Conflict and Health最新文献

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

{"title":"Maternal mortality estimation methodologies: a scoping review and evaluation of suitability for use in humanitarian settings.","authors":"Blake Erhardt-Ohren, Sandra I McCoy, Dennis M Feehan, Rohini J Haar, Ndola Prata","doi":"10.1186/s13031-024-00636-y","DOIUrl":"10.1186/s13031-024-00636-y","url":null,"abstract":"<p><strong>Background: </strong>Around the world, a maternal death occurs approximately every two minutes-most of these deaths are preventable. The maternal mortality ratio is a key indicator for the Sustainable Development Goals, yet we have no reliable way to estimate maternal deaths in refugee or internally displaced persons (IDP) camps and settlements. The goal of this study was to understand the methodologies most suited for adaptation for use to estimate the proportion of maternal mortality due to abortion complications in these settings.</p><p><strong>Methods: </strong>We conducted a scoping review of methodologies to estimate maternal mortality and evaluated them using a predetermined set of criteria. We evaluated nine original methodologies using eleven categories related to implementation in refugee or IDP camps and settlements: data sources, definitions, sample size, timing of point estimate relative to data collection, bias, human resources, time needed for implementation, data collection training, statistical training, digitalization, and cost. Each category could be assigned zero to four points, for a total score of 44 points. After evaluating each original methodology, we reviewed the original publication's citations or searched for other implementations through October 2022. We revised the original scores and developed a rank-order list of the methodologies according to their suitability for implementation in refugee and IDP camps.</p><p><strong>Results: </strong>We identified 124 publications that estimated maternal mortality. The Maternal Deaths from Informants/Maternal Death Follow on Review (MADE-IN/MADE-FOR) (33.5), hospital- or facility-based (33.5), and community informant-based (32.5) methodologies ranked highest due to low costs, short time interval needed for implementation, small sample sizes and close timing of point estimate relative to data collection, easy digitalization, and the need for no statistical training.</p><p><strong>Discussion: </strong>Similar to the lack of a \"perfect\" methodology to estimate maternal mortality in stable settings, there are compromises to consider when applying these methodologies to humanitarian settings. The most promising methodologies are adaptable to practical constraints in refugee and IDP camps and settlements. New methodologies that adapt and strengthen the MADE-IN/MADE-FOR, hospital- or facility-based, and community informant-based methodology show promise and must be further developed.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"18 1","pages":"75"},"PeriodicalIF":3.1,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11657123/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866265","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":"Fresh whole blood: A feasible alternative in disasters and mass casualty incidents? a systematic review and meta-analysis.","authors":"Alba Ripoll-Gallardo, Marta Caviglia, Matteo Ratti, Daniele Ceriotti, Grazia Meneghetti, Luca Pigozzi, Maria Brönstad, Luca Ragazzoni, Francesco Barone-Adesi","doi":"10.1186/s13031-024-00635-z","DOIUrl":"10.1186/s13031-024-00635-z","url":null,"abstract":"<p><strong>Introduction: </strong>While balanced blood component therapy (BCT) is pivotal in trauma patient damage control resuscitation in well-resourced settings, disasters, and mass casualty incidents (MCIs) pose significant challenges, especially in securing sufficient access to blood products. This systematic review and meta-analysis aim to explore the utilization of fresh whole blood (FWB) transfusion as a potential alternative to BCT, informing future research and clinical strategies.</p><p><strong>Methods: </strong>We searched Pubmed, MEDLINE, Embase, CINAHL, the Cochrane Library and grey literature for articles identifying FWB transfusions, limited to those published in English or French. We evaluated the outcomes of post-FWB transfusion and conducted a meta-analysis comparing overall mortality in patients receiving FWB in addition to BCT during damage control resuscitation with those receiving BCT or single blood components alone.</p><p><strong>Results: </strong>Of the 4830 studies identified, only 74 articles met all the eligibility criteria; the majority of them were conducted in military contexts. Mortality was lower among the FWB group compared to the BCT alone group, with a pooled OR of 0.61 (95% CI: 0.38-0.98) overall, and a pooled OR of 0.47 (95% CI: 0.25-0.87) among studies adjusting for confounders. FWB transfusion related complications rarely occurred.