Conflict and Health最新文献

{"title":"Increased utilization of health care services for non-communicable diseases during the COVID-19 pandemic among refugees in Jordan: a mixed-methods study.","authors":"Chiara Altare, Yousef Kakish, Gabrielle Prager, Ahmad Mobaideen, Waseem Rihani, Jennifer OKeeffe, Muhammad Fawad, Heba Hayek, Paul Spiegel, Adam Musa Khalifa","doi":"10.1186/s13031-026-00800-6","DOIUrl":"10.1186/s13031-026-00800-6","url":null,"abstract":"<p><strong>Background: </strong>Maintaining routine health services during epidemics and humanitarian crises is instrumental to reduce preventable mortality and morbidity. Given the health service disruptions observed during the COVID-19 pandemic worldwide, we aimed to investigate the evolution of health care service utilization for acute and routine chronic care among refugees in Jordan during distinct phases of the COVID-19 pandemic and discuss the interventions that may have contributed to the observed changes in utilization.</p><p><strong>Methods: </strong>We conducted a mixed-methods study with three components: (1) interrupted time-series analysis of routine health data in Azraq and Zaatari camps; (2) a household survey among refugees in and out-of-camps (descriptive statistics and comparisons across pandemic periods using Poisson models with household-correlated robust variance estimation); 3) focus group discussions among refugees in and out-of-camps (inductive and deductive thematic content analysis). The analyses compared outcomes across four study periods: (1) Pre-COVID-19 (January 2018-March 2020); (2) Lockdown (April 2020-June 2021); (3) Post-lockdown (July 2021-April 2022); (4) Normalization (May 2022-March 2023), and three refugee groups (Syrian in-camps, Syrian out-of-camps, non-Syrian out-of-camps). Study outcomes included health care utilization for acute and chronic conditions (average number of outpatient consultations per person per year) and self reported health care seeking behaviour.</p><p><strong>Results: </strong>Acute care utilization declined sharply during the lockdown and recovered gradually to pre-pandemic level during the post-lockdown period. Diabetes care utilization was low before the pandemic across groups. After a reduction during lockdown, it increased significantly during the normalization phase to above pre-pandemic rates. A package of service adaptations was introduced to facilitate access to services and medicines: multi-months drug prescription; new distribution system for medication home delivery; home visits; telephonic follow-up; hotline for questions. Study participants reported different experiences in accessing care, from spontaneous support to perceived barriers and limited access. While challenges were highlighted (waiting time, transportation, cost), most participants appreciated the intervention package and praised the comprehensiveness of the provided services.</p><p><strong>Conclusions: </strong>This paper investigates changes in health care services utilization of acute and routine chronic care among refugees in Jordan during the COVID-19 pandemic. We learned that acute care will likely rebound back to pre-shock levels and that the utilization of chronic care benefitted from introduced changes in the approach of service delivery, namely a package of complementary interventions that proved helpful in facilitating access to care and medicines for NCD patients while reducing COVID-19 exposure. ","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13439832/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147943742","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":"Public perceptions of mortality studies in conflict-affected areas of the Eastern Mediterranean Region: an exploratory study.","authors":"Esra Abdallah Abdalwahed Mahgoub, Ali Alshalah, Farah El Halabi, Manasik Mamoun, Azzam Ali Mohammad Fare'a, Leina Elomeiri, Sajjad Alazzawi, Abdirahman Khalif Mohamud, Awni Mokhtar Sallam Ali Awn, Mohammed Aref Ali Saeed Ahmed, Zahraa Zibara, Fadila Alhamwi, Noseiba Mahamoud Adam Abdelmoemen, Nour Jamal Houri, Mohamad Al Merhabi, Ola Ali Alftaeih, Mohamed Abdulkadir Ahmed Farah, Moneer Ali Abdallah Ali, Alessandra Ferrario","doi":"10.1186/s13031-026-00798-x","DOIUrl":"10.1186/s13031-026-00798-x","url":null,"abstract":"<p><strong>Background: </strong>Mortality surveys in conflict-affected settings are essential for documenting the human cost of armed conflict, guiding the humanitarian response, and promoting accountability. The success of such studies relies on the participation of the affected populations. Yet, we know little about how the public in conflict-affected countries perceives such studies, their willingness to participate, or the barriers they face to participate. This study aimed to explore public perceptions, willingness and barriers to participate in mortality surveys in six conflict-affected countries of the Eastern Mediterranean Region.