Conflict and Health最新文献

{"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}

{"title":"Finding strength in adversity: key protective factors and the role of experience of discrimination in young adult Syrian refugee stress, coping and wellbeing.","authors":"Lilian Ghandour, Grant Brown, Malak Tleis, Marwa Fares, Hanan Al Masri, Fadi Al Halabi, Yamen Najjar, Bayan Louis, Rima Nakkash, Rima A Afifi","doi":"10.1186/s13031-026-00781-6","DOIUrl":"10.1186/s13031-026-00781-6","url":null,"abstract":"<p><strong>Background: </strong>Refugees are at high risk for mental disorders given their exposure to violence and trauma in their country of origin, during migration, and in the host country. Protective factors can buffer, bolster, and build mental health. This paper aims to (i) assess the association between seven key protective factors - positive emotions, optimism and hope, supportive relationships, meaning/purpose in life, a sense of accomplishment, feelings of control/ autonomy, and engagement - both individually and synergistically, with four outcomes of wellbeing, adaptive coping, maladaptive coping, and stress; and (ii) to examine the moderating role of experience of discrimination among 86 Syrian refugee young adults (18-24 years, mean = 21.3) living in the Bekaa region, Lebanon.</p><p><strong>Methods: </strong>We analyzed the baseline assessment data of a larger RCT (brief title: Syrian Refugee Young Adults as Community Mental Health Workers-Lebanon; US trial number: NCT05265611/Lebanon trial number: LBCTR2023015206). Correlations between each of the mechanisms and the four outcomes listed above were examined; a series of regression models to examine the synergistic mechanism effect overall and between pairs of mechanisms were used. We further explored evidence for moderation of experience of discrimination on the four outcomes.</p><p><strong>Results: </strong>We found that meaning, accomplishment, autonomy, positive emotions and hope were protective factors significantly (p≤0.05) and positively associated to wellbeing ([Formula: see text]M:0.67/Ac:0.64/Au:0.53/P.E.:0.62/H:0.55 and adaptive coping ([Formula: see text]M:0.36/Ac:0.32 /Au:0.33/P.E.:0.52/H:0.37); while being significantly and negatively associated to stress (ρ; M:-0.71/ Ac:-0.51/ Au:-0.44/P.E.:-0.5/ H:-0.47). Meaning (ρ:-0.39), accomplishment (ρ:-0.32) and autonomy (ρ:-0.21) were significantly and negatively associated with maladaptive coping. Engagement was not significantly associated with any of the 4 outcomes, and supportive relationships (ρ:-0.22) was only weakly associated with stress. We found weak evidence for synergy, only partially consistent with the hypothesized directions. Finally, we did not see significant evidence for effect moderation for adaptive and maladaptive coping, but a positive interaction was detected between experience of discrimination and wellbeing.</p><p><strong>Conclusion: </strong>Our findings confirm that protective mechanisms are critical for enhanced wellbeing and adaptive coping, and decreased stress and maladaptive coping. Interventions that increase these protective factors may influence young adult refugee wellbeing, particularly for those who experience discrimination.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13104394/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147470279","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":"Adherence to anti-seizure medications among pediatric epilepsy patients during the Sudan armed conflict.","authors":"Aseel Adil Ahmed Abdelhafiz, Alag Adil Ahmed Abdelhafiz, Khalid Osman Mohamed, Elaf Abdelraheem, Lina M Omer, Lina S Altayib","doi":"10.1186/s13031-026-00783-4","DOIUrl":"10.1186/s13031-026-00783-4","url":null,"abstract":"<p><strong>Background: </strong>Poor adherence to antiseizure medications (ASMs) is responsible for 26-79% of breakthrough seizures. This study was conducted to evaluate the adherence of pediatric patients with epilepsy to their medications during armed conflict in Sudan.</p><p><strong>Methods: </strong>An observational, analytical cross-sectional study was conducted among pediatric patients (aged ≤18 years) diagnosed with epilepsy. A systematic random sampling technique was employed, and data were collected through structured phone interviews using the Medication Adherence Rating Scale (MAR-20) and the Pediatric Epilepsy Side Effects Questionnaire (PESQ). Associations between categorical variables were analyzed via the chi-square test or Fisher's exact test. For continuous variables, the Mann‒Whitney U test was used.</p><p><strong>Results: </strong>A total of 161 patients were included in this study. 