Conflict and Health最新文献

{"title":"Can improved handwashing infrastructure and soap change behavior? findings from a randomized control study in the Dadaab refugee camp in Kenya.","authors":"Dennis Akeyo, Innocent Tumwebaze, Naomi Ngáng'a, George Kiragu, Viviana Olivetto, Stephen Philips, Vishna Shah, Sheillah Simiyu","doi":"10.1186/s13031-026-00793-2","DOIUrl":"10.1186/s13031-026-00793-2","url":null,"abstract":"<p><strong>Background: </strong>Globally, around 40% of people lack access to handwashing facilities with soap and water, a proportion likely higher in crisis-affected settings such as refugee camps. This increases vulnerability to hygiene-related diseases including diarrhea and respiratory infections. This study assessed whether improved access to handwashing facilities (Jengu) increases handwashing with soap (HWWS) among refugees in Dadaab camp, Kenya. Jengu is a foot-operated handwashing facility which is designed to integrate water storage, soap placement, and drainage in a compact structure suitable for household use in resource-constrained environments.</p><p><strong>Methods: </strong>A randomized control study was conducted in Dadaab refugee camp in Kenya between June 2023 to July 2024. The sample size was 300 households across nine camp sections. Households were randomly assigned to receive either an intervention group receiving a Jengu handwashing facility with a 20-L jerry can and regular soap supply (n = 150) or a control group receiving soap provision only (n = 150). Soap was distributed bi-monthly to both groups. Data were collected through structured observations and household surveys at baseline, one-month post-intervention, and endline. Surveys assessed sociodemographic factors, knowledge, attitudes, and practices, while observations captured HWWS behavior at predefined critical hygiene moments. Descriptive statistics summarized baseline data. Logistic regression and a difference-in-differences approach were used to evaluate predictors and intervention effects.</p><p><strong>Results: </strong>Among respondents, 75.4% were female (mean age 42 ± 12.7 years), 62.3% of household heads had no formal education. Across all rounds, 4,323 critical handwashing events were observed, of which 38.5% involved HWWS. HWWS prevalence rose from 28.4% at baseline to 61.0% one-month post-intervention, then declined to 32.4% at endline, remaining above baseline. Total HWWS moments nearly doubled (350 to 597), with the largest relative increase before child feeding (sixfold rise). HWWS before eating was significantly greater in the intervention group at endline (OR = 1.77, 95% CI: 1.13-2.77, p = 0.013). Soap and water availability were key predictors, HWWS odds were 2.53 times higher with soap (95% CI: 2.08-3.06, p < 0.001) and 1.23 times higher with water (95% CI: 1.02-1.49, p = 0.027). Compared to baseline, HWWS odds tripled at one month(OR = 3.05, 95% CI: 2.47-3.73, p < 0.001) and remained elevated at endline (OR = 1.20, 95% CI: 1.01-1.42, p = 0.037).</p><p><strong>Conclusions: </strong>Enhanced handwashing facilities, consistent soap provision, and improved water access substantially increased HWWS in this refugee setting. Soap availability was critical for sustaining behaviors, while the Jengu facility prompted short-term gains. Integrated WASH interventions combining infrastructure, supply continuity, and behavior change strategies are essential ","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13200288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147629116","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":"Civilian family members' deaths and perceived causes in war-torn Tigray, Ethiopia: modified poisson regression.","authors":"Ataklti Gebretsadik, Brhane Ayele, Mussie Alemayehu, Mulugeta Tilahun, Desalegn Meresa, Haftu Gebrehiwot, Reda Shamie, Assefa Ayallew, Hailay Gebretnsae, Tsegay Hadgu, Asfawesen Aregay, Kiros Demoz, Znabu Hadush, Tsegay Wellay, Adhena Ayaliew, Mebrahtu Kalayu, Hayelom Kahsay, Fana Gebreslassie, Mulugeta Woldu, Gebrehaweria Gebrekurstos, Liya Mamo, Tadelle Tesfaen, Ferehhiwet Hailemariam, Abrham Gebrelibanos, Araya Abrha Medhanyie, Afework Mulugeta","doi":"10.1186/s13031-026-00789-y","DOIUrl":"10.1186/s13031-026-00789-y","url":null,"abstract":"<p><strong>Background: </strong>Civilians suffer greatly from mortality as a result of armed conflicts.The magnitude of family members' deaths and their perceived causes in households in war-affected settings of Tigray region of Ethiopia has not been investigated.