</p><p><strong>Methods: </strong>An exploratory, cross-sectional mixed-methods study was conducted in Sudan, Somalia, Syria, Lebanon, Iraq, and Yemen between March and June 2025. An online self-administered questionnaire captured both quantitative and qualitative data. Quantitative data were analyzed using descriptive statistics and bivariate tests, while qualitative responses underwent inductive content analysis.</p><p><strong>Results: </strong>Among 3455 participants (median age 29 years; 56.5% female), 94% (n = 3254) considered mortality surveys during armed conflicts important. Two-thirds (66.7%, n = 2306) expressed willingness to participate in mortality surveys, with a preference for electronic surveys. Willingness to participate was positively associated with older age, male sex, nationality, presence in the country during conflict, comfort with data sharing in social media, and absence of perceived cultural and religious barriers (p < 0.05). More than 40% of respondents reported trusting to provide death data to the government (44.3%, n = 1529) and international organizations (43.8%, n = 1515). Respondents reporting no trust to provide this data mentioned lack of credibility and political bias were the main reasons for distrust. Only 13.1% (n = 453) of the respondents perceived mortality surveys as harmful; key concerns included retaliation, political manipulation, and psychological distress. 19% (n = 658) cited cultural or religious barriers, most linked to sectarianism, honor, and the sanctity of death, as an obstacle to participation.</p><p><strong>Conclusion: </strong>Perceptions captured across the six conflict-affected EMR countries among the digitally-active adult respondents reflect both recognition of the importance of mortality surveys and concerns about safety, trust, and cultural sensitivities. Enhancing confidentiality, engaging trusted institutions in data collection, and adopting culturally sensitive approaches are critical to strengthening participation and ensuring the ethical implementation of mortality surveys in conflict zones.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13352670/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147943784","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":"Anxiety, posttraumatic stress, insomnia and quality of life in Ukrainian schoolchildren during wartime.","authors":"Maciej Wilski, Piotr Kazimierz Urbański, Andrii Ohnystyi, Volodymyr Naumchuk, Anna Nadolska, Iuliia Pavlova","doi":"10.1186/s13031-026-00803-3","DOIUrl":"10.1186/s13031-026-00803-3","url":null,"abstract":"<p><strong>Background: </strong>Children who have remained in Ukraine during the ongoing war are continuously exposed to threat and disruption of services, which places them at high risk of internalizing and trauma-related symptoms.</p><p><strong>Methods: </strong>In a school-based cross-sectional survey conducted in Ukraine (January-February 2024), 781 students aged 10-17 years completed standardized measures of quality of life (QoL) (PedsQL 4.0), depressive symptoms (CDI 2:SR), state and trait anxiety (STAIC), posttraumatic stress symptoms (CRIES-8), insomnia (Athens Insomnia Scale), resilience (CYRM-R) and coping (JSR). Four multiple linear regression models with forward stepwise selection were estimated.</p><p><strong>Results: </strong>All models were significant and explained 25-50% of the variance. Emotional functioning (R² = 0.50) was inversely associated with trait anxiety, PTSD symptoms, state anxiety and insomnia, while caregiver/relational resilience and situational emotion-focused coping made small positive contributions. Social functioning (R² = 0.33) was negatively related to trait anxiety and PTSD and positively related to personal resilience. School functioning (R² = 0.26) was negatively related to PTSD, depressive symptoms and insomnia, and positively related to situational resilience and caregiver/relational resilience. Physical functioning (R² = 0.25) was inversely related to state anxiety, PTSD and insomnia, and positively related to caregiver/relational resilience and active coping.</p><p><strong>Conclusions: </strong>Among war-exposed Ukrainian children who stayed in the country, QoL is mainly determined by symptom burden, especially anxiety, PTSD and sleep disturbance. Resilience and coping have smaller and domain-specific effects. School-based, trauma-informed and sleep-focused interventions should be prioritised in ongoing conflict settings.