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  1. 1
    Peer Reviewed

    Understanding health systems to improve community and facility level newborn care among displaced populations in South Sudan: a mixed methods case study.

    Sami S; Amsalu R; Dimiti A; Jackson D; Kenyi S; Meyers J; Mullany LC; Scudder E; Tomczyk B; Kerber K

    BMC Pregnancy and Childbirth. 2018; 18(325):12 p.

    Background: Targeted clinical interventions have been associated with a decreased risk of neonatal morbidity and mortality. In conflict-affected countries such as South Sudan, however, implementation of lifesaving interventions face barriers and facilitators that are not well understood. We aimed to describe the factors that influence implementation of a package of facility- and community-based neonatal interventions in four displaced person camps in South Sudan using a health systems framework. Methods: We used a mixed method case study design to document the implementation of neonatal interventions from June to November 2016 in one hospital, four primary health facilities, and four community health programs operated by International Medical Corps. We collected primary data using focus group discussions among health workers, in-depth interviews among program managers, and observations of health facility readiness. Secondary data were gathered from documents that were associated with the implementation of the intervention during our study period. Results: Key bottlenecks for implementing interventions in our study sites were leadership and governance for comprehensive neonatal services, health workforce for skilled care, and service delivery for small and sick newborns. Program managers felt national policies failed to promote integration of key newborn interventions in donor funding and clinical training institutions, resulting in deprioritizing newborn health during humanitarian response. Participants confirmed that severe shortage of skilled care at birth was the main bottleneck for implementing quality newborn care. Solutions to this included authorizing the task-shifting of emergency newborn care to mid-level cadre, transitioning facility-based traditional birth attendants to community health workers, and scaling up institutions to upgrade community midwives into professional midwives. Additionally, ongoing supportive supervision, educational materials, and community acceptance of practices enabled community health workers to identify and refer small and sick newborns. Conclusions: Improving integration of newborn interventions into national policies, training institutions, health referral systems, and humanitarian supply chain can expand emergency care provided to women and their newborns in these contexts.
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  2. 2

    Reproductive, maternal, neonatal and child health in conflict: a case study on Syria using Countdown indicators.

    DeJong J; Ghattas H; Bashour H; Mourtada R; Akik C; Reese-Masterson A

    BMJ Global Health. 2017; 2(3):e000302.

    Introduction: Women and children account for a disproportionate morbidity burden among conflict-affected populations, and yet they are not included in global accountability frameworks for women's and children's health. We use Countdown to 2015 (Millennium Development Goals) health indicators to provide an up-to-date review and analysis of the best available data on Syrian refugees in Jordan, Lebanon and Turkey and internally displaced within Syria and explore data challenges in this conflict setting. Methods: We searched Medline, PubMed, Scopus, Popline and Index Medicus for WHO Eastern Mediterranean Region Office and relevant development/humanitarian databases in all languages from January 2011 until December 2015. We met in person or emailed relevant key stakeholders in Lebanon, Jordan, Syria and Turkey to obtain any unpublished or missing data. We convened a meeting of experts working with these populations to discuss the results. Results: The following trends were found based on available data for these populations as compared with preconflict Syria. Birth registration in Syria and in host neighbouring countries decreased and was very low in Lebanon. In Syria, the infant mortality rate and under-five mortality rate increased, and coverage of antenatal care (one visit with a skilled attendant), skilled birth attendance and vaccination (except for DTP3 vaccine) declined. The number of Syrian refugee women attending more than four antenatal care visits was low in Lebanon and in non-camp settings in Jordan. Few data were available on these indicators among the internally displaced. In conflict settings such as that of Syria, coverage rates of interventions are often unknown or difficult to ascertain because of measurement challenges in accessing conflict-affected populations or to the inability to determine relevant denominators in this dynamic setting. Conclusion: Research, monitoring and evaluation in humanitarian settings could better inform public health interventions if findings were more widely shared, methodologies were more explicit and globally agreed definitions and indicators were used consistently.
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  3. 3

    Socio-Cultural Challenges of Family Planning Initiatives for Displaced Populations in Conflict Situations and Humanitarian Settings.

    Asgary R; Price JT

    Disaster Medicine and Public Health Preparedness. 2018 Apr 6; 1-5.