</p><p><strong>Methods: </strong>This study was part of a large integrated cross-sectional survey conducted in selected 13,915 households from 19 districts.The data analysis was done using STATA 17 versions software packages.We have fitted all the possible count regression models to discover the best fitted model. Log-likelihood, Akaike Information Criteria (AIC), and Bayesian Information Criteria (BIC) were also used to compare various candidate models. We found that the robust Poisson regression model better fits the mortality data. Adjusted Incidence Rate Ratio (AIRR) with 95% confidence intervals (CI) at P < 0.05 was used to establish the statistical significance in multivariable robust Poisson regression to assess the association between independent variables and the out come variable.</p><p><strong>Results: </strong>In this study, from the total 13,915 participants, 5% (n = 699) of them experienced civilian family members' war-associated death.Households with a disabled member (AIRR = 2.46; 95%CI: 1.80, 3.39), displaced from home (AIRR = 0.60; 95%CI: 0.50, 0.74,five and more family size (AIRR = 1.09; 95%CI: 1.04-1.14) and widowed marital status (AIRR = 3.72; 95%CI: 2.89-4.81),, and semi-urban place of residence (AIRR = 0.49; 95CI: 0.30, 0.82) were associated with the outcome variable .</p><p><strong>Conclusion: </strong>Civilian family members' death report in this study is high. Large family size, widowed marital status, not displacing from home, having a disabled member of the family, and rural residences were the identified factors associated with civilian's death. In the context of the cessation of hostilities following the Pretoria Peace Agreement, sustained efforts from the government, humanitarian organizations, and the international community are essential .</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13377969/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147624830","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":"Conflict-driven antenatal care interruption in conflict zones of Ethiopia: a systematic review and meta-analysis.","authors":"Amare Simegn, Yitayal Ayalew Goshu, Temesgen Lingerh Endalew, Yeshiambaw Eshetie, Yirgalem Abere, Yohannes Tesfahun, Temesgen Birlie Asmare, Negesse Zurbachew Gobezie, Habtie Bantider Wubet, Kumlachew Geta Belete, Belayneh Jejaw Abate, Getachew Mekete Deress, Biruk Demissie","doi":"10.1186/s13031-026-00790-5","DOIUrl":"10.1186/s13031-026-00790-5","url":null,"abstract":"<p><p>BACKGROUND: The delivery of maternal health services is compromised by conflict’s substantial disruption of health systems. Antenatal care (ANC) continuity in Ethiopia has been jeopardized by ongoing armed hostilities in conflict areas of Ethiopia. The purpose of this systematic review and meta-analysis was to determine the pooled prevalence of ANC interruption and investigate its drivers in war affected regions of Ethiopian. METHODS: We systematically researched articles published between 2015 and 2025 in PubMed, Embase, CINAHL and Scopus. Grey literatures (International Humanitarian Organizations, United Nations and International Monitoring Agencies like Offices of Coordination of Humanitarian Affairs-OCHA) were used to support completeness of the sources. Studies that reported ANC utilization or disruption in Ethiopia’s conflict-affected areas were included. Information about ANC results, study parameters, and contextual factors were extracted. I² statistics were used to evaluate heterogeneity, and pooled prevalence was estimated using random-effects model meta-analysis. RESULTS: Eight peer-reviewed studies were included for the review. The pooled prevalence of ANC interruption was 54.3% (95% CI: 39.2–69.4). Facility destruction, insecurity, and population displacement were among the determinants. These results were supported by grey literature, which stated that maternal services were extremely limited and most health institutions were non-operational. Grey literature corroborated these findings, reporting that the majority of health facilities were non-functional and maternal services severely limited. CONCLUSION: ANC interruption in conflict-affected Ethiopia is high, affecting more than half of pregnant women. Immediate interventions are required, including health facility rehabilitation, mobile outreach services, workforce strengthening, and supply chain restoration to mitigate maternal and neonatal morbidity and mortality. </p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13047819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147582586","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":"Interventions addressing mental health in conflict-affected settings: A literature review.","authors":"Nicoline Falkbøll, Marie Louise D Østergaard, José Gabriel Zapata García, Diego Mauricio Aponte Canencio, Jens Modvig, Marie Brasholt","doi":"10.1186/s13031-025-00746-1","DOIUrl":"10.1186/s13031-025-00746-1","url":null,"abstract":"<p><p>The