60.9% of the study participants were males, and 39.1% were females. A total of 70.2% of the participants still resided in Sudan during the armed conflict. The mean total score on the MAR scale (MAR-20) was 28.16 (SD = 13.5). Only 31.1% (n= 50) of patients achieved complete adherence to ASMs, whereas 68.9% (n= 111) were nonadherent. The most common challenges cited by caregivers were the unavailability of medications at pharmacies (39.1%) and the lack of transportation (32.9%). Complete adherence was significantly greater among children whose fathers had university degrees or higher (p value = 0.007) and among children who relocated outside Sudan during this armed conflict than among those residing in Sudan (p value = 0.027). Nonadherence was significantly associated with increased seizure frequency (p = 0.001). The mean total PESQ score and the cognitive domain score were significantly greater in nonadherent patients than in adherent patients (p value of 0.026 and 0.026, respectively).</p><p><strong>Conclusions: </strong>This study revealed a low rate of adherence to antiseizure medications (ASMs) among pediatric epilepsy patients in Sudan during ongoing conflict. Economic hardship, displacement, and disrupted medical services significantly hinder effective epilepsy management. There is an urgent need for multifaceted interventions that address both healthcare system barriers and caregiver support.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13104211/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147470330","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":"Determinants of service utilization and satisfaction with sexual and reproductive health services among displaced and migrant populations in Nigeria: a cross-sectional study.","authors":"Moréniké Oluwátóyìn Foláyan, Roberto Ariel Abeldaño Zuñiga, Veronica Akwenabuaye Undelikwo, Babatunde Adelekan, Oluwaranmilowo Amusan, Mohammed Abdullahi, Olujide O Arije, Idayat Uthman, Fadip Kpahnim Kwamkur, Fatimah Jajere, Gideon Bokkos","doi":"10.1186/s13031-026-00784-3","DOIUrl":"10.1186/s13031-026-00784-3","url":null,"abstract":"<p><strong>Background: </strong>Understanding the determinants of access to sexual and reproductive health (SRH) services in humanitarian settings, and their links to client satisfaction, is essential for effective programming. The primary objective of this study was to describe the levels of utilization of services providing modern contraceptives, STI services, cancer screening, and GBV management among women and men facing humanitarian crises. The secondary objective was to determine the associations between clients' perceived ease of access and their satisfaction with the services received.</p><p><strong>Methods: </strong>This was a secondary analysis of the data of a cross-sectional study conducted in five Nigerian states (Borno, Taraba, Yobe, Cross River, Benue) in December 2024. The study participants were refugees, internally displaced persons (IDPs), and migrants. Data were collected via interviews using a structured questionnaire. Utilization of five SRH services (modern contraceptive counseling, STI screening/treatment, cervical and prostate cancer screening, and GBV management) was assessed. Multivariable logistic regression was used to identify factors associated with service utilization, and cross-tabulations examined the link between perceived ease of access and satisfaction.</p><p><strong>Results: </strong>The study included 1,194 sexually active adults (842 women, 352 men). Service utilization was highly gendered. Compared to refugee women, IDP women had significantly lower odds of utilizing contraceptive (AOR: 0.50; 95% CI: 0.34-0.72) and STI services (AOR: 0.66; 95% CI: 0.44-1.00), while migrant women had higher odds of utilizing cervical cancer screening (AOR: 3.04; 95% CI: 1.70-5.44) and GBV management (AOR: 2.12; 95% CI: 1.09-4.09). For men, migrants had higher odds of utilizing STI services (AOR: 2.75; 95% CI: 1.37-5.54) and prostate cancer screening (AOR: 11.63; 95% CI: 3.47-38.98) compared to refugees. A strong, consistent association was found between ease of access and satisfaction. Over 93% of clients reporting 'easy' access were satisfied, while satisfaction plummeted to 20.8-33.3% among those reporting 'uneasy' access.</p><p><strong>Conclusion: </strong>Utilization of SRH services is shaped by gender, displacement status, and service type. The link between perceived ease of access and client satisfaction underscores that the process of obtaining care is as critical as the clinical service itself. SRH programs must adopt tailored, client-centered approaches that address unique sub-population barriers and systematically reduce logistical friction to improve both service utilization and quality of care.