Conflict and Health最新文献

{"title":"Realising health justice in Palestine: beyond humanitarian voices.","authors":"James Smith, Sara El-Solh, Layth Hanbali, Sawsan Abdulrahim, Sali Hafez, Samer Abuzerr, Bram Wispelwey, Mads Gilbert, Mohammed Seyam, Bassam Abu Hamad, Dorotea Gucciardo, Fahd Haddad, Rasha Khoury, Amira Nimerawi, David Mills, Ghassan Abu-Sittah","doi":"10.1186/s13031-024-00634-0","DOIUrl":"10.1186/s13031-024-00634-0","url":null,"abstract":"<p><p>In the shadow of Israel's ongoing genocide throughout occupied Palestine, this article examines the moral, political, and epistemic responsibilities of humanitarian, public health, global health, medical and related communities of practice amid profound violence and injustice. In this paper we offer a three-part critique of a May 2024 commentary by Karl Blanchet and colleagues, 'Rebuilding the health sector in Gaza: Alternative humanitarian voices' (Blanchet et al. in Confl Heal 18:42, 2024). We argue that in relation to the post-genocide reconstruction of the health system in Gaza, the authors have failed to adequately contextualise their analysis, or the health system reconstruction policy proposal as commissioned by the Gaza Health Initiative [Gaza Health Rebuilding Initiative (GHRI), Future of the Gaza health system: Needs assessment. https://static1.squarespace.com/static/656c4ff5b219116063f8099e/t/65c30c4d3e80fd21f1165b57/1707281499127/Final+first+draft+-+Gaza+health+system+report.pdf . Accessed 8 November 2024], and as such have failed to elucidate the root causes of what manifests most immediately as an entirely manufactured humanitarian crisis. This in turn undermines the substance and utility of the recovery proposal as it has been presented. We also argue that the authors have failed to afford due recognition to several key health actors in Palestine, in particular the Palestinian Ministry of Health in Gaza and UNRWA, and that this subtle but critical act of erasure further undermines the relevance and applicability of their recovery proposal as presented. In response we emphasise the centrality of Palestinian perspectives, and the need to uphold Palestinian leadership in all stages of the recovery process. Thirdly, we take issue with the suggested chronology and substance of the recovery proposal as presented, which overlooks response and recovery efforts already underway and led by Palestinians in Gaza, and which overstates ultimately harmful intervention strategies such as networks of internationally managed field hospitals. Against the backdrop of a very limited window for what we consider morally justifiable humanitarian engagement in Gaza, we join many others who have called for a paradigm shift away from the inertia of supposed objectivity and claimed neutrality that function to perpetuate injustice. Instead, we call for the collective practice of critical advocacy, solidarity with people affected by injustice and oppression, and an emancipatory politics in pursuit of justice in Palestine.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"19 1","pages":"7"},"PeriodicalIF":3.1,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A descriptive analysis of a medical humanitarian aid initiative for quality perinatal management in war-torn Ukraine.","authors":"Iryna Mogilevkina, Dmytro Dobryanskyy, Rhona MacDonald, Diane Watson, David Southall","doi":"10.1186/s13031-025-00644-6","DOIUrl":"10.1186/s13031-025-00644-6","url":null,"abstract":"<p><strong>Background: </strong>Russian's invasion of Ukraine has seriously disrupted perinatal care. In a humanitarian initiative, emergency obstetric and neonatal equipment and drugs were provided by Maternal and Childhealth Advocacy International and distributed by Ukrainian partners to a selected 61 maternity hospitals throughout Ukraine. The programme included engaging mothers in labour to undertake fetal heart rate monitoring using a battery operated, portable, doppler ultrasound probe. This paper describes some characteristics of participants and analyses differences in fetal distress management and maternal / neonatal outcomes following different approaches to fetal health surveillance.</p><p><strong>Methods: </strong>Data from 28,808 births were collected in specially developed database which contained information on maternal characteristics, course of pregnancy and childbirth, maternal and neonatal outcomes and donated drugs and equipment used. After informed consent, mothers (n = 13735) who agreed to use in labour fetal self-monitoring in addition to standard intrapartum fetal health surveillance, monitored and recorded fetal heart rate changes on a \"contraction-by-contraction\" basis into a special form. Data on maternal experience with self-monitoring were collected. Cases where fetal heart rate changes were identified (n = 1434) were extracted and analysed for differences in case management and maternal and neonatal outcomes in different approaches: joint monitoring (mother plus staff, n = 901) vs. staff only monitoring (n = 533) and different actors in case of joint monitoring (mothers, n = 512, vs. staff, n = 389).