burden of mental health disorders is high in conflict-affected populations. However, there is still limited evidence from studies that measure the effectiveness of mental health interventions implemented in conflict and post-conflict settings. This study presents the results of a literature review aiming to identify those mental health interventions that have been implemented in such contexts. A systematic literature search was conducted in MEDLINE (PubMed), Scopus and PsycINFO leading to the identification of 33 relevant studies reporting on results of mental health-focused interventions with pre- and post- measurements. Eighteen studies were randomized clinical trials (RCTs), five were quasi-experimental and 10 were studies without controls. They covered 21 countries. Five RCTs reported effect sizes that were categorized as large. Their intervention models were Resource-Oriented Trauma Therapy (ROTATE), Problem Management Plus (PM+), a version of Narrative Exposure Therapy adapted for forensic offenders (FORNET), a contextual adaptation of the Unified Protocol (CXA-UP) and Common Elements Treatment Approach (CETA) respectively. Five other RCTs showed moderate effect sizes. All quasi-experimental studies and studies without controls reported some level of improvement in clients' well-being. Target groups and intervention types as well as providers of the interventions differed significantly across studies, as did outcome measures. PM + and NET including FORNET are the interventions best studied and have shown moderate to high effect in several contexts and for different populations. CETA and ROTATE have shown large effect in one RCT each. These four treatment modalities are all focused on the individual and delivered by mental health professionals, but some can also be delivered in groups and by lay health workers, which may be important in low resource contexts and where emphasis is put on the collective. Ways to standardize and manualize interventions need to be found so that they can be adequately tested in different contexts, on different well-defined target groups, with due consideration to who provides the services in question and with well-defined outcome measures both immediately post-intervention and at long-term follow-up.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13154505/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147576621","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":"Between bullets and outbreaks: epidemic control in Sudan's forgotten war.","authors":"Salma Ibrahim Mohammed Adam, Rawa Badri, Iyas Dawood, Safa Abdalrhim, Alaa Elsaeed, Mohamed Idries, Lina Hemmeda","doi":"10.1186/s13031-026-00763-8","DOIUrl":"10.1186/s13031-026-00763-8","url":null,"abstract":"<p><p>Two years into Sudan's prolonged war, the collapse of health systems has fueled multiple concurrent epidemics, triggering a complex humanitarian emergency with regional spillover risks. Over 30 million people need aid, more than 11 million displaced internally, and cross-border movement has exacerbated the spread of vaccine-preventable diseases, including Cholera, Measles, and circulating vaccine-derived Poliovirus type 2 (cVDPV2). This review analyzes emerging epidemiological patterns and operational barriers to epidemic control in the context of armed conflict, displacement, and infrastructure collapse. It concludes with targeted recommendations for conflict-sensitive public health interventions.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"20 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13011572/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505589","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":"Pathways to care among women hospitalized with severe abortion complications in Bangui, Central African Republic, a conflict-affected urban setting: qualitative results of the AMoCo (abortion-related morbidity and mortality in conflict-affected and fragile settings) study.","authors":"Tamara Fetters, Pascale Lissouba, Catrin Schulte-Hillen, Daphné Lagrou, Ann M Moore, Marietta Claudia Adame Gbanzi, Richard Ngbale, Bill Powell, Claire Fotheringham, Onikepe Owolabi, Huiwu Chen, Timothy Williams, Elisabeth Poulet, Estelle Pasquier","doi":"10.1186/s13031-026-00768-3","DOIUrl":"10.1186/s13031-026-00768-3","url":null,"abstract":"<p><strong>Background: </strong>The Central African Republic (CAR), a fragile and conflict-affected setting, has one of the highest maternal mortality ratios in the world. Complications of unsafe abortion, while preventable, are one of the major contributors. Legal abortion is authorized in limited circumstances before eight weeks but in practice, is unavailable. This study explored the experiences of patients hospitalized with severe postabortion complications at a Ministry of Health (MoH) maternity hospital supported by Médecins sans Frontières to understand women's challenges accessing appropriate care.