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13104287/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147464040","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":"A village health worker intervention to reduce cardiovascular disease risk in remote areas of armed conflict in Myanmar-results from a feasibility study in three villages.","authors":"Anu Ramachandran, Su Mon Thwe, Cho Zin Win, Nay Lynn Htet, Saw Kyaw Myint, Nan Ei Mon Myint, Nicholus Tint Zaw, Ravi Goyal, Zin Mar Win, Zay Yar Phyo Aung, Tom Traill, Adam Kimball Richards, Parveen Parmar","doi":"10.1186/s13031-026-00785-2","DOIUrl":"10.1186/s13031-026-00785-2","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular disease (CVD) is a leading cause of death in low-income countries and those affected by armed conflict, including Myanmar. Community health worker interventions can effectively address CVD risk factors in low-income countries but have not been tested among displaced populations in active conflict zones.</p><p><strong>Objectives: </strong>We conducted a feasibility study of a village health worker (VHW) care model to identify individuals at high CVD risk and deliver care in conflict-affected regions of Karen State, Myanmar. This study was conducted by an international non-governmental organization collaborating with a regional local health organization.</p><p><strong>Methods: </strong>Following a village census, trained VHWs and medics screened individuals age ≥ 40 for CVD risk factors in three villages. Eligible individuals had HTN, diabetes, calculated CVD risk > 10%, or history of heart attack or stroke, confirmed during a second visit 1-2 weeks later. VHWs visited households every 3-6 weeks for 2 months to monitor blood pressure, glucose, medication adherence/side effects, and deliver medic-prescribed medications. Feasibility evaluation centered on reach, adoption, and acceptability. Outcomes included CVD risk factor prevalence, recruitment and retention, medication initiation/adherence, changes in hypertension control, and adverse outcomes. VHW and medic focus group discussions and study participant interviews were conducted.</p><p><strong>Results: </strong>CVD teams screened 294 individuals, conducted confirmatory visits with 132, enrolled all 97 eligible participants, and completed two home visits with 94 patients. Several prescription errors were made, halting medication initiation; root cause analysis identified opportunities to improve pre-testing of electronic tools and strengthen clinician CVD training. The proportion of eligible participants receiving antihypertensive or statin medications increased from 23% to 56%. Among those with HTN, the proportion achieving blood pressure control < 140/90 mmHg increased from 22.9% to 65.7%. Qualitative assessment revealed support for the care model and opportunities to improve training and streamline clinical protocols.</p><p><strong>Conclusions: </strong>Our study suggests a VHW care model for CVD in remote villages in Myanmar experiencing armed conflict is feasible and can increase medication access. Opportunities exist to simplify CVD treatment guidelines and augment training and support of local providers. Findings informed a cluster randomized controlled trial to test the impact of a modified VHW care model on medication adherence, CVD risk, and cost.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov, NCT06819839, retrospectively registered 27 October 2024.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13104435/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147464033","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":"Minimum dietary diversity and its associated factors among children aged 6-23 months in Mekelle, Northern Ethiopia, following the Tigray war.","authors":"Nebyu Daniel Amaha, Hadush Gebregziabher","doi":"10.1186/s13031-026-00786-1","DOIUrl":"10.1186/s13031-026-00786-1","url":null,"abstract":"<p><strong>Background: </strong>Despite the known impact of conflict on child nutrition, limited evidence exists on dietary diversity in urban post-conflict settings. The World Health Organization (WHO) defines Minimum Dietary Diversity (MDD) as the consumption of at least five out of the eight defined food groups in the previous 24 h. This study determined the post-war prevalence of MDD and its associated factors among children aged 6-23 months in Mekelle, northern Ethiopia.