</p><p><strong>Conclusions: </strong>While FWB shows potential as an alternative to BCT for managing severe haemorrhagic shock in disasters and MCIs, additional research is essential to validate FWB's efficacy before considering it as a standard approach in civilian scenarios. Further studies focusing on the feasibility of implementing FWB in civilian contexts are also warranted.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"18 1","pages":"74"},"PeriodicalIF":3.1,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11656982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142856402","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":"Health and well-being of older populations affected by humanitarian crises in low- and middle-income countries: a scoping review of peer-reviewed literature.","authors":"Sarah Al Omari, Stephen J McCall, Layal Hneiny, Abla Mehio Sibai","doi":"10.1186/s13031-024-00626-0","DOIUrl":"10.1186/s13031-024-00626-0","url":null,"abstract":"<p><strong>Background: </strong>The convergence of global demographic changes and rising humanitarian crises in low- and middle-income countries (LMICs) has raised the number of affected older people (OP). These individuals face the challenges of aging and the adverse conditions of disasters, particularly pronounced in LMICs. This review aims to explore literature on the health and well-being of older populations during humanitarian crises in LMICs.</p><p><strong>Methods: </strong>This scoping review included primary studies on the health and well-being of older populations in humanitarian crises in LMIC. A search was conducted in five bibliographic databases last updated in 2023. A numerical summary and thematic analysis of study characteristics and themes were executed and findings were narratively synthesized.</p><p><strong>Results: </strong>A total of 84 eligible studies were included. The majority of studies were quantitative (n = 56), followed by qualitative (n = 22) and mixed-methods (n = 6). Most literature focuses on the high burden of mental health conditions and their determinants, such as depression, anxiety, and Post-Traumatic Stress Disorder (PTSD). The second most common theme is physical health, discussing high levels of mortality, disability, some non-communicable diseases, and limited evidence on the poor nutritional status. OP lack access to routine healthcare due to cost barriers. The key gaps in the literature are in mental and psychosocial health, especially pertaining to vulnerabilities and risk factors, and to contextualized interventions. Physical health research is relatively narrow lacking a wider range of chronic diseases while no research was performed on communicable diseases other than COVID-19.</p><p><strong>Conclusions: </strong>Findings show the complex vulnerabilities of OP in humanitarian crises which exacerbate their physical, mental, and psychosocial health outcomes. There is a need to strengthen evidence on the effectiveness of interventions, and to investigate determinants of health, especially mental and psychosocial health, across different contexts. Research should also explore cross-cutting issues like gender, access to livelihoods, and equitable access to humanitarian assistance.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"18 1","pages":"73"},"PeriodicalIF":3.1,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11616339/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781220","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":"Building hope: early rehabilitation response of the international committee of the red cross post beirut port blast.","authors":"Linda Abou-Abbas, Iman Najmeddine, Lucia Maddalena Bernhard, Rana Abou Jaoude, Aicha Benyaich, Sally Yaacoub, Hala Al Sultan","doi":"10.1186/s13031-024-00633-1","DOIUrl":"10.1186/s13031-024-00633-1","url":null,"abstract":"<p><strong>Background: </strong>In the face of escalating health emergencies globally, the need for timely rehabilitation services has become increasingly evident. However, deficiencies in the provision of early rehabilitation interventions following disasters underscore the urgent need for improved integration and response strategies. The objective of this study is to assess the effectiveness of the early physical rehabilitation response initiated by the International Committee of the Red Cross (ICRC) following the 2020 Beirut blast, with a focus on evaluating patient outcomes, time to intervention, and long-term outcomes. Additionally, the study aims to extract valuable lessons and to propose a plan of action aimed at enhancing preparedness and response frameworks for similar emergencies.