | - Chinyere N Ugwu
- Department of Publication and Extension, Kampala International University, Uganda, Kampala, Uganda
| | - Fabian C Ogenyi
- Department of Publication and Extension, Kampala International University, Uganda, Kampala, Uganda
| | - Michael Ben Okon
- Department of Publication and Extension, Kampala International University, Uganda, Kampala, Uganda
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Ayenew B, Belay DM, Gashaw Y, Gimja W, Gardie Y. WHO's end of TB targets: unachievable by 2035 without addressing under nutrition, forced displacement, and homelessness: trend analysis from 2015 to 2022. BMC Public Health 2024; 24:961. [PMID: 38575958 PMCID: PMC10996214 DOI: 10.1186/s12889-024-18400-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/20/2024] [Indexed: 04/06/2024] Open
Abstract
Tuberculosis (TB) remains a significant global health challenge, despite the World Health Organization (WHO) actively working towards its eradication through various initiatives and programs. Undernutrition, forced displacement, and homelessness worsen TB's burden and challenge control efforts; however, there is still no adequate research that shows the trend of these underlying factors to attain the WHO's ambitious TB targets. So, this study aims to analyze the trend analysis of these underlying factors worldwide from 2015 to 2022 and their impact on the feasibility and implications of reaching the End TB targets by 2035. We utilized international databases, including UNHCR, FAO, and WHO reports, as secondary data sources. Data were extracted chronologically from 2015 to 2022 to illustrate trends in undernutrition, forced displacement, and homelessness on a global level.This trend analysis reveals that undernutrition, forced displacement, and homelessness have worsened over time. Undernutrition rose from 8.4 to 9.8% globally between 2015 and 2021, affecting 22.7 million additional individuals each year. In 2022, undernutrition affected 735 million people globally. Africa (21.9%) and Asia (10.6%) had the highest rates, while Western Europe and North America had lower rates than the global average: 3.4% and 2.5%, respectively.Similarly, the global rate of forced displacement increased from 65.1 million people in 2015 to 108.4 million in 2022, a 21% increase from 2021. This means that an extra 19 million people were displaced in 2021. Globally, homelessness, affecting 1.6 billion people, has worsened over time. Despite being a highly vulnerable group to TB, homeless individuals are often neglected in TB control efforts. Our findings underscore the critical importance of addressing undernutrition, forced displacement, and homelessness in achieving the World Health Organization's ambitious End TB targets by 2035, as highlighted through trend analysis from 2015 to 2022. Implementing policies focusing on nutrition, stable housing, and the challenges faced by displaced populations is imperative for progress toward a TB-free world.
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Affiliation(s)
- Birhanu Ayenew
- Department of Adult Health Nursing, College of Health Science, Assosa University, Assosa, Ethiopia.
| | - Dawit Misganaw Belay
- Department of Midwifery, College of Health Sciences, Assosa University, Assosa, Ethiopia
| | - Yegoraw Gashaw
- Department of Pediatric and Child Health Nursing, College of Health Science, Assosa University, Assosa, Ethiopia
| | - Wondimu Gimja
- Department of Adult Health Nursing, College of Health Science, Assosa University, Assosa, Ethiopia
| | - Yimenu Gardie
- Department of Pediatric and Child Health Nursing, College of Health Science, Assosa University, Assosa, Ethiopia
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Arage MW, Kumsa H, Asfaw MS, Kassaw AT, Mebratu E, Tunta A, Kassahun W, Adissu A, Yigzaw M, Hailu T, Tenaw LA. Assessing the health consequences of northern Ethiopian armed conflict, 2022. J Public Health Policy 2024; 45:43-57. [PMID: 38310169 PMCID: PMC10920422 DOI: 10.1057/s41271-023-00464-z] [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] [Accepted: 12/28/2023] [Indexed: 02/05/2024]
Abstract
Armed conflict is a complicated topic with multidimensional impact on population health. This study aimed to assess of the health consequences of the northern Ethiopian conflict, 2022. We used a mixed method study design with a retrospective cross-sectional study supplemented by a qualitative study conducted from May to June 2022. We interviewed 1806 individuals from 423 households and conducted 100 in-depth interviews and focused group discussion. We identified 224 people who self-reported cases of illness (124/1000 people) with only 48 (21%) people who fell ill visited a health institution. We also detected 27 cases of deaths (15/1000 people) during the conflict. The collapse of the health system, evacuation of health personnel, and shortage of medical supplies, and instability with a lack of transportation were consequences of the conflict. The northern Ethiopian conflict has greatly affected the community's health through the breakdown of the health system and health-supporting structures.