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13347883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147935372","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":"Exposure to intimate partner violence against women and its association with experiences and perpetration of violence among children and youth in refugee camps in Ethiopia.","authors":"Stella Muthuri, Dagim Habteyesus, George Odwe, Abir Nur, Francis Obare, Peter Kisaakye, Gloria Seruwagi, Yohannes Wado, Yadeta Dessie, Bonnie Wandera, Caroline W Kabiru, Chi-Chi Undie","doi":"10.1186/s13031-026-00797-y","DOIUrl":"10.1186/s13031-026-00797-y","url":null,"abstract":"<p><strong>Background: </strong>A substantial body of research has established a positive association between exposure to intimate partner violence against women (IPVAW) and childhood experiences of violence. However, limited evidence exists on this association in Ethiopia, particularly within humanitarian settings, where children and youth face compounded vulnerabilities. This paper examines the association between witnessing IPVAW during childhood and experiences or perpetration of violence among children and youth aged 13-24 years living in refugee camps in Ethiopia.</p><p><strong>Methods: </strong>This study draws on data from the 2024 Ethiopian Humanitarian Violence Against Children and Youth Survey (HVACS) of 1,937 females and 1,536 males. It assesses associations between witnessing IPVAW during childhood and experiencing physical or emotional violence by a caregiver, experiencing sexual violence by any perpetrator, and perpetrating physical violence. Analyses included descriptive statistics, cross-tabulations with Pearson's Chi-Square (χ²) tests, and bivariate and multivariate logistic regression models.</p><p><strong>Results: </strong>Among 13-17-year-olds, 29.4% of females and 24.7% of males reported witnessing IPVAW, while among 18-24-year-olds, the prevalence was 27.8% for females and 31.3% for males. For females aged 13-17, witnessing IPVAW was associated with higher odds of experiencing physical (AOR = 3.96), emotional (AOR = 2.51), and sexual violence (AOR = 1.92), and of perpetrating physical violence (AOR = 2.25). Among males in the same age group, witnessing IPVAW was linked to increased odds of experiencing physical (AOR = 2.48) and emotional (AOR = 3.96) violence, but not sexual violence, and of perpetrating physical violence (AOR = 8.98). For females aged 18-24, witnessing IPVAW was associated with elevated odds of experiencing physical (AOR = 6.15), emotional (AOR = 3.01), and sexual (AOR = 3.06) violence, and perpetrating physical violence (AOR = 3.62). Males aged 18-24 who had witnessed IPVAW had notably increased odds of experiencing physical (AOR = 13.68) and emotional (AOR = 6.27) violence, but not sexual violence, and of perpetrating physical violence (AOR = 3.70).</p><p><strong>Conclusions: </strong>Witnessing IPVAW during childhood was significantly associated with increased odds of experiencing and perpetrating violence across age and gender groups in these refugee camps. These findings underscore the urgent need for coordinated, multisectoral interventions to prevent violence, support survivors, and break the intergenerational cycles of abuse in humanitarian settings.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13343654/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147935388","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":"Nighttime lights as a proxy for conflict intensity and infrastructure recovery in Yemen and Ukraine.","authors":"Maia C Tarnas, Tetyana I Vasylyeva, Volodymyr M Minin, Daniel M Parker","doi":"10.1186/s13031-026-00801-5","DOIUrl":"10.1186/s13031-026-00801-5","url":null,"abstract":"<p><strong>Introduction: </strong>Quantifying the impacts of armed conflict on civilians and infrastructure remains a major challenge, particularly where reporting is limited. Most conflict measurement tools require affected populations to report events and are limited by short time series, under-reporting, and varying methods. These tools do not capture infrastructural rebuilding, which has important health implications. Given this, we demonstrate the utility of nighttime lights (NTL) as a complementary tool for measuring conflict dynamics and infrastructure recovery with an epidemiological application.</p><p><strong>Methods: </strong>We used monthly NASA Black Marble data to analyze NTL patterns in Yemen (2012-2022) and Ukraine (2019-2024) before and after the onset of large-scale military operations. We calculated month-specific NTL ratios relative to pre-event baselines and assessed the alignment of structural breakpoints, identified using BFAST methods, with aerial attack onset. Generalized additive models were used to measure the relationship between NTL and aerial attacks while accounting for the built environment, population, diesel price (Yemen), and spatiotemporal factors. Finally, we applied NTL to an existing model on the association between conflict, measured via air raids, and cholera in Yemen by replacing the original conflict categories with ones defined by NTL and included a variable for NTL recovery.