</p><p><strong>Results: </strong>Vacuum assisted delivery was utilised in only < 2% cases. Caesarean section rate was 27%. Mothers reported their experience with self-monitoring as great or good in 79%. Preterm deliveries were less frequent where fetal monitoring was provided by both staff and mothers jointly. In the staff plus mother group, more often lateral tilt, intravenous fluid, spontaneous vaginal and vacuum assisted delivery and less often caesarean sections were undertaken even when fetal distress alone was an indication for operative delivery at term pregnancy.</p><p><strong>Conclusion: </strong>Involvement of women may help to make delivery safer for mothers as complications may be recognized earlier and appropriately treated. Overall, the data shows that despite the full-scale war in Ukraine, it remained possible for high quality perinatal health care to continue.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"19 1","pages":"6"},"PeriodicalIF":3.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11786421/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of a peer support group programme for vulnerable host population and refugees living with diabetes and/or hypertension in Lebanon: a before-after study.","authors":"Leah Anku Sanga, Carla Njeim, Éimhín Ansbro, Rima Kighsro Naimi, Ali Ibrahim, Benjamin Schmid, Jasmin Lilian Diab, Jytte Roswall, Tim Clayton, Lars Bruun Larsen, Pablo Perel","doi":"10.1186/s13031-025-00646-4","DOIUrl":"10.1186/s13031-025-00646-4","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Non-communicable diseases (NCDs) are the leading cause of death globally, and many humanitarian crises occur in countries with high NCD burdens. Peer support is a promising approach to improve NCD care in these settings. However, evidence on peer support for people living with NCDs in humanitarian settings is limited. We evaluated the implementation of peer support groups (PSGs) for people with diabetes and/or hypertension as part of an integrated NCD care model in four primary care centers in Lebanon.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Our objectives were to: (1) evaluate the reach of the PSGs; (2) evaluate the association of PSGs with patient-reported outcomes; and (3) evaluate the association of PSGs with clinical outcomes (blood pressure, HbA1c, and BMI). We used a before-after study design and included a control group for clinical outcomes. The PSG intervention began in December 2022 and was carried out in two waves. The first wave was implemented from December 2022 to July 2023, and the second wave from July 2023 to January 2024. For the control group on clinical outcomes, we used data collected from January 2023 to January 2024. We used routinely collected programmatic and administrative data. The patient reported outcomes (PROMs) were collected at baseline and at six months by trained volunteers for all PSG participants. We performed a before-after analysis of PROMs for all patients who completed the PSG sessions. T-tests were used to analyze the differences in PROMs from baseline. Change in PROMs, together with 95% confidence intervals (CIs), and p-values for the changes were reported. To assess the association between the implementation of the PSG strategy and changes in clinical outcomes, including systolic blood pressure (SBP), glycated hemoglobin A1c (HbA1c), and body mass index (BMI), analysis of covariance (ANCOVA) models were used, adjusting for age, sex, and the baseline values of the outcome being analyzed (baseline SBP and baseline HbA1c, respectively).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 445 patients were approached for enrolment in wave 1, 259 (58%) consented, of whom 81 were enrolled. In wave 2, 169 patients were approached, 92 (54%) consented of whom 91 were enrolled. We found some statistical evidence that PSG improved certain PROMs, including potentially clinical meaningful improvements in overall quality of life (wave 1), physical quality of life (wave 1), social quality of life (wave 2), environmental quality of life (wave 1), adherence (wave 2), patient centeredness (wave 1), and exercise (wave 1). However, we did not find strong statistical evidence of an improvement in clinical outcomes (SBP, HbA1c, or BMI) in participants of the PSGs compared to the control group. We found differences in the association of PSGs and outcomes between the two waves.