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Affiliation(s)
- Mulugeta Wodaje Arage
- School of Midwifery, College of Health Sciences, Woldia University, North Wollo, Amhara Region, Ethiopia.
| | - Henok Kumsa
- School of Midwifery, College of Health Sciences, Woldia University, North Wollo, Amhara Region, Ethiopia
| | - Mulu Shiferaw Asfaw
- School of Medicine, College of Health Sciences, Woldia University, North Wollo, Amhara Region, Ethiopia
| | - Abebe Tarekegn Kassaw
- Department of Pharmacy, College of Health Sciences, Woldia University, North Wollo, Amhara Region, Ethiopia
| | - Ephrem Mebratu
- Department of Pharmacy, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Amhara Region, Ethiopia
| | - Abayneh Tunta
- School of Medicine, College of Health Sciences, Woldia University, North Wollo, Amhara Region, Ethiopia
| | - Woldeteklehymanot Kassahun
- Department of Medical Laboratory, College of Health Sciences, Woldia University, North Wollo, Amhara Region, Ethiopia
| | - Amanuel Adissu
- Department of Public Health, College of Health Sciences, Injibara University, Injibara, Amhara Region, Ethiopia
| | - Molla Yigzaw
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Amhara Region, Ethiopia
| | - Tilahun Hailu
- School of Public Health, College of Health Sciences, Woldia University, North Wollo, Amhara Region, Ethiopia
| | - Lebeza Alemu Tenaw
- School of Public Health, College of Health Sciences, Woldia University, North Wollo, Amhara Region, Ethiopia
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Allison LE, Alhaffar M, Checchi F, Abdelmagid N, Nor B, Sabahelzain MM, Light PM, Singh NS. A Systematic Review of Vaccination Guidance for Humanitarian Responses. Vaccines (Basel) 2023; 11:1743. [PMID: 38140148 PMCID: PMC10747938 DOI: 10.3390/vaccines11121743] [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: 10/20/2023] [Revised: 11/08/2023] [Accepted: 11/16/2023] [Indexed: 12/24/2023] Open
Abstract
Delivering vaccines in humanitarian response requires rigourous and continuous analysis of evidence. This systematic review mapped the normative landscape of vaccination guidance on vaccine-preventable diseases in crisis-affected settings. Guidance published between 2000 and 2022 was searched for, in English and French, on websites of humanitarian actors, Google, and Bing. Peer-reviewed database searches were performed in Global Health and Embase. Reference lists of all included documents were screened. We disseminated an online survey to professionals working in vaccination delivery in humanitarian contexts. There was a total of 48 eligible guidance documents, including technical guidance (n = 17), descriptive guidance (n = 16), operational guidance (n = 11), evidence reviews (n = 3), and ethical guidance (n = 1). Most were World Health Organization documents (n = 21) targeting children under 5 years of age. Critical appraisal revealed insufficient inclusion of affected populations and limited rigour in guideline development. We found limited information on vaccines including, yellow fever, cholera, meningococcal, hepatitis A, and varicella, as well as human papilloma virus (HPV). There is a plethora of vaccination guidance for vaccine-preventable diseases in humanitarian contexts. However, gaps remain in the critical and systematic inclusion of evidence, inclusion of the concept of "zero-dose" children and affected populations, ethical guidance, and specific recommendations for HPV and non-universally recommended vaccines, which must be addressed.
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Affiliation(s)
- Lauren E. Allison
- Department of Infectious Disease Epidemiology and International Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (L.E.A.); (M.A.); (F.C.); (N.A.); (P.M.L.)
| | - Mervat Alhaffar
- Department of Infectious Disease Epidemiology and International Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (L.E.A.); (M.A.); (F.C.); (N.A.); (P.M.L.)
- Syria Research Group, Co-Hosted between London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK and National University of Singapore Saw Swee Hock School of Public Health, Singapore 117549, Singapore
| | - Francesco Checchi
- Department of Infectious Disease Epidemiology and International Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (L.E.A.); (M.A.); (F.C.); (N.A.); (P.M.L.)
| | - Nada Abdelmagid
- Department of Infectious Disease Epidemiology and International Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (L.E.A.); (M.A.); (F.C.); (N.A.); (P.M.L.)
| | - Barni Nor
- Department of Women’s Children’s Health, Uppsala University, 751 05 Uppsala, Sweden;
| | - Majdi M. Sabahelzain
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia;
| | - Page M. Light
- Department of Infectious Disease Epidemiology and International Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (L.E.A.); (M.A.); (F.C.); (N.A.); (P.M.L.)