</p><p><strong>Methods: </strong>We interviewed 18 purposively selected girls and women following medical treatment for near-miss or potentially life-threatening abortion complications. In-depth interviews were conducted to understand women's challenges accessing appropriate care. Data were analysed thematically to identify patterns in decisions, care-seeking trajectories, and factors that may have delayed seeking and receiving postabortion care.</p><p><strong>Results: </strong>About two-thirds of participants reported that they had induced the abortion, either on their own or with assistance, before seeking postabortion care. Participants faced multiple barriers accessing abortion which led them to choose ineffective and harmful abortion methods, notably a lack of reliable information and access to safe abortion care services, compounded by individual, interpersonal and socio-economic constraints. When experiencing postabortion complications, the decision to seek care was delayed by limited knowledge and attempts at maintaining secrecy surrounding the abortion. Participants, including those not reporting induced abortion, described complex nonlinear care-seeking pathways, including attempts to self-manage symptoms and consulting closer health care facilities that weren't able to handle the complications due to lack of capacity. Postabortion complications were associated with taxing and potentially long-term physical, psychological, social and financial consequences, which often negatively impacted women, families and communities.</p><p><strong>Conclusions: </strong>Our findings highlight the urgent need for MoH and partners to implement strategies improving timely access to high-quality postabortion care, such as informing communities about danger signs of abortion complications, treatment locations, improving referral systems, and reducing financial barriers. Training informal and lower-level medical staff in the recognition and treatment of abortion complications and about respectful non-judgmental communication with patients would also be of benefit. Furthermore, creating a more supportive environment for the provision of postabortion and safe abortion care and information should be prioritized, including the decentralisation of care to primary care facilities.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13130683/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147494664","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":"Estimating abortion incidence and unintended pregnancy among adolescents living in refugee settlements in Uganda.","authors":"Stephanie Andrea Küng, Margaret Giorgio, Peter Kisaakye, Bonnie Wandera, Yohannes Dibaba Wado, George Odwe","doi":"10.1186/s13031-026-00782-5","DOIUrl":"10.1186/s13031-026-00782-5","url":null,"abstract":"<p><strong>Background: </strong>Uganda has one of the highest teenage pregnancy rates in the world. While barriers to contraceptive uptake are well documented, little is known about the incidence of abortion and unintended pregnancy among adolescents living in refugee settlements in Uganda.</p><p><strong>Methods: </strong>We used an age-specific variant of the Abortion Incidence Complications Method (AICM), modified for refugee settings. We drew on three surveys administered in Uganda in 2023: a Health Facilities Survey, Knowledgeable Informant Survey, and Prospective Morbidity Survey. We used chi-squared tests for association to assess differences in reproductive health characteristics and outcomes between adolescent and non-adolescent post abortion care (PAC) patients.</p><p><strong>Results: </strong>Adolescents aged 15-19 living in refugee settlements have the lowest overall abortion rate (19.7 per 1,000 women). However, when adjusted for sexual activity, adolescents living in refugee settlements have the highest abortion rates when assessed only among those who have ever had sex (89.0 per 1,000 women) or had recent sex (123.7 per 1,000 women). Over one-half of pregnancies among adolescent refugees are unintended (57.2%), but compared to other women of reproductive age they have the lowest proportion of unintended pregnancies ending in abortion (40.6%). There were no significant differences in patient care experiences and severity of abortion complications between adolescent and non-adolescent PAC patients.