</p><p><strong>Methods: </strong>A retrospective observational study was conducted on data from the ICRC physical rehabilitation program (PRP) database in Lebanon, encompassing patients who were identified as eligible for PRP rehabilitation services following the Beirut Blast. Hospital records and a dedicated hotline were used for recruitment, with 102 patients meeting the eligibility criteria. Rehabilitation interventions included mobility aid provision and individualized assessments for physiotherapy sessions, with outcomes evaluated using the Functional Independence Measure (FIM) score.</p><p><strong>Results: </strong>A total of 102 eligible patients were included in the analysis, 41.2% of whom were aged 40-65 years, with the majority residing in Beirut (55.9%) and being Lebanese nationals (85.3%). Assistive devices and mobility aids were distributed to 60% of patients, and physiotherapy sessions were provided to 68.6% of patients, with variations in timing and frequency. Early initiation of physiotherapy sessions correlated with greater improvements in the FIM score, particularly among patients with secondary blast injuries and tendon cuts. Follow-up assessments revealed that 53% of patients achieved full recovery, while some required additional therapy or experienced permanent functional impairment. The proactive plan of action proposed by the ICRC PRP team for any emergency risk underscores the essential integration of its two core components: Preparedness and Response.</p><p><strong>Conclusions: </strong>In the wake of the Beirut port blast, the collaborative efforts of a rehabilitation team to provide supportive/assistive devices alongside physiotherapy significantly contributed to the recovery of the victims' functional capabilities. While life-saving surgeries and critical interventions are essential for managing the immediate impact of such catastrophes, prioritizing early physical rehabilitation is equally pivotal for reducing injury-related disability. The interconnectedness of preparedness and response components within the PRP's emergency rehabilitation strategy underscores the necessity for proactive planning and coordination to effectively addr","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"18 1","pages":"72"},"PeriodicalIF":3.1,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11600745/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142734668","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":"Exploring the use of COVID-19 antigen rapid diagnostic tests among displaced populations in Iraq: findings from a pilot project in four IDP camps.","authors":"Lara Abou Ammar, Caitlin M Wolfe, Lamiaa Nagib, Mohammed Slebei, Sezan Shawkat, Dilman Amo, Raveen Abdullah, Rawshan Abdulmalik, Hiwa Muhammed Amin, Huda Shafiq, Shivan Hafthalah, Aso Qahraman, Jirjees Mohammed, Hassan Ghawji, Srinath Satyanarayana, Nevin Wilson, Sanjay Sarin, Kekeletso Kao, Nellie Ghusayni","doi":"10.1186/s13031-024-00623-3","DOIUrl":"10.1186/s13031-024-00623-3","url":null,"abstract":"<p><strong>Background: </strong>IOM piloted the use of Ag RDTs for COVID-19 in Iraq, in collaboration with FIND, the Global Alliance for Diagnostics, to facilitate access to testing and understand barriers and opportunities for testing in a displacement context. The purpose was to (i) evaluate the performance metrics of the Sure Status COVID-19 Antigen Card Test in this population; (ii) compare Ag RDT results across high- and low-probability cases, vaccination status, and symptom severity; and (iii) report participant perspectives on Ag RDT use for COVID-19 and other diseases.</p><p><strong>Methods: </strong>Secondary analysis was conducted using de-identified cross-sectional data collected from November 2022-March 2023 in four IDP camps in the Kurdistan region of Iraq. Data was collected during the recording, reporting, and monitoring processes of the pilot project using Ag RDTs for COVID-19 among displaced populations. Descriptive statistics and bivariate analyses were conducted in Stata (version 17).</p><p><strong>Results: </strong>9,346 Sure Status Ag RDTs were performed from November 2022-March 2023. Observed performance metrics were as follows: sensitivity = 72.73% (95% CI: 69.56-75.80%); specificity = 99.74% (95% CI: 99.39-100%), PPV = 92.31% (95% CI: 92.31-94.15%), and NPV = 98.85% (95% CI: 98.11-99.58%). Ag RDT uptake was higher among women and symptomatic individuals, and preference for Ag RDTs was especially strong among illiterate respondents. The overall positivity of Ag RDTs and PCR results in this population remained lower than national averages. Concerningly, 23.39% of respondents declined an Ag RDT because they did not believe in COVID-19.</p><p><strong>Conclusions: </strong>This pilot program was among the first to explore Ag RDT use in Iraqi Kurdistan. Over 99% of respondents reported satisfaction with their experience, and over 90% wanted to see Ag RDTs available for other diseases. Findings can inform implementation of RDTs and screening protocols for other infectious diseases, and patient perspectives on Ag RDTs for testing and screening of COVID-19 among displaced populations can inform health programming within Iraq and globally.