| | - Neha S. Singh
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
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Khai TS. Vulnerability to health and well-being of internally displaced persons (IDPs) in Myanmar post-military coup and COVID-19. Arch Public Health 2023; 81:185. [PMID: 37865802 PMCID: PMC10589919 DOI: 10.1186/s13690-023-01204-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 10/15/2023] [Indexed: 10/23/2023] Open
Abstract
Across the globe, the COVID-19 pandemic has aggravated particular challenges for internally displaced people (IDPs). Over 1.9 million people in Myanmar have been displaced due to the escalation of armed conflict after the military coup in 2021. The vulnerability faced by IDPs in Myanmar, coupled with the impact of the recent military coup and the ongoing COVID-19 pandemic, has received little global attention. This study examined how military coup exacerbated the health and well-being of IDPs in Myanmar post the military coup. The study employed purposive sampling and Non-Government Organisations (NGOs) referrals to find participants. Qualitative in-depth telephone interviews were conducted with a total of 17 IDPs. A thematic analysis of the findings indicates that IDPs experience anxiety and fear daily, adversely affecting their mental health due to the increased escalation of armed conflict and attacks on civilian places, including IDPs shelters. Some IDPs contract COVID-19 and suffer from malaria and dengue fever owing to their precarious living conditions. Moreover, the military's restrictions on humanitarian aid distribution, including healthcare, medicine, and food, have severely impacted the health and well-being of IDPs in Myanmar, exacerbating food shortages and limiting healthcare access.
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Affiliation(s)
- Tual Sawn Khai
- School of Graduate Studies, Lingnan University, Hong Kong (SAR), People's Republic of China.
- Refugee Law Initiative (RLI), School of Advanced Study, University of London, London, UK.
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Yakovleva A, Kovalenko G, Redlinger M, Smyrnov P, Tymets O, Korobchuk A, Kotlyk L, Kolodiazieva A, Podolina A, Cherniavska S, Antonenko P, Strathdee SA, Friedman SR, Goodfellow I, Wertheim JO, Bortz E, Meredith L, Vasylyeva TI. Hepatitis C Virus in people with experience of injection drug use following their displacement to Southern Ukraine before 2020. BMC Infect Dis 2023; 23:446. [PMID: 37400776 DOI: 10.1186/s12879-023-08423-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 06/24/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Due to practical challenges associated with genetic sequencing in low-resource environments, the burden of hepatitis C virus (HCV) in forcibly displaced people is understudied. We examined the use of field applicable HCV sequencing methods and phylogenetic analysis to determine HCV transmission dynamics in internally displaced people who inject drugs (IDPWID) in Ukraine. METHODS In this cross-sectional study, we used modified respondent-driven sampling to recruit IDPWID who were displaced to Odesa, Ukraine, before 2020. We generated partial and near full length genome (NFLG) HCV sequences using Oxford Nanopore Technology (ONT) MinION in a simulated field environment. Maximum likelihood and Bayesian methods were used to establish phylodynamic relationships. RESULTS Between June and September 2020, we collected epidemiological data and whole blood samples from 164 IDPWID (PNAS Nexus.2023;2(3):pgad008). Rapid testing (Wondfo® One Step HCV; Wondfo® One Step HIV1/2) identified an anti-HCV seroprevalence of 67.7%, and 31.1% of participants tested positive for both anti-HCV and HIV. We generated 57 partial or NFLG HCV sequences and identified eight transmission clusters, of which at least two originated within a year and a half post-displacement. CONCLUSIONS Locally generated genomic data and phylogenetic analysis in rapidly changing low-resource environments, such as those faced by forcibly displaced people, can help inform effective public health strategies. For example, evidence of HCV transmission clusters originating soon after displacement highlights the importance of implementing urgent preventive interventions in ongoing situations of forced displacement.
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Affiliation(s)
- Anna Yakovleva
- Medical Sciences Division, University of Oxford, Oxford, UK
| | - Ganna Kovalenko
- Department of Pathology, Division of Virology, University of Cambridge, Cambridge, UK
- Department of Biological Sciences, University of Alaska Anchorage, Anchorage, AK, USA
| | - Matthew Redlinger
- Department of Biological Sciences, University of Alaska Anchorage, Anchorage, AK, USA
| | | | | | | | | | | | | | | | | | - Steffanie A Strathdee
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Samuel R Friedman
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Ian Goodfellow
- Department of Pathology, Division of Virology, University of Cambridge, Cambridge, UK
| | - Joel O Wertheim
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Eric Bortz
- Department of Biological Sciences, University of Alaska Anchorage, Anchorage, AK, USA
| | - Luke Meredith
- Department of Pathology, Division of Virology, University of Cambridge, Cambridge, UK
| | - Tetyana I Vasylyeva
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA.