</p><p><strong>Methods: </strong>A health-facility-based cross-sectional study of 584 participants was conducted from November to December 2024 in Mekelle using proportional allocation. Sociodemographic and dietary data were collected using a 24-hour dietary recall questionnaire. Associations were assessed using multivariable logistic regression in STATA ^® version 15. Missing values were imputed using single imputation, and sensitivity analyses compared complete-cases (n = 474) versus imputed cases (n = 584).</p><p><strong>Results: </strong>Only a quarter (25.2%; 95% CI: 21.6-28.7) of children aged 6-23 months in Mekelle achieved MDD. Grains (92.1%) and legumes (69.3%) were the most commonly consumed food items, while vitamin A-rich foods (26%), other fruits and vegetables (18.2%) and flesh foods (7.2%) were the least. Children aged 18-23 months were 3.2 times more likely (Adjusted Odds Ratio (AOR) = 3.2, p = 0.001) to achieve MDD than those aged 6-11 months. Children from middle- and high-income households were 6.13-fold (AOR = 6.13, p < 0.001) and 13.58-fold (AOR = 13.58, p < 0.001) more likely to meet MDD, respectively. Households with 5-8 members had 3.6-fold higher odds of providing MDD than those with 1-3 members (AOR = 3.6, p = 0.017). Children whose mothers were aged 26-35 years (AOR = 0.48, p = 0.026) and 36-42 years (AOR = 0.29, p = 0.017) had lower odds. Fathers with above-secondary paternal education (AOR = 2.58, p = 0.031) and merchant occupation (AOR = 3.17, p = 0.001) were positively associated with MDD when compared to below-secondary and government employment.</p><p><strong>Conclusions: </strong>Post-war dietary diversity in Mekelle remains low and is significantly associated with socioeconomic and demographic factors. The reduced intake of nutrient-dense foods highlights critical gaps in child nutrition. Targeted nutrition education for caregivers and interventions promoting dietary diversity are essential in conflict recovery areas.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13104210/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147464090","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":"Maternal and child healthcare coverage and trends: refugee vs. non-refugee districts in Uganda.","authors":"Rogers Nsubuga, Rornald Muhumuza Kananura, Ronald Wasswa, Catherine Birabwa, Jimmy Ogwal, Winfred Dotse-Gborgbortsi, George Mwinnyaa, Amanuel Abajobir, Julius Kisozi, Alypio Nyandwi, Ties Boerma, Peter Waiswa, Kristine Nilsen","doi":"10.1186/s13031-026-00780-7","DOIUrl":"10.1186/s13031-026-00780-7","url":null,"abstract":"<p><strong>Background: </strong>Uganda hosts the largest refugee population in Africa, which exerts much pressure on the district health systems. While refugee-hosting districts (RH) receive targeted investments, the extent to which these influence maternal and child health (MCH) service coverage remains unclear. Using routine facility data, we examined differences in MCH coverage and trends between RH and non-refugee-hosting (non-RH) districts and also explored the effects of government health financing and health system performance on MCH coverage.</p><p><strong>Methods: </strong>We conducted a retrospective analysis utilizing routine health facility MCH data from the Uganda District Health Information System and district-level government Primary Healthcare (PHC) expenditure data from 2020 to 2023. MCH indicators were ANC1st trimester, ANC4, Institutional deliveries, mothers' Post-natal care (PNC), Measles1 and DPT3 vaccination. We computed a composite coverage index (CCI), health systems performance z-score and compared trends across RH and non-RH districts. Mixed Effects Models assessed the association between government expenditure, RH-status, health system performance over the years.</p><p><strong>Results: </strong>RH districts consistently had modestly higher coverage of ANC1st trimester, ANC4, Institutional deliveries, PNC, Measles vaccination and CCI trends. Government expenditure was significantly higher in RH districts and refugee-dominant (RD) districts (p < 0.001 vs. p = 0.007). Refugee-dominant districts had higher but non-significant MCH coverage. Unadjusted models of MCH indicators and CCI were positively influenced by government financing and health systems performance z-score except for DPT3 and Measles, respectively. Adjusted models revealed that ANC4 coverage was 7.4% points higher in RH districts (7.42; 95% CI:0.753, 14.090; p = 0.029) and increased by 3.6% points for every unit increase in z-score (3.60; 95% CI: 0.729, 6.462; p = 0.014). CCI increased by 1.6% points and 2.3% points for every unit increased in the government expenditure and z-score respectively (1.55; 95% CI: 0.310, 2.788; p = 0.014) vs. (2.31; 95% CI: 0.642, 3.975; p = 0.007).