    Provision of family planning services for refugee populations in conflict and humanitarian settings has been improving. Availability of services, however, does not translate into acceptability and uptake; understanding socio-cultural settings and barriers is critical to ensure utilization of services. Misconceptions and apprehensions surrounding family planning services are common. Populations may see limiting pregnancies as counterproductive in light of high child mortality or suspicious in the context of ethnic violence; larger family size has the perceived advantage of additional security for the community or ethnic group, assistance with family duties in a subsistence structure, and a social service investment for parents as they age; and there may be religious and moral objections to contraception. Any service planning and implementation must take into account community perceptions and address socio-cultural contextual subtleties. Ongoing community education via local initiatives from within the refugee community, region-wide structural strategies for service implementation and sustainability, and efforts to reconcile reproductive rights and family planning services within the religious and social context are crucial. (Disaster Med Public Health Preparedness. 2018;page 1 of 5).
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  4. 4
    Peer Reviewed

    Using a quality improvement approach to improve maternal and neonatal care in North Kivu, Democratic Republic of Congo.

    Hynes M; Meehan K; Meyers J; Mashukano Maneno L; Hulland E

    Reproductive Health Matters. 2017 Nov; 25(51):140-150.

    Providing quality health care services in humanitarian settings is challenging due to population displacement, lack of qualified staff and supervisory oversight, and disruption of supply chains. This study explored whether a participatory quality improvement (QI) intervention could be used in a protracted conflict setting to improve facility-based maternal and newborn care. A longitudinal quasi-experimental design was used to examine delivery of maternal and newborn care components at 12 health facilities in eastern Democratic Republic of Congo. Study facilities were split into two groups, with both groups receiving an initial "standard" intervention of clinical training. The "enhanced" intervention group then applied a QI methodology, which involved QI teams in each facility, supported by coaches, testing small changes to improve care. This paper presents findings on two of the study outcomes: delivery of active management of the third stage of labour (AMTSL) and essential newborn care (ENC). We measured AMTSL and ENC through exit interviews with post-partum women and matched partographs at baseline and endline over a 9-month period. Using generalised equation estimation models, the enhanced intervention group showed a greater rate of change than the control group for AMTSL (aOR 3.47, 95% CI: 1.17-10.23) and ENC (OR: 49.62, 95% CI: 2.79-888.28), and achieved 100% ENC completion at endline. This is one of the first studies where this QI methodology has been used in a protracted conflict setting. A method where health staff take ownership of improving care is of even greater value in a humanitarian context where external resources and support are scarce.
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  5. 5
    Peer Reviewed

    State of newborn care in South Sudan's displacement camps: a descriptive study of facility-based deliveries.

    Sami S; Kerber K; Kenyi S; Amsalu R; Tomczyk B; Jackson D; Dimiti A; Scudder E; Meyers J; Umurungi JPC; Kenneth K; Mullany LC

    Reproductive Health. 2017 Nov 29; 14(1):161.

    BACKGROUND: Approximately 2.7 million neonatal deaths occur annually, with highest rates of neonatal mortality in countries that have recently experienced conflict. Constant instability in South Sudan further strains a weakened health system and poses public health challenges during the neonatal period. We aimed to describe the state of newborn facility-level care in displaced person camps across Juba, Malakal, and Maban. METHODS: We conducted clinical observations of the labor and delivery period, exit interviews with recently delivered mothers, health facility assessments, and direct observations of midwife time-use. Study participants were mother-newborn pairs who sought services and birth attendants who provided delivery services between April and June 2016 in five health facilities. RESULTS: Facilities were found to be lacking the recommended medical supplies for essential newborn care. Two of the five facilities had skilled midwives working during all operating hours, with 6.2% of their time spent on postnatal care. Selected components of thermal care (62.5%), infection prevention (74.8%), and feeding support (63.6%) were commonly practiced, but postnatal monitoring (27.7%) was less consistently observed. Differences were found when comparing the primary care level to the hospital (thermal: relative risk [RR] 0.48 [95% CI] 0.40-0.58; infection: RR 1.28 [1.11-1.47]; feeding: RR 0.49 [0.40-0.58]; postnatal: RR 3.17 [2.01-5.00]). In the primary care level, relative to newborns delivered by traditional birth attendants, those delivered by skilled attendants were more likely to receive postnatal monitoring (RR 1.59 [1.09-2.32]), but other practices were not statistically different. Mothers' knowledge of danger signs was poor, with fever as the highest reported (44.8%) followed by not feeding well (41.0%), difficulty breathing (28.9%), reduced activity (27.7%), feeling cold (18.0%) and convulsions (11.2%). CONCLUSIONS: Addressing health service delivery in contexts affected by conflict is vital to reducing the global newborn mortality rate and reaching the Sustainable Development Goals. Gaps in intrapartum and postnatal care, particularly skilled care at birth, suggest a critical need to build the capacity of the existing health workforce while increasing access to skilled deliveries.
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  6. 6
    Peer Reviewed