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The forms and adverse effects of insecurities among internally displaced children in Ethiopia. BMC Public Health 2023; 23:200. [PMID: 36717843 PMCID: PMC9885394 DOI: 10.1186/s12889-023-15109-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 01/17/2023] [Accepted: 01/20/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Ethiopia has seen an increase in the number of internally displaced persons (IDPs) due to conflict and violence related to border-based disputes and climate change. This study examines the insecurities experienced by IDPs in the Burayu camp and how they navigate and challenge them. Violence and insecurity have daunted Ethiopian regions for decades, violated children's rights, and impeded the achievement of the United Nation's sustainable development goals related to children, such as good healthcare and mental health, quality education, clean water, and sanitation. The deteriorating security concerns in Ethiopia could also expose IDP children to poor health outcomes associated with a lack of access to healthcare services. METHODS This was an exploratory qualitative case study guided by intersectionality theoretical lens to explore the forms of insecurities perceived and experienced by IDPs in Ethiopia. Participants were selected using a purposeful sampling approach. We interviewed 20 children, 20 parents or guardians, and 13 service providers. Interviews were audio recorded and transcribed verbatim in Afan Oromo, then translated into English. We used NVivo 12 qualitative data analysis software to analyze data following Braun & Clarke's approach to thematic data analysis. RESULTS The participants reported that IDP children in Burayu town faced many challenges related to poor socioeconomic conditions that exposed them to several insecurities and negatively affected their well-being. They reported inadequate access to clothing and shelter, clean water, sanitary facilities, food, and adequate healthcare due to financial barriers, lack of drugs, and quality of care. Our data analysis shows that socioeconomic and contextual factors intersect to determine the health and well-being of children in the Ethiopian IDP camp studied. The children experienced insecurities while navigating their daily lives. This is compounded by institutional practices that shape gender relations, income status, and access to healthcare, education, and food. These deficiencies expose children to traumatic events that could decrease future livelihood prospects and lead to compromised mental health, rendering them susceptible to prolonged post-traumatic stress disorder and depression. Results are presented under the following topics: (1) basic needs insecurity, (2) healthcare insecurity, (3) academic insecurity, (4) economic insecurity, (5) food insecurity, and (6) physical and mental health insecurity. CONCLUSION Successful relocation and reintegration of IDPs would help to alleviate both parent and child post-conflict stressors. Managing and following up on economic reintegration efforts is needed in both the short and long term. Such measures will help to achieve goals for specific projects attached to donor support outcomes, consequently enabling social support and conflict resolution management efforts.
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Kim GU, Jung E, Shim MS, Kim GS. Association between post-traumatic stress symptoms and functional health among internally displaced people in Myanmar. J Psychiatr Ment Health Nurs 2022; 29:555-567. [PMID: 35467061 DOI: 10.1111/jpm.12837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 01/27/2022] [Accepted: 04/19/2022] [Indexed: 11/30/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Internally displaced persons (IDPs) in Myanmar have been exposed to conflict and violence for a long time and experience physical, psychological and social problems. Post-traumatic stress symptoms (PTSS) are more prevalent among IDPs than among general populations and refugees, and limited research is available on this topic among IDPs in Myanmar. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: More than one-third of the IDPs in our sample from Myanmar camps had a high PTSS score. More than two-thirds experienced traumatic events and left home after age 18. The overall functional health of IDPs was poor, and the presence or absence of PTSS led to differences in the factors associated with functional health in each group. Resilience and PTSS were associated with the functional health of IDPs in Myanmar. Further, functional health was positively correlated with levels of resilience among those relatively low in PTSS. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health nurses need to assess IDPs' health status and PTSS by first performing health screening at camps in Myanmar. Subsequently, tailored interventions can be provided according to individual health conditions and PTSS severity. IDPs in Myanmar need psychological first aid to cope with the ongoing conflict and violence, and further mental health nurse training is necessary to implement this aid and tailored interventions for PTSS. ABSTRACT INTRODUCTION: Internally displaced persons (IDPs) are individuals forced to leave their homes and move within their country. Post-traumatic stress symptoms (PTSS) are prevalent in this population. AIM To investigate trauma symptoms and functional health of IDPs in Myanmar and identify the factors associated with their functional health according to the presence/absence of PTSS. METHOD This cross-sectional study included 201 IDPs who completed a questionnaire on functional health, PTSS, resilience, social support and hope. The analysis included descriptive statistics, t-tests, Pearson's correlation coefficients and multiple linear regression with interaction analyses. RESULTS Over one-third of the participants had PTSS, with low functional health scores. The greater the resilience, the better the functional health. The higher participants' PTSS, the poorer their functional health. There was a significant interaction between resilience and PTSS. DISCUSSION Tailored resilience-building programs, as well as health policies and services, are needed to enhance IDPs' functional health and help them overcome PTSS. IMPLICATIONS FOR PRACTICE Psychological first aid should be provided to minimize PTSS experienced in situations of ongoing conflict and violence. Mental health nurses should be trained to assess IDPs' health status and tailor interventions accordingly.