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"18 1","pages":"71"},"PeriodicalIF":3.1,"publicationDate":"2024-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11587649/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711808","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":"Exploring relationships between conflict intensity, forced displacement, and healthcare attacks: a retrospective analysis from Syria, 2016-2022.","authors":"Maia C Tarnas, Mohamed Hamze, Bachir Tajaldin, Richard Sullivan, Daniel M Parker, Aula Abbara","doi":"10.1186/s13031-024-00630-4","DOIUrl":"10.1186/s13031-024-00630-4","url":null,"abstract":"<p><strong>Introduction: </strong>Attacks on healthcare have been committed throughout the Syrian conflict in violation of International Humanitarian Law (IHL), contributing to the devastation of the country's healthcare system. The conflict has also forcibly displaced over half of Syria's pre-conflict population, 7.2 million of whom are internally displaced. In this retrospective analysis, we aim to assess the relationships between (1) healthcare attacks and general conflict and (2) healthcare attacks and forced displacement between 2016 and 2022.</p><p><strong>Methods: </strong>Data on healthcare attacks, conflict events, and displacement were extracted from the Syrian American Medical Society (SAMS), Uppsala Conflict Data Project, and OCHA Türkiye, respectively. The analysis addresses three research questions: the associations between (1) healthcare attacks and conflict events, (2) healthcare attacks and conflict events in the week after an attack on a healthcare facility, and (3) healthcare attacks and forced displacement. For each, we used generalized additive models with a negative binomial distribution that also accounted for spatial and temporal factors.</p><p><strong>Results: </strong>SAMS recorded a total of 541 attack events, comprising 650 attack rounds over 235 facilities between 2016 and 2022. Conflict events were significantly associated with healthcare attacks in the same week (IRR: 1.14, 95% CI 1.12-1.17), and healthcare attacks in one week were associated with a maximum of 1.44 greater risk (95% CI 1.08-1.91) of conflict events in the following week, even when accounting for general conflict levels in the previous weeks. Healthcare attacks were also significantly associated with increased displacement up to three months following the attacks.</p><p><strong>Discussion: </strong>We find that healthcare facilities are not avoided during conflict (as obliged under IHL), and that healthcare attacks significantly precede an escalation of general conflict in the same area. Healthcare attacks are also significantly associated with displacement for months following the attacks, even when accounting for conflict levels. Based on these findings, we present a framework outlining one pathway through which healthcare attacks may contribute to larger conflict tactics. Our findings highlight the critical role of healthcare infrastructure in conflict and reaffirm calls to hold perpetrators of these attacks accountable.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"18 1","pages":"70"},"PeriodicalIF":3.1,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11580498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142688754","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":"Feasibility and challenges in sustaining a community based surveillance system in post-Ebola Sierra Leone.","authors":"Christina Mergenthaler, Ankie van den Broek, Noor Tromp, Kimberly Nehal, Jip Janssen, Shiyong Wang, T T Samba, Mohammed Vandhi, Alpha Augustin Kombo, Osman Sankoh, M Koblo Kamara, Mirjam I Bakker","doi":"10.1186/s13031-024-00618-0","DOIUrl":"10.1186/s13031-024-00618-0","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;In outbreak-prone settings, community-based surveillance (CBS) systems can alert health authorities to respond in a timely manner where suspected cases of disease are being reported. After the 2014-2016 Ebola outbreak, the WHO and other stakeholders supported the establishment of CBS in Sierra Leone, for which community health workers (CHW) were trained to collect and report symptoms data of 11 priority health conditions in their communities. Our study objective was to assess feasibility and challenges to sustain CBS in a low resource setting as part of a World Bank evaluation of Sierra Leone's Ministry of Health and Sanitation's (MoHS) CBS and electronic Integrated Disease Surveillance & Response (eIDSR) systems.