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Our study showed mixed results. In terms of reach, over 50% of those approached consented to particip","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"19 1","pages":"5"},"PeriodicalIF":3.1,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11776164/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Social determinants of student mental health before and after the Beirut port explosion: two cross-sectional studies.","authors":"Julia Scheuring, Tania Bosqui","doi":"10.1186/s13031-025-00645-5","DOIUrl":"10.1186/s13031-025-00645-5","url":null,"abstract":"<p><strong>Background: </strong>Students in Lebanon are facing the devastating impact of multiple national crises, including an unprecedented economic collapse and the Beirut port explosion that killed hundreds, injured thousands, and displaced hundreds of thousands of people. The aim of this study was to identify key social determinants of common mental health symptoms before and after the Beirut port explosion for students at the American University of Beirut, a university based around 4 km from the port.</p><p><strong>Methods: </strong>Two cross-sectional studies were conducted using a representative sample of undergraduate and graduate students at the American University of Beirut. The study was conducted just before (Study 1) and repeated after the Beirut port explosion (Study 2).</p><p><strong>Results: </strong>A total of 217 students participated (n = 143 in Study 1 and n = 74 in Study 2). In Study 1 before the explosion, poorer family functioning and social support were correlated with higher levels of depressive symptoms, but not with anxiety or trauma symptoms. Financial stress was correlated with depressive and trauma symptoms. In the partially adjusted regression model (adjusting for demographics), only financial stress was significantly associated with depressive symptoms. In the fully adjusted model (adjusting for adversity), financial stress was associated with depressive and anxiety symptoms. In Study 2 after the explosion, poorer family functioning and poorer social support were correlated with higher levels of depressive symptoms, while only poorer social support was correlated with higher levels of anxiety symptoms-trauma symptoms were not correlated with either. Financial stress was correlated with all symptoms. In the partially adjusted regression model, only financial stress was significantly associated with all symptom clusters. In the fully adjusted model, no variables were significant.</p><p><strong>Conclusion: </strong>Findings indicate a detrimental impact of financial stress on the mental health of students in Lebanon, beyond the otherwise protective effects of family and social support, in the context of an unprecedented economic crisis and extremely high levels of distress after the explosion. Findings indicate that mental health interventions for college students in Lebanon should include addressing financial stress, and that further research is needed to identify protective factors during acute emergencies.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"19 1","pages":"4"},"PeriodicalIF":3.1,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11776283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examining the integration of refugees into the national health system in Uganda: an analysis using the policy triangle framework.","authors":"Henry Komakech, Shatha Elnakib, Lama Bou Karroum, Evelyn Nyachwo, Winnie Adoch, Sarah Sali, Godfrey Goddie Okeny, Christopher Garimoi Orach","doi":"10.1186/s13031-024-00640-2","DOIUrl":"10.1186/s13031-024-00640-2","url":null,"abstract":"<p><strong>Background: </strong>Uganda has been confronted with a sustained influx of refugees for decades. This prompted the government to explore opportunities to integrate refugees into local service structures including its national health system. This paper chronicles the history of policies and strategies that have influenced the integration of refugees into the national health system in Uganda and investigates factors that impacted policy evolution and progression.</p><p><strong>Methods: </strong>We used a case study approach that drew on a document review and key informant interviews with 28 respondents at national and subnational levels. Interviews were analyzed using thematic qualitative analysis and findings were organized using Walt and Gilson's Policy Triangle Framework. Data from the literature review, media review, and key informant interviews were triangulated.