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Affiliation(s)
- Go-Un Kim
- College of Nursing, Inje University, Busan, South Korea
| | - Eunyoung Jung
- Korea Armed Forces Nursing Academy, Daejeon, South Korea
| | - Mi-So Shim
- College of Nursing, Yonsei University, Seoul, South Korea
| | - Gwang Suk Kim
- College of Nursing, Yonsei University, Seoul, South Korea.,Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea
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Ekezie W. Management resilience of Internally Displaced Persons (IDPs) living in camp-like settings: a Northern Nigeria case study. J Migr Health 2022; 6:100115. [PMID: 35668733 PMCID: PMC9166470 DOI: 10.1016/j.jmh.2022.100115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/01/2022] [Accepted: 05/25/2022] [Indexed: 11/10/2022] Open
Abstract
Background There are about 55 million Internally Displaced Persons (IDP), and some live in camp settlements, often for protracted periods. However, there is limited evidence on camp management and self-management strategies adopted by camp-dwelling IDPs. This paper reflects on the camp management and health resilience strategies practised by IDPs settled in camp-like settings, based on the first strategic objective of the International Organisation for Migration (IOM) Progressive Resolution of Displacement Situations (PRDS). Methods Eight focus group discussions were conducted with 49 IDP camp leaders across eight camp-like settings in Northern Nigeria. Issues explored included community structure, leadership, public interaction, communication, and health management. Data were analysed using a framework approach under five factors related to the IOM PRDS first objective. Findings IDPs exhibited resilience by adapting to their current locations, establishing internal camp and health management structures, and advocating with external organisations. Supportive communal relationships were an integral element in their adaptation. Methods of resilience involved social cohesion, setting up camp leadership committees, and seeking alternative means of income, protection, and healthcare management. Additionally, selecting representatives who could advocate for their well-being allowed them to request support and exercise their rights. Conclusion Despite resource shortages, the IDPs adapted by setting up techniques for managing their affairs and available resources, finding innovative ways to cater for themselves, advocating for their needs, and supporting each other. These observations showed how displaced populations can be active actors in their change and development if basic and essential management support is provided. Engaging IDPs in camp management could reduce long-term dependency on humanitarian aid.
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Olufadewa II, Adesina MA, Oladele RI, Ayorinde TA. “Watching my family being killed by terrorists made me really depressed”: Mental health experiences, challenges and needed support of young internally displaced persons in northern Nigeria. J Migr Health 2022; 6:100121. [PMID: 35694419 PMCID: PMC9178342 DOI: 10.1016/j.jmh.2022.100121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 05/06/2022] [Accepted: 05/28/2022] [Indexed: 11/28/2022] Open
Abstract
Background Over 3.9 million people have been displaced in Nigeria as a result of the over one-decade-long Boko Haram insurgency and about 2.1 million of this population are internally displaced within the country. Young internally displaced persons (IDPs) are at higher risk of mental illness such as depression, anxiety, post-traumatic stress disorder (PTSD) among others, however, there are sparse studies on this population. Therefore, this study explored the mental health experiences, challenges, and needed support for young internally displaced persons in Durumi and New Kuchingoro Internally Displaced Persons Camps in Nigeria. Methods This qualitative study was conducted among young IDPs in Durumi and New Kuchingoro IDP camps in Northern Nigeria. Fourteen (14) focus group discussions comprising 89 participants and 30 in-depth interviews with 30 participants were conducted with young IDPs. The interviews were in Hausa and Pidgin English, audio-recorded, transcribed, translated into English, and applied thematic analysis was done using MAXQDA Analytics Pro 2020 Results A total of 89 participants consisting of 47 males and 42 females participated in the FGDs and IDIs. Five key themes emerged from the FGDs and IDI: (1) knowledge about mental health, (2) mental Health Experiences, (3) coping strategies, (4) availability of mental health and other health Support, and (5) needed support. Young IDPs had fair knowledge about mental healthcare. Participants reported their experience before displacement as being peaceful with members of the family together in a good environment while they experienced stress, trauma, shock, sadness, and symptoms of anxiety, depression, and PTSD during and post displacement. Personal coping strategies such as listening to music, engaging in sports, reading books, farming, and other economic activities were reported by participants. Participants reported the absence of structured and specialized mental health support in the IDP camps and solicited mental health, physical health, economic and educational support. Conclusion Young IDPs had negative experiences that led to symptoms of mental health disorders such as depression, anxiety disorders, PTSD among others with little or no access to quality mental healthcare. Hence, they require specialized and structured mental health support to lead healthy and productive lives. Policy and programs aimed at increasing access to mental health information and services for forced migrants are recommended.