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In 2019 we conducted a mixed methods assessment consisting of a household incidence survey, health facility survey, household case verification survey, a costing analysis, and in-depth interviews and focus group discussions with key stakeholders of the CBS system in eight chiefdoms of 4 purposefully selected districts in Sierra Leone. The study period for primary data collection was February through April 2019. We also conducted secondary data analysis of surveillance data in DHIS2 of all 32 chiefdoms.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In districts where CBS was 'fully functional', the number and type of CBS alerts corresponded to the number and type of diseases reported through facility based eIDSR system in the same period. However under-reporting of diarrhea and measles suspects from the community still appeared to occur, and reporting deteriorated when primary health care staff including CHWs reported the stoppage of stipends. The annual budget impact for CBS was estimated at 4.4 million USD in 2018. The majority of costs were made at community level (73%) compared to regional (0.3%), primary health unit (21%), district (4%) and national (2%) level. The most important costs drivers were training of CHWs (59% of total costs) and salaries (including stipends of the CHWs) of human resources (15%). Barriers included sustainable financing of human resources, internet connectivity, as well as limited trainings and supportive supervision, and unsupported transportation costs for CHWs and peer supervisors (PS). CHWs and community members reported that communities are more willing to share information about health issues compared to the pre-CBS implementation period.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The similarity between CBS and IDSR reports support the possibility that CBS increases the sensitivity of disease surveillance to the level of the community, which would enable local authorities to take early prevention measures when and where impact will be the greatest. Qualitative interviews suggest that CBS has improved the interface between the community and primary level of the health system. However if the barriers to sustainability are left unaddressed, opportunities for CBS","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"18 1","pages":"69"},"PeriodicalIF":3.1,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11550538/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632471","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":"Integrating mental health and psychosocial support into economic inclusion programming for displaced families in Ecuador.","authors":"Arianna Moyano, Daniela Vergara, Amaleah Mirti, Annie G Bonz, Adriana Monar, Efrén Astudillo, Sara Vaca, Karen Cordova, Andrea Armijos, Adrian Barroso, Cesar Cherrez, Jennie Cottle, Aimée DuBois, Isabella Fernandez Capriles, Jean Pierre Grandes, Matias Irarrazaval, Belen Jaramillo, Jeremy C Kane, Carmen Martinez-Viciana, Franco Mascayano, Yescárleth Rodríguez, Matthew Schojan, Kathleen Sikkema, Ezra Susser, Peter Ventevogel, Mike Wessells, Aaron Zambrano López, Kathryn L Lovero, M Claire Greene","doi":"10.1186/s13031-024-00629-x","DOIUrl":"10.1186/s13031-024-00629-x","url":null,"abstract":"<p><strong>Background: </strong>Poverty is a key social determinant of mental health among forcibly displaced persons. This study aimed to design and pilot test a strategy to integrate existing mental health and economic inclusion interventions for displaced families in Ecuador.</p><p><strong>Methods: </strong>We conducted a series of qualitative interviews (n = 30), focus groups (n = 6), and workshops (n = 3) to develop a set of strategies for integrating cross-cutting and focused mental health and psychosocial support (MHPSS) strategies into an existing economic inclusion program for displaced families in Quito. We non-randomly assigned two field offices in Quito to (1) integrate cross-cutting strategies focused on improving economic outcomes or (2) integrate both those cross-cutting strategies plus focused MHPSS strategies into an economic inclusion program. We measured site-level implementation outcomes (adoption, appropriateness, acceptability, feasibility, fidelity, reach, retention, usability) and participant-level psychosocial (wellbeing, depressive symptoms, anxiety symptoms, functioning) and economic inclusion outcomes (financial resources, diet diversity, social capital/networks, self-reliance) over six months. We conducted a mixed-methods analysis to explore the acceptability and feasibility of the integration strategies and the ability to evaluate their effects in a future cluster randomized trial.