</p><p><strong>Results: </strong>Mean NTL declined by 53.3% in Yemen and 21.0% in Ukraine following conflict escalation, with detected breakpoints aligning with aerial attack onset in 85.7% of Yemeni governorates and 51.9% of Ukrainian oblasts. Generalized additive models showed that attacks were significantly associated with NTL reductions, independent of built environment factors. Incorporating NTL-based conflict measures into a cholera transmission model for Yemen produced results consistent with attack-based models and found that light recovery was associated with reduced disease risk.</p><p><strong>Discussion: </strong>NTL is a viable tool for measuring conflict and can offer insights on dynamics that are not present in standard tools while avoiding many of these tools' limitations. These data have epidemiological applications and can be a proxy for important events affecting transmission dynamics. While event-based tools have vast utility, NTL can complement them with specific strengths and means of application.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13335313/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147876420","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":"Real-time analytical insights for disease surveillance and response during the severe drought and food security crisis, Somalia 2022-2023.","authors":"Jonathan A Polonsky, Farid Muhammad, Mutaawe Athanansius Lubogo, Mukhtar Shube, Mustafe Awil Jama, Robin Thompson, Sk Md Mamunur Rahman Malik","doi":"10.1186/s13031-026-00799-w","DOIUrl":"10.1186/s13031-026-00799-w","url":null,"abstract":"<p><strong>Background: </strong>Decades of conflict, epidemics, and climatic shocks have severely weakened Somalia's health system. The failure of five consecutive rainy seasons in 2022-2023 led to the longest and most severe drought in recent history, resulting in an unprecedented nutrition and food security crisis. These conditions have heightened the risk of disease epidemics, particularly cholera and measles. To assess the effect of interventions on disease transmission in real time, make short-term projections of disease incidence, and inform response efforts, the World Health Organization Somalia Country Office developed the Somalia infectious disease explorer (WHO-SIDE).</p><p><strong>Objective: </strong>To describe the development and application of WHO-SIDE and demonstrate its potential to identify high-risk areas for targeted public health interventions.</p><p><strong>Description: </strong>WHO-SIDE is an interactive web-based application designed using the Shiny framework in R. It estimates the time-varying reproduction number (Rt), projects case incidence, and evaluates the impact of interventions on transmission. The application uses routine disease surveillance data, offering features such as data visualization, geographic analysis, and customizable epidemic projections.</p><p><strong>Implementation: </strong>Since its deployment, WHO-SIDE has been used to monitor infectious disease trends, guide targeted interventions, and evaluate public health response efforts in Somalia. Outputs were reviewed jointly by WHO and Ministry of Health staff and formed part of the evidence base used to prioritise response activities. Challenges including limited access to technology, incomplete surveillance data, and a lack of trained personnel have hindered its full potential.</p><p><strong>Implications: </strong>WHO-SIDE highlights the feasibility and utility of analytical tools for disease monitoring and response in resource-limited, crisis-affected settings. Realising this potential will require sustained investment in three areas: building analytical capacity among local health staff; improving the completeness and timeliness of surveillance data; and developing processes for integrating modelled outputs with field intelligence. Without progress in these areas, tools such as WHO-SIDE risk producing outputs that are difficult to interpret and act upon in operational contexts.