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Roberts B, Ekezie W, Jobanputra K, Smith J, Ellithy S, Cantor D, Singh N, Patel P. Analysis of health overseas development aid for internally displaced persons in low- and middle-income countries. J Migr Health 2022; 5:100090. [PMID: 35373164 PMCID: PMC8965138 DOI: 10.1016/j.jmh.2022.100090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/09/2022] [Accepted: 03/16/2022] [Indexed: 11/20/2022] Open
Abstract
First detailed analysis of overseas development aid (ODA) for the health of IDPs. Reports low and declining health ODA for IDPs. Indicates major inequity in health ODA for IDPs compared to refugees. Negligible ODA for IDPs was for non-communicable diseases and mental health. Health ODA for IDPs did not appear to be related to IDP health needs.
Background There are an estimated 55 million internally displaced persons (IDPs) globally. IDPs commonly have worse health outcomes than host populations and other forcibly displaced populations such as refugees. Official development assistance (ODA) is a major source of the global financial response for health in low- and middle-income countries (LMICs), including for populations affected by armed conflict and forced displacement. Analysis of ODA supports efforts to improve donor accountability, transparency and the equitable use of ODA. The aim of this study is to examine international donor support and responsiveness to IDP health needs through analysis of ODA disbursements to LMICs between 2010 and 2019. Methods ODA disbursement data to LMICs from 2010 to 2019 were extracted from the Creditor Reporting System (CRS) database and analysed with Stata software using a combination of: (i) text searching for IDP and refugee related terms; and (ii) relevant health and humanitarian CRS purpose codes. Descriptive analysis was used to examine patterns of ODA disbursement, and nonlinear least squared regression analysis was used to examine responsiveness of ODA disbursement to recipient country IDP population size and health system capacity and health characteristics. Findings The study highlighted declining per IDP capita health ODA from USD 5.34 in 2010 to USD 3.72 in 2019 (with annual average decline of -38% from the 2010 baseline). In contrast, health ODA for refugees in LMICs increased from USD 18.55 in 2010 to USD 23.31 in 2019 (with an annual average increase of +14%). Certain health topics for IDPs received very low ODA, with only 0.44% of IDP health ODA disbursed for non-communicable diseases (including mental health). There was also weak evidence of IDP health ODA being related to recipient country IDP population size, and health system capacity and health characteristics. The paper highlights the need for increased investment by donors in IDP health ODA and to ensure that it is responsive to their health needs.
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Ekezie W, Siebert P, Timmons S, Murray RL, Bains M. Exploring the influence of health management processes on health outcomes among internally displaced persons (IDPs). J Migr Health 2022; 6:100124. [PMID: 35795078 PMCID: PMC9251554 DOI: 10.1016/j.jmh.2022.100124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 06/01/2022] [Accepted: 06/19/2022] [Indexed: 11/20/2022] Open
Abstract
Background Despite global action and policy initiatives, internally displaced persons (IDPs) experience poor living conditions and lack healthcare access compared to refugees. This study sought to understand the relationship between health management processes and health outcomes among camp-dwelling IDPs in northern Nigeria. Method 73 individuals participated in either a focus group (n = 49) or one-to-one interview (n = 24), comprising IDPs (n = 49), camp managers (n = 9), health workers (n = 7) and government administrative authorities (n = 8). Interviews explored IDP health management processes, partners and perceptions around camp management. Data were analysed using an inductive thematic approach. Results Four main themes were identified: opinions about healthcare organisation and management, service availability, interventions and information management, and IDP health outcomes. Though many stakeholders, partnerships, and national and international government agencies were involved in the provision of healthcare services, respondents described efforts as disjointed. Reports suggested that the coordination and management of health services and resources were not tailored to the needs of those living in all camps. And because so many national and international agencies were involved, but under weak coordination, access to services was less than optimal and adequate management of critical public health interventions was lacking. Varied allocation of resources such as funding, medication and medically trained staff were viewed as key factors in the availability and the ability to access what was considered as essential healthcare services. Conclusion The health of IDPs in camp-like settings was compromised by uncoordinated management, treatment, and control of communicable and non-communicable diseases. Government authorities need to be aware and consider the complexity of the multiagency involvement in the management and provision of IDP healthcare services. Introducing systems to streamline, monitor and support IDP healthcare management could be cost-effective strategies for achieving optimal health care.