    Community-Based Noncommunicable Disease Care for Syrian Refugees in Lebanon.

    Sethi S; Jonsson R; Skaff R; Tyler F

    Global Health: Science and Practice. 2017 Sep 27; 5(3):495-506.

    In the sixth year of the Syrian conflict, 11 million people have been displaced, including more than 1.1 million seeking refuge in Lebanon. Prior to the crisis, noncommunicable diseases (NCDs) accounted for 80% of all deaths in Syria, and the underlying health behaviors such as tobacco use, obesity, and physical inactivity are still prevalent among Syrian refugees in Lebanon. Humanitarian agencies initially responded to the acute health care needs of refugees by delivering services to informal settlements via mobile medical clinics. As the crisis has become more protracted, humanitarian response plans have shifted their focus to strengthening local health systems in order to better address the needs of both the host and refugee populations. To that end, we identified gaps in care for NCDs and launched a program to deliver chronic disease care for refugees. Based on a participatory needs assessment and community surveys, and building on the success of community health programs in other contexts, we developed a network of 500 refugee outreach volunteers who are supported with training, supervision, and materials to facilitate health promotion and disease control for community members, target NCDs and other priority conditions, and make referrals to a primary health care center for subsidized care. This model demonstrates that volunteer refugee health workers can implement community-based primary health activities in a complex humanitarian emergency.
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  7. 7

    Socio-economic consequences of development-induced internal displacement and the coping strategies of female victims in Lagos Nigeria: An ethno-demographic study.

    Oyefara JL; Alabi BO

    African Population Studies. 2016; 30(2 Suppl):2520-2532.

    The plethora of violent strife, man-made or natural disasters, economic vicissitudes, and major development schemes have swelled the number refugees and internally displaced people, in the developing countries of the world lately. Statistics revealed that there are over 55 million people in this dire situation globally consisting of over 38 million internally displacedpeople, over 16 million refugees and over 1 million asylum-seekers. This study highlights the impacts, the socio-economic consequences of development-induced internal displacement on females in the Lagos urban space, evaluating the coping strategies employed by them. This is a qualitative study that employed a combination of key informant and in-depth interview methods to generate primary data from the samples purposively drawn from the population of interestwhich comprised people forcibly evicted from Badia, in Lagos State, Nigeria. The interviews were conducted from Tuesday 14th to Thursday 16th October 2014 using unstructured interview guide. The study establishes thatforcible eviction and the consequent displacements brought a myriad of economic, social and psychological hardships on the female victims in Badia, to which they were compelled to devise various ingenious survival and coping strategies. The study ascertains that women cope better emotionally and economically than men in such circumstances and it also found that extended family members are a significant pillar of support to displaced persons.
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  8. 8
    Peer Reviewed

    The REFANI-S study protocol: a non-randomised cluster controlled trial to assess the role of an unconditional cash transfer, a non-food item kit, and free piped water in reducing the risk of acute malnutrition among children aged 6-59 months living in camps for internally displaced persons in the Afgooye corridor, Somalia.

    Jelle M; Grijalva-Eternod CS; Haghparast-Bidgoli H; King S; Cox CL; Skordis-Worrall J; Morrison J; Colbourn T; Fottrell E; Seal AJ

    BMC Public Health. 2017 Jul 06; 17(1):632.