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13330143/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857691","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":"Patient characteristics and interventions at a trauma stabilization point in Gaza- a retrospective analysis.","authors":"Wessam El Ghoul, Hareen De Silva, Samar Al-Hajj, Jonas Zimmerman, Marta Caviglia, Johan von Schreeb, Luca Pigozzi, Flavio Salio, Luca Ragazzoni, Martin Gerdin Wärnberg","doi":"10.1186/s13031-026-00795-0","DOIUrl":"10.1186/s13031-026-00795-0","url":null,"abstract":"<p><strong>Background: </strong>Timely prehospital care is essential in preventing trauma‑related deaths in conflict settings, yet civilian systems often lack the capacity for rapid stabilization and evacuation. Trauma Stabilization Points (TSPs), adapted from military models, have been introduced in Gaza to provide forward‑deployed triage and stabilization. This study describes patient characteristics, clinical presentations, interventions, and outcomes at a TSP operating in Khan Younis, Gaza, in 2024 during the ongoing war.</p><p><strong>Methods: </strong>We conducted a retrospective cross‑sectional analysis of routinely collected patient‑level data from a TSP operated by the Palestinian Red Crescent Society with support from the WHO and an international emergency medical team. All patients presenting between 12 February and 28 April 2024 were included. Descriptive statistics and logistic regression assessed associations between patient characteristics, injury severity, interventions, and referral outcomes.</p><p><strong>Results: </strong>1,928 patients were entered into the dataset. Non‑traumatic conditions accounted for 53% of attendances, while 47% were trauma‑related. Most patients (94.8%) were stable, as defined by the Interagency Integrated Triage Tool (IITT) on arrival. A total of 3482 interventions were recorded, dominated by basic care (86%). Overall, 80.6% of patients were discharged, 19.3% referred to still-functioning hospitals, and 0.1% died at the TSP. Clinical instability, fractures, and penetrating injuries were significantly associated with referral, while basic interventions (e.g., wound suturing, antipyretics) predicted discharge.</p><p><strong>Conclusions: </strong>Despite operating in a high‑intensity conflict, the TSP primarily functioned as a triage and primary‑care access point rather than a trauma‑focused facility. The dominance of on-site treatment and same-day discharge suggest the TSP offloaded some non-urgent patients from overwhelmed hospitals and likely contributed to reducing consumption of limited ambulance resources.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"20 1","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13151167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846034","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":"Unplanned pregnancy and contraceptive use in humanitarian settings: the case of Syrian refugee women in Lebanon.","authors":"Samar Karout, Hani M J Khojah, Tareq L Mukattash, Abdalla El-Lakany","doi":"10.1186/s13031-026-00792-3","DOIUrl":"10.1186/s13031-026-00792-3","url":null,"abstract":"<p><strong>Background: </strong>Contraception is a vital component of reproductive health, yet refugee women often face multiple barriers to accessing family planning (FP) services. This study aimed to explore contraception experiences, practices, and adherence among Syrian refugee women in Lebanon and to identify key sociodemographic predictors influencing contraceptive use.</p><p><strong>Methods: </strong>A descriptive, cross-sectional study was conducted between November 2023 and March 2024 among 790 married Syrian refugee women aged 18-50 across four Lebanese governorates. Structured face-to-face interviews were conducted using a validated questionnaire. Descriptive statistics and logistic regression were used to analyze the data.</p><p><strong>Results: </strong>Nearly 45% had experienced an unplanned pregnancy, with 27.4% resulting in spontaneous miscarriage and 11.3% ending in medical or surgical abortion. About 67.1% were using contraception, with withdrawal (33.2%), intrauterine devices (30.4%), and oral contraceptive pills (OCPs) (19.8%) being the most frequently used method. Among OCP users, 40% were unaware of the medication name, though adherence was generally high (mean score = 21.95 ± 3.68 on a 25-point scale). Logistic regression showed that higher parity (adjusted odds ratio [AOR] = 41.03), residing in Lebanon more than ten years (AOR = 1.57), and employment (AOR = 1.49) were significant predictors of contraceptive use (p < 0.001). Primary barriers to non-use included the desire for more children (31.9%) and spousal opposition (20.4%). More than half of the participants (52.8%) reported at least one chronic condition, with migraine with aura, hypertension, and cardiovascular disease being most common.</p><p><strong>Conclusion: </strong>The high prevalence of unplanned pregnancy (44.5%) and reliance on traditional methods (33.2%) highlight critical gaps in reproductive healthcare. For women with an unmet need for contraception, cultural, informational, and systemic barriers hinder access to modern methods. Improving education, engaging men in FP initiatives, strengthening healthcare infrastructure, and enhancing access to affordable contraceptive methods are essential for advancing reproductive autonomy and health in this vulnerable population.