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Affiliation(s)
- Winifred Ekezie
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, United Kingdom
- Health and Internal Displacement Network (HIDN)
- Corresponding author at: Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, United Kingdom.
| | - Penelope Siebert
- School of Health and Social Care, Nottingham Trent University, Nottingham, United Kingdom
| | - Stephen Timmons
- Nottingham University Business School, University of Nottingham, Nottingham, United Kingdom
| | - Rachael L. Murray
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Manpreet Bains
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
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Cantor D, Swartz J, Roberts B, Abbara A, Ager A, Bhutta ZA, Blanchet K, Madoro Bunte D, Chukwuorji JC, Daoud N, Ekezie W, Jimenez-Damary C, Jobanputra K, Makhashvili N, Rayes D, Restrepo-Espinosa MH, Rodriguez-Morales AJ, Salami B, Smith J. Understanding the health needs of internally displaced persons: A scoping review. J Migr Health 2021; 4:100071. [PMID: 34820657 PMCID: PMC8600058 DOI: 10.1016/j.jmh.2021.100071] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 10/26/2021] [Accepted: 10/26/2021] [Indexed: 11/01/2022] Open
Abstract
We seek to strengthen understanding of the health needs of internally displaced persons (IDPs) in contexts of conflict or violence. Based upon a scoping review, our paper identified limited evidence on IDP health, but nevertheless indicates that IDPs tend to experience worse health outcomes than other conflict-affected populations across a range of health issues; and this is due to the particularly vulnerable situation of IDPs relative to these other populations, including reduced access to health services. Further research is required to better understand these needs and the interventions that can most effectively address these needs.
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Affiliation(s)
- David Cantor
- Internal Displacement Research Programme, School of Advanced Study, University of London, UK
| | | | - Bayard Roberts
- Health Services Research and Policy Department, London School of Hygiene and Tropical Medicine, UK
| | - Aula Abbara
- Department of Infectious Disease, Imperial College London, London, UK; Syria Public Health Network
| | - Alastair Ager
- Institute for Global Health & Development, Queen Margaret University, Edinburgh, UK
- Mailman School of Public Health, Columbia University, USA
| | | | - Karl Blanchet
- Geneva Centre of Humanitarian Studies, University of Geneva, Switzerland
| | | | | | - Nihaya Daoud
- Department of Public Health, Ben-Gurion University of the Negev, Israel
| | | | | | | | | | - Diana Rayes
- Johns Hopkins Bloomberg School of Public Health, USA
| | | | - Alfonso J. Rodriguez-Morales
- Grupo de Investigación Biomedicina, Fundacion Universitaria Autónoma de las Americas, Colombia
- Universidad Cientifica del Sur, Peru
| | | | - James Smith
- Elrha; Health in Humanitarian Crises Centre, London School of Hygiene and Tropical Medicine, UK
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Baaees MSO, Naiene JD, Al-Waleedi AA, Bin-Azoon NS, Khan MF, Mahmoud N, Musani A. Community-based surveillance in internally displaced people's camps and urban settings during a complex emergency in Yemen in 2020. Confl Health 2021; 15:54. [PMID: 34225760 PMCID: PMC8256204 DOI: 10.1186/s13031-021-00394-1] [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: 12/22/2020] [Accepted: 06/29/2021] [Indexed: 12/28/2022] Open
Abstract
Background The need for early identification of coronavirus disease (COVID-19) cases in communities was high in Yemen during the first wave of the COVID-19 epidemic because most cases presenting to health facilities were severe. Early detection of cases would allow early interventions to interrupt the transmission chains. This study aimed to describe the implementation of community-based surveillance (CBS) in in internally displaced people (IDP) camps and urban settings in Yemen from 15 April 2020 to 30 September 2020. Methods Following the Centers for Disease Control and Prevention guidance for evaluation of surveillance systems, we assessed the usefulness and acceptability of CBS. For acceptability, we calculated the proportion of trained volunteers who