</p><p><strong>Results: </strong>Uganda's experience with the integration of refugee's dates to 1999 when the country first implemented the Self-reliance strategy. Since then, policy learning and evolution have taken place, with policies around integration evolving and improving over time, moving the country towards more effective implementation of integrated health services. A conducive policy environment was key as a set of legislations at national and district-levels and sector-specific plans and budgets that included refugees have provided the foundation for implementation. The integration received support and buy-in from the highest levels of government including the President and the Office of The Prime Minister. This was coupled with deliberate efforts by the government to mainstream refugee response in local plans and budgets, allowing implementation at district and sub-district levels. These factors were pivotal to the implementation of the integration agenda.</p><p><strong>Conclusion: </strong>Our study highlights the complex, dynamic, evolving, and multifaceted nature of the multisectoral health policy process in the integration of health services in refugee settings. The findings shed light on the importance of collaboration between stakeholders, mobilization of legal and political frameworks to shape the integration of refugee health services into the national health system, and the importance of ensuring that high-level commitments translate to action and development plans at local levels.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"18 Suppl 1","pages":"78"},"PeriodicalIF":3.1,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11752622/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating challenges, solutions and requirements in the provision of trauma care in conflict settings by humanitarian actors: a scoping literature review.","authors":"Nikolaos Markou-Pappas, Luca Ragazzoni, Claudia Truppa, Flavio Salio, Francesco Barone-Adesi, Hamdi Lamine","doi":"10.1186/s13031-025-00643-7","DOIUrl":"10.1186/s13031-025-00643-7","url":null,"abstract":"<p><strong>Background: </strong>The evolving nature of irregular warfare and the increasingly frequent violations of human rights law and international humanitarian law pose unique challenges for humanitarian actors delivering trauma care in conflict settings.</p><p><strong>Methods: </strong>A scoping review was conducted on PubMed, Scopus, and Web of Science and a web search (on Google, Google scholar and Bing) to analyze and review past humanitarian interventions offering trauma care in conflict settings. Relevant records were identified from scientific and grey literature. The thematic areas identified by the framework for a Public Health Emergency Operations Centre were used to facilitate the synthesis and analysis.</p><p><strong>Results: </strong>Eleven records examining all phases of conflict identifying gaps throughout the continuum of care in the trauma systems were included. Challenges, solutions and requirements in transportation capacity, data collection methodologies, field coordination mechanisms, and rehabilitative care services were highlighted. Addressing the shortages in skilled healthcare workers, implementing quality improvement measures, and developing standardized training curricula were some of the requirements reported.</p><p><strong>Conclusions: </strong>Our findings suggest that a multidimensional approach emphasizing strong coordination, with inclusive partnerships, is fundamental for effective trauma care systems in conflict zones. Key recommendations include robust medical transport, comprehensive healthcare training, preemptive mass casualty planning, standardized educational materials, continuous context reassessment, data protection, and improved transparency. These strategies could enhance trauma care interventions, ensuring they are effective, equitable, accountable, and sustainable.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"19 1","pages":"3"},"PeriodicalIF":3.1,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11742194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The status of care for youth with type 1 diabetes within and coming from humanitarian crises settings: a narrative review.","authors":"Steven James, Samira B Jabakhanji, Roopa Mehta, John McCaffrey, Maisoon Mairghani, Dominika Bhatia, Olive James, Sylvia Kehlenbrink, Philippa Boulle, Kiran Mejia Mehta, David Simmons, Edward W Gregg","doi":"10.1186/s13031-024-00631-3","DOIUrl":"10.1186/s13031-024-00631-3","url":null,"abstract":"<p><strong>Background: </strong>Humanitarian crises bring unique, and potentially growing challenges to people with type 1 diabetes (T1D). We aimed to determine, in youth with T1D (mean age (± 1SD) 0-17.9 years) within and coming from humanitarian crises settings (HCS), the reported prevalence that meet international consensus targets for glycaemic, blood pressure and lipid management, and incidence of severe hypoglycaemia or diabetic ketoacidosis.</p><p><strong>Methods: </strong>A narrative review of quantitative data was conducted, using a systematic process. MEDLINE (Ovid), Global Health, Web of Science, Scopus, Embase, CINAHL, APA PsycINFO, Cochrane trials, and the reference lists of eligible records were searched (January 2014-February 2024); ten records covering ten separate studies were retrieved.