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13251265/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788965","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":"From discovery to delivery: a systems-based pathway for translating science into global and humanitarian health impact.","authors":"Ben Ramalingam","doi":"10.1186/s13031-026-00778-1","DOIUrl":"10.1186/s13031-026-00778-1","url":null,"abstract":"<p><p>Global and humanitarian health impact pathways consist of multiple well-understood stages: setting strategic and policy priorities, scientific discovery, solution development, industry efforts, harnessing delivery systems and meaningful policy and public engagement. Yet it is in the transitions between these stages that progress is often lost. This Commentary argues that breakdowns at 'baton pass' handover points - just as much as challenges within each stage of the pathway - are a major source of unrealised impact. It proposes an end-to-end 'science-to-health' pathway framework to help actors identify where progress is stuck, diagnose underlying vulnerabilities, and select targeted systems-based leverage points to strengthen these baton passes. The leverage points are the 6Rs: Resources, Roles, Relationships, Rules, Routines and Results. Four case examples - antimicrobial resistance, oral cholera vaccine deployment, mpox response in Africa and an illustrative donor health portfolio - show how the tool can guide strategic and operational decisions across diverse health and institutional contexts.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"20 1","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13085610/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147700747","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":"Rationale for the under-implementation of catch-up vaccination in conflict-affected regions, Northeast Ethiopia.","authors":"Muluemebet Kassa Mezen, Yemisrach Belete Biru","doi":"10.1186/s13031-026-00794-1","DOIUrl":"10.1186/s13031-026-00794-1","url":null,"abstract":"<p><strong>Introduction: </strong>In conflict-affected settings, catch-up vaccinations are recognized as a crucial strategy to reinforce the Expanded Program on Immunization (EPI) when the standard immunization schedule is interrupted. In the North Wolo zone after the Northern conflict which lasts for six months, 44% of children less than two years old defaulted from the immunization program. This study aims to explore the rationales influencing parents' decisions not to engage in the catch-up vaccination in the aftermath of the conflict, with the goal of developing evidence-based interventions to improve the health of children in conflict-affected areas.</p><p><strong>Method: </strong>A phenomenological qualitative study design was conducted in conflict-affected areas of Northeast Ethiopia from July to September 2022. The study included mothers of children aged 6 to 23 months who either defaulted on vaccinations due to conflict and did not return, or who gave birth during the conflict and never initiated vaccinations. Data were collected from 109 mothers through in-depth interviews and focus group discussions. All audio recordings were transcribed, translated, and cleaned for analysis. The thematic analysis was conducted by considering Preliminary or interim analysis started in the field and MAXQDA 2020 software.</p><p><strong>Result: </strong>The primary client-related factors contributing to the decision not to consider catch-up vaccinations after the conflict included a lack of awareness about these vaccines, loss of vaccination cards, fear of side effects, and the increased workload on mothers, exacerbated by insufficient support from male partners and family members, as well as traditional gender roles. Health facility-related factors included the inability of health facilities to resume previous services, distance from home, the burden on certain healthcare professionals, and long waiting times.</p><p><strong>Conclusion: </strong>This study reveals that the low uptake of catch-up vaccination in conflict-affected areas is not due to a single cause, but a complex interplay of client and health system barriers. At the individual level, parental decisions are hindered by a lack of information, fear of side effects, and significant gender-based domestic burdens. Simultaneously, health facilities struggle with service limitations, accessibility issues, and overburdened staff.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13200344/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147663334","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}