    BACKGROUND: The prevalence of acute malnutrition is often high in emergency-affected populations and is associated with elevated mortality risk and long-term health consequences. Increasingly, cash transfer programmes (CTP) are used instead of direct food aid as a nutritional intervention, but there is sparse evidence on their nutritional impact. We aim to understand whether CTP reduces acute malnutrition and its known risk factors. METHODS/DESIGN: A non-randomised, cluster-controlled trial will assess the impact of an unconditional cash transfer of US$84 per month for 5 months, a single non-food items kit, and free piped water on the risk of acute malnutrition in children, aged 6-59 months. The study will take place in camps for internally displaced persons (IDP) in peri-urban Mogadishu, Somalia. A cluster will consist of one IDP camp and 10 camps will be allocated to receive the intervention based on vulnerability targeting criteria. The control camps will then be selected from the same geographical area. Needs assessment data indicates small differences in vulnerability between camps. In each trial arm, 120 households will be randomly sampled and two detailed household surveys will be implemented at baseline and 3 months after the initiation of the cash transfer. The survey questionnaire will cover risk factors for malnutrition including household expenditure, assets, food security, diet diversity, coping strategies, morbidity, WASH, and access to health care. A community surveillance system will collect monthly mid-upper arm circumference measurements from all children aged 6-59 months in the study clusters to assess the incidence of acute malnutrition over the duration of the intervention. Process evaluation data will be compiled from routine quantitative programme data and primary qualitative data collected using key informant interviews and focus group discussions. The UK Department for International Development will provide funding for this study. The European Civil Protection and Humanitarian Aid Operations will fund the intervention. Concern Worldwide will implement the intervention as part of their humanitarian programming. DISCUSSION: This non-randomised cluster controlled trial will provide needed evidence on the role of unconditional CTP in reducing the risk of acute malnutrition among IDP in this context. TRIAL REGISTRATION: ISRCTN29521514 . Registered 19 January 2016.
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  9. 9

    Lives on hold: making sure no child is left behind in Myanmar.


    [New York, New York], UNICEF, 2017 May. 20 p.

    As part of a series highlighting the challenges faced by children in current crisis situations, this UNICEF Child Alert examines the impact of the reforms, economic growth and national reconciliation process in Myanmar. It also looks at the investments in children’s health, education and protection that Myanmar is making, and shows how children in remote, conflict-affected parts of the country have yet to benefit from them.
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  10. 10

    Interventions for Prevention of Intimate Partner Violence Against Women in Humanitarian Settings: A Protocol for a Systematic Review.

    Delkhosh M; Ardalan A; Rahimiforoushani A; Keshtkar A; Amiri Farahani L; Merghati Khoei E

    PLoS Currents. 2017 Jul 12; 9

    INTRODUCTION: Humanitarian emergencies and the number of people who are adversely affected are increasing. In such emergencies, the vulnerability of women and girls to gender-based violence increases signifi-cantly and they often experience high levels of intimate partner violence (IPV). There are a limited number of interventions to reduce gender-based violence (GBV) and IPV in the contexts of humanitarian emergencies, and there is uncertainty about the effectiveness of these preventive interventions. This is the protocol for a systematic review that will synthesize the evidence on interventions for primary or secondary prevention of IPV in humanitarian settings, and assess the effect of existing types of IPV-related interventions in these settings. METHODS AND DESIGN: The PRISMA-P 2015 statement has been used to prepare this report. Studies published from January 2000 to January 2017 will be reviewed with no language limits. Any experimental, quasi-experimental, or controlled trials will be included. A combination of four key concepts, including "IPV" AND "population" AND "humanitarian setting" AND "intervention" will be used in the search and a variety of information sources will be used: (1) bibliographic databases; (2) special databases and grey literature; (3) and the reference lists of eligible studies. Two reviewers will independently screen articles, extract relevant data and assess study quality. Discrepancies will be resolved through consensus. Risk of bias will be assessed using the Cochrane Risk of Bias tool and the quality of evidence will be assessed using the CONSORT checklist. A narrative synthesis will be provided. If a sufficient number of studies are found, their results will be pooled using a random-effects meta-analysis. For dichotomous outcomes, summaries of intervention effects for each study will be provided by calculating risk ratios with 95% confidence interval. Standardized mean differences will be used for continuous outcomes. DISCUSSION: The review will be useful for IPV management policy and related planning. It will help researchers, policymakers and guideline developers with an interest in reducing violence against women among refugees, internally displaced persons (IDPs), and conflict-affected population.
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  11. 11

    Adolescent girls in disaster and conflict. Interventions for improving access to sexual and reproductive health services.