</p><p><strong>Results: </strong>Glycaemic management was consistently suboptimal in HCS. However, among individuals coming from HCS, glycaemia varied. Across both groups, data relating to blood pressure, lipids, severe hypoglycaemia or diabetic ketoacidosis were either unavailable or limited.</p><p><strong>Conclusion: </strong>Findings expose the dearth of data relating to defined youth with T1D within and coming from HCS, leaving the status of this population largely uncharacterised. With limited data indicating suboptimal T1D management, there is a pressing need for the development of a consensus guideline on, and core indicators relating to such youth within and coming from HCS, plus monitoring systems and outcome data.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"19 1","pages":"2"},"PeriodicalIF":3.1,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11731439/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association between perceived neighborhood social cohesion and intimate partner violence in a refugee camp in Dollo Ado, Ethiopia.","authors":"Rebecca Hailu Astatke, Theodros Woldegiorgis, Jennifer Scott, Ndola Prata, Kim G Harley, Negussie Deyessa, Anne Bennett, Vandana Sharma","doi":"10.1186/s13031-024-00637-x","DOIUrl":"https://doi.org/10.1186/s13031-024-00637-x","url":null,"abstract":"<p><strong>Background: </strong>Intimate partner violence (IPV) is the most common form of gender-based violence affecting women and girls worldwide and is exacerbated in humanitarian settings. There is evidence that neighborhood social processes influence IPV. Perceived neighborhood social cohesion (P-NSC)-a measure of community trust, attachment, safety, and reciprocity-may be protective against women's experience of and men's perpetration of IPV and controlling behaviors.</p><p><strong>Methods: </strong>A quantitative social network study, comprised of individual verbally-administered surveys, was conducted in Bokolmayo refugee camp in Dollo Ado, Ethiopia in 2019. In total, 302 Somali refugees (147 women and 155 men), sampled using snowball sampling, participated in the data collection. Logistic regression was used to examine P-NSC and its association with IPV to inform an IPV and HIV prevention intervention.</p><p><strong>Results: </strong>Low P-NSC and men's perpetration of physical IPV in the past month were strongly associated (adjusted AOR = 23.6, 95% CI: 6.2-89.9). Low P-NSC, conversely, was associated with decreased odds of women's experiences of controlling behaviors by an intimate partner in the past year (AOR = 0.1, 95% CI: 0.0-0.5). Women's experiences of other forms of IPV, including physical, sexual, and emotional IPV within the past year, were not associated with P-NSC in adjusted models; P-NSC was significantly associated with all forms of IPV in unadjusted models.</p><p><strong>Conclusion: </strong>Social cohesion programs and other neighborhood approaches to improve P-NSC should be explored as potential avenues to prevent and reduce IPV, with a focus on male IPV and controlling behavior perpetration.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"19 1","pages":"1"},"PeriodicalIF":3.1,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11702093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decision-making for childhood vaccination in crisis settings: a survey of practice & barriers.","authors":"Page M Light, Neha S Singh, Mervat Alhaffar, Lauren E Allison, Sandra Mounier-Jack, Ruwan Ratnayake, Francesco Checchi, Nada Abdelmagid","doi":"10.1186/s13031-024-00638-w","DOIUrl":"10.1186/s13031-024-00638-w","url":null,"abstract":"<p><strong>Background: </strong>Children, particularly those who have received no routine vaccinations (zero-dose children), are at high risk of vaccine-preventable diseases in humanitarian crisis settings. However, the decision-making processes underlying vaccine intervention design and delivery in such settings are poorly understood. The present study investigated the decision-making practices of organisations involved in childhood vaccination in humanitarian crisis settings globally via an online survey.</p><p><strong>Methods: </strong>Individuals involved in the design or delivery of childhood vaccination programmes in humanitarian crisis settings were invited to fill out a self-administered online survey. Respondents were asked about factors influencing intervention design and vaccine delivery; use of technical guidance, specifically the WHO decision-making framework for vaccination in acute humanitarian emergencies (WHO Framework); and practices for reaching zero-dose children.