reported disease alerts. To assess the usefulness, we compared the alerts reported through the electronic diseases early warning system (eDEWS) with the alerts reported through CBS and described the response activities implemented. Results In Al-Mukalla City, 18% (14/78) of the volunteers reported at least one alert. In IDP camps, 58% (18/31) of volunteers reported at least one alert. In Al-Mukalla City, CBS detected 49 alerts of influenza-like illness, whereas health facilities detected 561 cases of COVID-19. In IDP camps, CBS detected 91 alerts of influenza-like illness, compared to 10 alerts detected through eDEWS. In IDP camps, CBS detected three other syndromes besides influenza-like illness (febrile illness outbreak suspicion, acute diarrhoea, and skin disease). In IDP camps, public health actions were implemented for each disease detected and no further cases were reported. Conclusions In Yemen, CBS was useful for detecting suspected outbreaks in IDP camps. CBS implementation did not yield expected results in general communities in urban areas in the early stage of the COVID-19 pandemic when little was known about the disease. In the urban setting, the system failed to detect suspected COVID-19 cases and other diseases despite the ongoing outbreaks reported through eDEWS. In Yemen, as in other countries, feasibility and acceptability studies should be conducted few months before CBS expansion in urban communities. The project should be expanded in IDP camps, by creating COVID-19 and other disease outbreak reporting sites. Supplementary Information The online version contains supplementary material available at 10.1186/s13031-021-00394-1.
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Khan FU, Asghar Z, Tipu MK, Rehman AU, Khan A, Ur-Rehman T. Effect of Displacement on Adherence to TB Treatment: An Observational Study in TB Patients from Internally Displaced Persons of Pakistan. Pak J Med Sci 2021; 37:675-679. [PMID: 34104146 PMCID: PMC8155409 DOI: 10.12669/pjms.37.3.2992] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: This study was aimed to investigate TB patients adherence and treatment outcomes among internally displaced patients in comparison with adjacent settled areas. Methods: The study was designed as an observational cross-sectional study among the TB patients of internally displaced populations (IDPs) of North Waziristan Agency (NWA) and adjacent settled areas of Bannu and Lakki Marwat (NIDPs). Based on the study inclusion and exclusion criteria 330 patients fullfilled the inclusion criteria and were assigned equally to both IDPs and NIDPs study groups. Odds ratio (OR) with 95% confidence interval was calculated and p-values, 0.05 were considered statistically significant. Results: The treatment outcomes with the status of “cured” and “completed treatment” were better among NIDPs as compared to IDPs. Patients with treatment outcome status of “defaulted treatment”, “without documentary evidence, and “failure” were high in IDPs as compared to NIDPs. Adherence to TB treatment was better among NIDPs (50.9%) as compared to IDPs (39.4%). The patients showing non-adherence to TB treatment were more among IDPS (27.3%) than NIDPs (10.9%). Conclusion: Overall results of this study revealed a poor adherence to the TB treatment medications with an odds ratio of 0.286, (p<0.05) among IDPs as compared with NIDPs.
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Affiliation(s)
- Farman Ullah Khan
- Farman Ullah Khan, Department of Pharmacy, Faculty of Biological Science, Quaid-i-Azam University, 45320 Islamabad, Pakistan
| | - Zahid Asghar
- Zahid Asghar, School of Economics, Faculty of Social Sciences, Quaid-i-Azam University, 45320 Islamabad, Pakistan
| | - Muhammad Khalid Tipu
- Muhammad Khalid Tipu, Department of Pharmacy, Faculty of Biological Science, Quaid-i-Azam University, 45320 Islamabad, Pakistan
| | - Asim Ur Rehman
- Asim.ur.Rehman, Department of Pharmacy, Faculty of Biological Science, Quaid-i-Azam University, 45320 Islamabad, Pakistan
| | - Asif Khan
- Asif Khan, District TB Control Program, Bannu, 28100 Khyber PakhtunKhwa, Pakistan
| | - Tofeeq Ur-Rehman
- Tofeeq Ur-Rehman, Department of Pharmacy, Faculty of Biological Science, Quaid-i-Azam University, 45320 Islamabad, Pakistan
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