    United Nations Population Fund [UNFPA]

    New York, New York, UNFPA, 2016. 92 p.

    Safe spaces, mobile medical teams and youth engagement are effective ways to reach displaced, uprooted, crisis-affected girls at a critical time in their young lives. Adolescent Girls in Disaster & Conflict: Interventions for Improving Access to Sexual and Reproductive Health Services is a collection of UNFPA-supported humanitarian interventions for reaching adolescents when crisis heightens vulnerability to gender-based violence, unwanted pregnancy, HIV infection, early and forced marriage and other risks.
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  12. 12
    Peer Reviewed

    Caregiver parenting and gender attitudes: Associations with violence against adolescent girls in South Kivu, Democratic Republic of Congo.

    Falb KL; Asghar K; Laird B; Tanner S; Graybill E; Mallinga P; Stark L

    Child Abuse and Neglect. 2017; 69:278-284.

    Violence against adolescent girls occurs at alarmingly high rates in conflict-affected settings, in part due to their increased vulnerability from their age and gender. However, humanitarian programming efforts have historically focused either on child abuse prevention or intimate partner violence prevention and have not fully addressed the specific needs of adolescent girls, including engagement of caregivers to reduce risk of violence against adolescent girls. Thus, the objectives of this analysis are to examine the whether gendered and parental attitudes of caregivers in South Kivu, Democratic Republic of Congo (DRC) were associated with their adolescent girls’ experiences of violence and girls’ attitudes towards IPV. Cross-sectional data from 869 girls (10–14 years) and their caregivers (n = 764) were drawn from a baseline assessment of a violence prevention evaluation conducted in 2015. Findings suggest that female caregiver's gender equitable attitudes for adults may be associated with reduced odds of sexual abuse and less acceptance of IPV for adolescent girl children. Parenting attitudes and beliefs and gender equity for girl children were not associated with violence risk for girls, while increased accepting attitudes of negative discipline were only associated with lowered odds of sexual abuse. Understanding of caregivers’ attitudes may provide potential insight into how to more effectively engage and develop programming for caregivers to promote the safety and well-being of adolescent girls. © 2017
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  13. 13

    Improving family planning service delivery in humanitarian crises.

    Undie CC; Khosla R; Blanchet K

    Geneva, Switzerland, World Health Organization, Department of Reproductive Health and Research, 2017 Jul. 3 p. (Family Planning Evidence Brief WHO/RHR/17.13)

    Meeting family planning needs in humanitarian emergencies is challenging but feasible, and could present opportunities for reaching marginalized, remote, or otherwise under-served populations. Young people in such settings are usually new users of contraception and could initiate contraceptive use that continues into adulthood. Where humanitarian assistance is delivered in encamped spaces, this structure could facilitate the provision of family planning services and information. In camp settings specifically, the process of resettling displaced persons requires communication of health information to underserved populations, and there are openings for integrating family planning information and services into such processes.
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  14. 14

    Reducing GBV risks through better shelter programme design.

    Rule A; Izquierdo J; Piccioli A

    Forced Migration Review. 2017 Jun; 55:43-45.

    Good shelter programming must include mitigation measures throughout the project cycle in order to reduce GBV risks. Shelters must be habitable, and provide physical safety and adequate space, as well as protection against the elements. They are also homes where people seek well-being and safety, especially so in displacement. In essence, shelter offers protection. However, it is not enough to build shelters. These – and settlements in which shelters are built – also need to provide protection from violence, including gender-based violence (GBV).
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  15. 15

    Family planning saves lives and promotes resilience in humanitarian contexts.

    Inter-Agency Working Group on Reproductive Health in Crises [IAWG]

    [London, United Kingdom], IAWG, [2017]. 15 p.