</p><p><strong>Results: </strong>Fourteen responses were received. Large international organisations and UN agencies were overrepresented in the sample. Technical guidance was considered of high importance when designing vaccine interventions. However, the WHO Framework is not available in relevant languages and has not been well-distributed to local and national actors. Awareness of initiatives to reach zero-dose children was high within our sample, though this may not accurately reflect global awareness. Security and resource availability were key barriers to vaccine delivery and reaching zero-dose children. Problems with vaccine access in our sample pertained primarily to issues with the procurement system rather than vaccine cost.</p><p><strong>Conclusions: </strong>The WHO Framework should be provided in more languages, and vaccination actors at local and national level should be engaged to improve its practicality and increase awareness of its aims. In order to reach zero-dose children, vaccines must be made available for use in expanded age groups, which is sometimes not currently feasible within the Gavi/UNICEF procurement system. Clarifying this policy would allow relevant organisations to reach more zero-dose children. Additionally, security is a key barrier impeding vaccine delivery, including for zero-dose children. Safe operational space for humanitarian actors in conflict must be maintained and global conflict resolution mechanisms improved.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"18 1","pages":"77"},"PeriodicalIF":3.1,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11667873/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142882384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vaccination strategies to identify and reach zero-dose and under-immunized children in crisis-affected states in Sudan: a qualitative study.","authors":"Majdi M Sabahelzain, Alaa Almaleeh, Nada Abdelmagid, Omayma Abdalla, Barni Nor, Sandra Mounier-Jack, Neha S Singh","doi":"10.1186/s13031-024-00639-9","DOIUrl":"10.1186/s13031-024-00639-9","url":null,"abstract":"<p><strong>Background: </strong>Globally, 21 million children were un- or under-vaccinated with Diphtheria-Tetanus-Pertussis (DTP)-containing vaccines in 2023. Around 20% of zero-dose children, those who had not received any DTP doses, live in conflict-affected settings in low and middle-income countries. There is insufficient evidence on vaccination interventions to identify and reach zero-dose children in these settings. This study aimed to map and assess current vaccination strategies to identify and reach zero-dose and under-vaccinated children in the crisis-affected states of South Kordofan, South Darfur and Blue Nile in Sudan.</p><p><strong>Methods: </strong>We conducted a cross-sectional qualitative study guided by the (Identify-Reach-Monitor-Measure-Advocate (IRMMA) framework, developed by Gavi, the Vaccine Alliance. We conducted 20 individual semi-structured interviews during November and December 2022. We interviewed governmental and non-governmental vaccination stakeholders at federal, state and locality levels. We used the IRMMA framework to analyze the interview transcripts.</p><p><strong>Results: </strong>Zero-dose and under-immunized children in the study sites were concentrated in opposition-controlled areas, nomadic communities, and remote rural areas. Zero-dose and under-immunized children in accessible areas were identified through routine vaccination strategies and surveillance reports. Various strategies were used in inaccessible areas. This includes tasking local institutions and individuals trusted by communities to identify and reach children, and infrequent integration and co-delivery of routine vaccines with other health interventions such as COVID-19 vaccination and insecticidal net distribution. There are inaccurate population estimates and a lack of guidance from ministries of health for measuring and monitoring zero-dose and under-immunized children. Respondents conflated advocacy with mobilization, and advocacy was broadly characterized as an ad hoc activity mostly connected to immunization campaigns.</p><p><strong>Conclusions: </strong>Our study underscored the complexity of vaccinating zero-dose and under-immunized children in crisis-affected states of Sudan. Further research is needed to evaluate these practices and the role of non-governmental organizations (NGOs) and community engagement in improving vaccination coverage. Furthermore, exploring alternative funding methods and using geographic information systems (GIS) could enhance vaccination data and address funding limitations.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"18 1","pages":"76"},"PeriodicalIF":3.1,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11665122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142882607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}