</p><p><strong>Conclusions: </strong>Adolescents living in refugee settlements have high rates of induced abortion and unintended pregnancy. Expanding access to sexual and reproductive health information and services, including safe abortion and contraception, is critical. In particular, efforts should focus on strengthening supply chains, ensuring sexual and reproductive health is integrated into humanitarian programming, and strengthening community outreach to disseminate safe abortion information and make contraceptive services more accessible.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13130766/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147494695","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":"Women's perceptions of person-centered comprehensive abortion care and associated factors in Northern Ethiopia: a facility-based cross-sectional study in a humanitarian setting.","authors":"Nakachew Sewnet Amare, Tewodros Seyoum, Amare Tariku, Cristina Mattison, Marie Klingberg Allvin","doi":"10.1186/s13031-026-00788-z","DOIUrl":"10.1186/s13031-026-00788-z","url":null,"abstract":"<p><strong>Background: </strong>In humanitarian settings, women and girls face limited access to contraceptives, increasing the risk of unintended pregnancies, unsafe abortions, and related complications. Strengthening abortion care is essential to ensure quality and accessibility in Ethiopia's humanitarian context. However, evidence on person-centered abortion care remains limited, highlighting the need to bridge this gap. This study aimed to assess women's perceptions of person-centered comprehensive abortion care (PC-CAC) and identify associated individual, clinical, and facility-level factors in public health facilities in the humanitarian setting of northern Ethiopia.</p><p><strong>Methods: </strong>An institution-based cross-sectional study was conducted from September 2023 to March 2024 in 31 health facilities, involving 1,642 women and girls who received abortion care. Data were collected using a standardized questionnaire. The perceived quality of PC-CAC was categorized into three levels based on percentile cut-offs: low (< 25th percentile), medium (25th-75th percentile), and high (> 75th percentile). An ordered generalized linear mixed-effect model was fitted using STATA 17 to identify factors associated with PC-CAC.</p><p><strong>Result: </strong>Among the participants, 23.6% reported experiencing a high level of PC-CAC, 25.9% a low level, and 50.5% a medium level of care. The odds of experiencing high-level PC-CAC were significantly higher among women and girls who did not experience abortion-related complications (AOR: 2.05; 95% CI: 1.43-2.95), received care at a health center (AOR: 1.49; 95% CI: 1.02-2.21), and obtained abortion care at the first visited health facility (AOR: 1.51; 95% CI: 1.18-1.94). In contrast, the likelihood of experiencing high-level PC-CAC was significantly lower among those whose pregnancy termination was due to rape (AOR: 0.44; 95% CI: 0.29-0.67) and those admitted with incomplete abortion (AOR: 0.67; 95% CI: 0.52-0.87).</p><p><strong>Conclusion: </strong>Only one in four women and girls experienced high-level PC-CAC in this humanitarian setting. These findings underscore the urgent need to standardize PC-CAC across all facility types, with particular attention to improving care in hospitals and for women who are survivors of rape, as well as those presenting with incomplete abortions and related complications.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13047825/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147492003","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":"Trauma and post-traumatic stress symptoms among internally displaced populations in Yemen: evidence from a mixed-methods study.","authors":"Aamer Aldbyani, Aiman Rosen, Ahmed Salem, Hassan A M M Almansoub","doi":"10.1186/s13031-026-00779-0","DOIUrl":"10.1186/s13031-026-00779-0","url":null,"abstract":"<p><strong>Background: </strong>Prolonged armed conflict has caused widespread internal displacement in Yemen, exposing internally displaced persons (IDPs), including children, to multiple traumatic events and heightened risks of post-traumatic stress symptoms (PTSS). Despite the scale of displacement, empirical evidence on trauma exposure and mental health needs in this population remains limited.</p><p><strong>Methods: </strong>A mixed-methods design was employed, including a quantitative assessment of 321 internally displaced adults and qualitative interviews with 33 caregivers and 21 psychosocial specialists in Yemen. Quantitative data were collected using the Harvard Trauma Questionnaire (HTQ) and the PTSD Checklist for DSM-5 (PCL-5). Both instruments were completed by adult participants through online self-administered questionnaires. Qualitative data were obtained through semi-structured interviews with 33 caregivers and 21 psychosocial specialists. Quantitative analyses involved descriptive statistics and Pearson correlation coefficients, while qualitative data were examined through thematic analysis.