</p><p><strong>Results: </strong>We developed a toolkit that included 10 strategies for integrating MHPSS into economic inclusion interventions. Fifty displaced persons participating in an existing economic inclusion program (25 per study condition) were enrolled and 88% remained in the study through the six-month follow-up. Participants and implementers reported that the integration strategy was appropriate, acceptable, feasible, and usable. Implementers, including people without prior experience in delivering mental health services, were able to deliver the intervention with high fidelity. Integration of focused MHPSS intervention components into an economic inclusion program appeared to improve MHPSS outcomes, the strength of social capital and networks, and engagement in economic and other programs.</p><p><strong>Conclusions: </strong>This study provides preliminary evidence of the acceptability and feasibility of integrating MHPSS into economic inclusion programs for displaced people. We found evidence supporting evaluation methods that can be employed in a future study to definitively test the added value of integrated approaches to mental health and economic wellbeing for displaced persons.</p>","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"18 1","pages":"68"},"PeriodicalIF":3.1,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11542440/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592059","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 newborn health prioritization in Yobe State, Nigeria: analysis of stakeholders' perspective.","authors":"Emilia Ngozi Iwu, Charity Pring'ar Maina, Rifkatu Sunday Aimu, Rejoice Helma Abimiku, Sussan Israel-Isah, Kazeem Olalekan Ayodeji, George Odonye, Hadiza Sabo, Naoko Kozuki, Mamothena Mothupi","doi":"10.1186/s13031-024-00628-y","DOIUrl":"10.1186/s13031-024-00628-y","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Maternal and newborn mortality and morbidity in conflict-affected northeastern areas of Nigeria, such as Yobe State, are disproportionately higher than those in the rest of the country. There is limited evidence on the factors that influence maternal and newborn health (MNH) policymaking and implementation in this region, particularly with respect to the impact of conflict and context-specific issues. This study explores the political, economic and health system factors that drive the prioritization of MNH policies in Yobe State. The aim of this study was to elucidate the conflict-related factors influencing MNH outcomes, which could inform targeted interventions to improve MNH.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The study is a descriptive case study that relies on multiple data sources and is guided by the Health Policy Analysis Triangle. We reviewed national and subnational research, technical reports and policies related to reproductive health and the MNH in Nigeria since 2010. Following stakeholder mapping, we identified and invited prospective participants in the MNH policymaking space. Nineteen stakeholders from the government, civil society and nongovernmental organizations, donor agencies, and public and private sector health providers in Yobe State participated in the semistructured in-depth interviews. Data were collected from November 2022 through January 2023 and were thematically analysed via Dedoose software.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;MNH services in Yobe State have received considerable attention through initiatives such as the National Midwifery Service Scheme, free MNH services, training of midwives with deployment to rural areas, and health facility renovations. The effective implementation of MNH services and policies faces challenges due to insufficient funding, and sustainability is hampered by changes in governance and political transitions. The Boko Haram insurgency exacerbated the humanitarian crisis in Yobe State and disrupted MNH services due to the displacement of populations and the decline in the number of health workers. Additionally, sociocultural and religious beliefs hinder timely access to and utilization of MNH services. Although policies and guidelines for MNH services exist in the state, they are inadequately disseminated to health providers, which affects their effective implementation across facilities. Collaboration and intersectoral coordination platforms exist, but competition and rivalries among unions, political entities, and implementing agencies sometimes impede progress.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Enhancing MNH services in Yobe state requires increased commitment for funding through the Northeast Development Commission rehabilitation fund; strengthening the health workforce, safety and retention plan; promoting gender inclusivity within the health sector; and addressing sociocultural barriers to women's health-seeking behaviors. Concrete, time-bound plans f","PeriodicalId":54287,"journal":{"name":"Conflict and Health","volume":"18 1","pages":"67"},"PeriodicalIF":3.1,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11539819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142585370","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}