</p><p><strong>Conclusion: </strong>Novel approach - leveraging routine facility data, revealed MCH coverage was modestly consistently higher in RH districts over the years and RH status influenced ANC4 coverage. Overall district-CCI depended on Government investment and health systems performance implying increase in PHC financing could be a key driver to universal district-level improvement.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13088383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147437225","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":"Longitudinal serological response to SARS-CoV-2 among Rohingya refugees in cox's bazar, Bangladesh: implications for pandemic preparedness in humanitarian settings.","authors":"Nabid Anjum Tanvir, Abu Bakar Siddik, Sharmin Aktar Mukta, Mohammad Saiful Islam, Moon Moon Monisha Dey, Shariful Islam Khan, Zahirul Islam, Abu Toha M R H Bhuiyan, Md Rofiqur Rahman, Firdausi Qadri, Valentina Sanchez Picot","doi":"10.1186/s13031-026-00774-5","DOIUrl":"10.1186/s13031-026-00774-5","url":null,"abstract":"<p><strong>Background: </strong>Rohingya Myanmar nationals are at high risk of contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) due to densely populated camp areas with inadequate water, sanitation, and hygiene (WASH) infrastructure, along with limited awareness of hygiene practices. This study aimed to characterize the longitudinal SARS-CoV-2 antibody dynamics among Rohingya refugees in Cox's Bazar to inform vaccination strategies and public health preparedness in humanitarian settings.</p><p><strong>Method: </strong>Reverse transcription polymerase chain reaction (RT-PCR)-confirmed SARS-CoV-2 positive cases and their household members were enrolled and followed at multiple time points to monitor the IgG antibody response against the SARS-CoV-2 receptor binding domain (RBD) of the spike (S) protein.</p><p><strong>Result: </strong>A total of 194 primary SARS-CoV-2 RT-PCR-positive cases were enrolled at baseline, of whom 47% were symptomatic, with the highest burden observed among individuals aged 18-55 years. At enrollment, 56% of primary cases had detectable IgG antibodies (≥ 500 ng/mL). Seropositivity increased to 80%, 88%, and 93% at days 30, 180, and 360, respectively. Among unvaccinated participants, RBD-specific IgG titers peaked at one month and remained detectable up to 12 months following natural infection. Among household members, seropositivity increased from 57% at enrollment to 71% at the one-month follow-up. Among vaccinated primary cases, antibody titers peaked at 1-2 months after vaccination and declined markedly within 4-5 months.</p><p><strong>Conclusion: </strong>This study demonstrates robust antibody responses following natural SARS-CoV-2 infection and a marked rise-but rapid decline-of vaccine-induced immunity among Rohingya refugees. The findings highlight the need for timely booster doses, strengthened vaccination coverage, and continued serological monitoring to maintain protective immunity in high-density humanitarian settings. These insights can support targeted public health interventions and pandemic preparedness strategies for displaced and vulnerable populations.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13101099/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147379413","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":"Strengthening and sustaining gender-based violence (GBV) coordination in emergencies: a synthesis of practitioner-driven, globally applicable recommendations.","authors":"Philomena Raftery, Alina Potts, Melanie Hyde, Yermeyn York Wuyke, Hira Hashmey, Liliane Munezero, Ligia Kiss, Mazeda Hossain, Jennifer Palmer","doi":"10.1186/s13031-026-00770-9","DOIUrl":"10.1186/s13031-026-00770-9","url":null,"abstract":"<p><p>INTRODUCTION: Gender-based violence (GBV) is a global public health and human rights crisis, requiring coordinated efforts to ensure effective prevention, risk mitigation, and response, particularly in emergencies. Despite policy commitments underlining the importance of addressing GBV in emergencies, funding remains insufficient, inconsistent, and poorly aligned with aid prioritisation in the changing humanitarian and global health financing landscape. This paper synthesizes evidence on GBV coordination in humanitarian and public health emergencies and presents global recommendations to inform policy and practice in the context of