</p><p><strong>Results: </strong>Quantitative findings showed moderate to high levels of trauma exposure (HTQ total mean = 2.95, SD = 0.60) and elevated PTSS (PCL-5 total mean = 2.80, SD = 0.62). Significant positive correlations were observed between trauma exposure and PTSS domains (r = .55-.76, p < .001), with the strongest association between total HTQ and total PCL-5 scores (r = .76). Thematic analysis identified four major themes: (1) exposure to multiple and repeated traumatic events, (2) psychological and behavioral manifestations in children, (3) barriers to psychosocial support, and (4) protective factors and recovery pathways.</p><p><strong>Conclusions: </strong>The findings reveal the severe psychological burden faced by IDPs in Yemen and underscore the urgent need for structured, trauma-informed psychosocial and mental health interventions that address both individual symptomatology and broader contextual factors. This evidence can inform targeted support strategies for displaced populations in conflict-affected settings.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13112912/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147482569","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":"Utilizing the COM-B model to identify childhood routine vaccination barriers and uptake among parents and caregivers living in the frontline and Zakarpattia regions of Ukraine amidst Russia's full-scale invasion.","authors":"Olha Bondarenko, Georgia Venner, Brett Craig, Stanislav Gaievskyi, Yevgenii Grechukha, Jarno Habicht","doi":"10.1186/s13031-026-00787-0","DOIUrl":"10.1186/s13031-026-00787-0","url":null,"abstract":"<p><strong>Background: </strong>In Ukraine, historical challenges of vaccination behavior and uptake, rooted in complex social and structural factors, have long hindered efforts to reach the 95% childhood vaccination coverage for herd immunity. These difficulties were further exacerbated by the Russian Federation's full-scale invasion in February 2022. Internally displaced people (IDPs) encountered additional barriers in host regions already under considerable strain, and vulnerable regions of Ukraine continued to experience suboptimal routine vaccination coverage and growing misinformation. Empirical research exploring vaccine behavior and uptake using qualitative methods in Ukraine is limited.</p><p><strong>Methods: </strong>This study employed a qualitative design comprised of 12 online focus group discussions with parents and caregivers, including IDPs, of children under 7 years old between July and August 2024. Regions selected included the Zakarpattia oblast and the frontline areas of Kharkivska, Odeska, and Dnipropetrovska. The analysis was guided by the Capability, Opportunity, and Motivation model of behavior change (COM-B) to identify vaccination behaviors at the individual and community level.</p><p><strong>Results: </strong>Participants' capability factors demonstrated moderate knowledge of vaccines, with most of this knowledge held by mothers or female caregivers. The psychological and financial impact of the war has dramatically affected their livelihoods. Strong motivating factors included the need to protect their children from disease. A small number firmly believed the vaccine caused harm and did not vaccinate their child. State-provided free vaccines with origins outside of Europe motivated some participants to pay out of pocket. Factors affecting physical opportunities to vaccination included infrastructure damage, supply issues, and a lack of access to healthcare providers (especially for IDPs), mainly due to the war. Factors influenced by social opportunities included perceived vaccine experiences within family circles and online community groups, and the spread of vaccine rumors and misinformation. Participants heavily relied on family doctors for vaccine-related information, but many reported challenges with information-seeking and access.</p><p><strong>Conclusion: </strong>Ukraine faces heightened risks of vaccine-preventable disease outbreaks due to war-related disruptions, limiting vaccination opportunities despite strong parental motivation. Improving access to services, increasing vaccine availability, providing tailored public health education, and conducting further research are needed to strengthen routine immunization among children.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13112654/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147476439","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}