the ongoing Humanitarian Reset. METHODS: Using a three-phase qualitative methodology—comprising evidence synthesis, case study analysis, and a global expert practitioner consultation—we developed a framework and present strategic recommendations to strengthen and sustain GBV coordination in emergencies. RESULTS: Our findings identify seven strategic recommendations aimed at investing in, sustaining, and transforming GBV coordination efforts globally. Key investment priorities include expanding the GBV coordination workforce, including for risk mitigation, prioritizing and systematically addressing GBV within public health emergencies, and investing in information management systems and strategic research. To sustain GBV coordination, we recommend adapting funding models, diversifying financial sources, advancing national leadership and localization, and implementing context-specific coordination approaches, including at the sub-national level. Furthermore, we propose that emergencies can serve as catalysts for broader social and legal transformations that advance GBV prevention and gender equality. CONCLUSION: Rather than accepting the deprioritisation of GBV coordination as an inevitable consequence of funding reductions framed as efficiency gains, our findings underscore the critical value of maintaining a dedicated focus on GBV within humanitarian coordination. Our findings provide practical, evidence-based recommendations and a global framework for policymakers, donors, and practitioners to strengthen and sustain GBV coordination in diverse emergency contexts. Sustained progress will require collective commitment to address GBV, even as funding landscapes change, and the backlash against gender equality continues to intensify. </p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13001181/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147373601","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":"Geographic disparities and determinants of DTP3 vaccination coverage among children aged 0-59 months in Somalia: a multilevel analysis.","authors":"Mohamed Abdirahim Omar, Mohamud Ali Mohamud, Abdifatah Ibrahim Mouse, Abdisalam Hassan Muse","doi":"10.1186/s13031-026-00777-2","DOIUrl":"10.1186/s13031-026-00777-2","url":null,"abstract":"<p><strong>Background: </strong>In Somalia, a fragile state characterized by protracted conflict and fragmented health governance, childhood immunization remains a critical challenge. The third dose of the Diphtheria-Tetanus-Pertussis (DTP3) vaccine serves as a key indicator of health system performance and retention. This study aimed to identify structural and individual-level determinants of DTP3 coverage to understand the inequities in this humanitarian setting.</p><p><strong>Methods: </strong>A cross-sectional analysis was conducted using data from the 2020 Somali Health and Demographic Survey (SHDS). A total sample of 1,268 children was analyzed. Multilevel mixed-effects logistic regression models were fitted to account for the hierarchical structure of the data (children nested within communities). Fixed effects were reported as adjusted odds ratios (aOR) with 95% confidence intervals (CI).</p><p><strong>Results: </strong>The overall prevalence of DTP3 vaccination coverage was 39.51% [95% CI: 36.85-42.23]. At the individual level, higher maternal education (Secondary vs. no education: aOR = 1.83; 95% CI: 1.07-3.12), wealth status (Rich vs. poor: aOR = 2.41; 95% CI: 1.53-3.79), and antenatal care (ANC) attendance (3-4 visits vs. zero visits: aOR = 2.19; 95% CI: 1.43-3.36) were significantly associated with higher odds of vaccination. Older children had higher odds of vaccination compared to infants, suggesting delayed rather than timely uptake. At the community level, children in rural (aOR = 0.40; 95% CI: 0.28-0.57) and urban (aOR = 0.64; 95% CI: 0.45-0.91) areas had lower odds of vaccination compared to those in nomadic communities. Significant regional disparities were also observed.</p><p><strong>Conclusions: </strong>DTP3 coverage in Somalia is critically below the WHO 90% target. Vaccination status is shaped by a complex interplay of socioeconomic status, maternal healthcare utilization, and geographic location. Policy interventions must urgently address the 'urban penalty' identified in this study, where settled urban-poor populations now face lower odds of vaccination than nomadic groups targeted by mobile outreach.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13059285/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147328008","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}