    Globally, it is estimated that 128.6 million people are currently in need of humanitarian assistance. Of these individuals, approximately one-fourth are women and girls of reproductive age. Although family planning is one of the most life-saving, empowering, and cost-effective interventions for women and girls, it remains an overwhelming gap in emergency responses due to a lack of prioritisation and funding. Consequently, many women and girls are forced to contend with an unmet need for family planning and unplanned pregnancies in addition to the traumas of conflict, disaster, and displacement. The Family Planning Summit (FP Summit), convened in London on 11 July 2017, presents a critical opportunity to accelerate efforts to deliver family planning to women and girls globally -- including those affected by humanitarian crises. In preparation, on 4 May 2017, the Inter-agency Working Group for Reproductive Health in Crises (IAWG) convened an expert consultation on family planning in humanitarian contexts, on behalf of the humanitarian workstream of the 2017 FP Summit, including DFID, the Bill & Melinda Gates Foundation and UNFPA. At the expert consultation, IAWG members presented their experiences providing family planning in diverse humanitarian contexts, demonstrating that there is consistent demand for family planning services and that it is feasible to provide them, even in the most challenging contexts. Building on this momentum, the International Rescue Committee, in partnership with Care, Save the Children and the Women’s Refugee Commission, organised a donor consultation on 7 June 2017 to seek input from donors and stakeholders to shape messages and recommendations for the London FP summit. This paper is a synthesis of the findings developed through both consultations and identifies collaborative solutions and actions to be taken at the FP Summit and beyond.
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  16. 16
    Peer Reviewed

    Challenges to understanding the reproductive health needs of women forcibly displaced by the Syrian conflict.

    DeJong J

    Journal of Family Planning and Reproductive Health Care. 2017 Apr; 43(2):103-104.

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  17. 17

    “They Forgot about Us!” Gender and Haiti’s IDP camps.

    Schuller M

    Meridians: Feminism, Race, Transnationalism. 2011; 11(1):149-157.

    Interviews with and personal narratives of women about their experiences living in Haiti's camps for internally displaced persons, following the 2010 earthquake.
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  18. 18

    Nurses’ yse of global information systems for provision of outreach reproductive health services to internally displaced persons.

    Shaikh MA

    2008 May-Jun; 23(3):s35-s38.

    TRODUCTION: A long and protracted civil war compounded by the occurrence of nature-related disasters have forced thousands of Somalis to take refuge in camps for internally displaced persons (IDPs) to escape violence and seek shelter. Dwellers of these camps have limited accessibility to and affordability of the fractured healthcare facilities located in nearby towns. A free, outreach, mobile, reproductive healthcare delivery system staffed with nurses and using an ambulance guided by a global information systems (GIS) map was established to address the accessibility and affordability issues hindering provision of quality reproductive healthcare to the women in the IDP camps and in the outskirts of Baidoa City, Somalia. METHODS: All 14 IDP camps in Baidoa City were visited to determine the number of families/huts, and to acquire their global positioning system (GPS) central point locations. Global information systems (GIS) shape files containing major roads, river, and dwellings, and straight-line distances from the base clinic to each IDP camp were computed. The objective of creating and using this specially designed map was to help nurses in determining which camps realistically could be visited on a given day, and how best to access them considering the security situation and the condition of rain-affected areas in the city. RESULTS: Use of the GIS map was instrumental in facilitating the delivery of healthcare services to IDPs and ensuring that resources were adequately utilized. Free healthcare services were provided each work day for the month long duration of the project; 3,095 consultations were provided, inclusive of 948 consultations for children under the age of 16 years, and delivery of three babies. ONCLUSIONS: Creation and use of a simple, need-specific GIS map in this pilot project effectively aided the logistical planning and delivery of mobile, outreach reproductive health services by directing the ambulance and nurses safely to accessible IDP camps in an area marred with long and protracted disasters from both natural and human causes.
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  19. 19
    Peer Reviewed

    Maternal and Child Health of Internally Displaced Persons in Ukraine: A Qualitative Study.

    Nidzvetska S; Rodriguez-Llanes JM; Aujoulat I; Gil Cuesta J; Tappis H; van Loenhout JA; Guha-Sapir D

    International Journal of Environmental Research and Public Health. 2017 Jan 09; 14(1)

    Due to the conflict that started in spring 2014 in Eastern Ukraine, a total of 1.75 million internally displaced persons (IDPs) fled the area and have been registered in government-controlled areas of the country. This paper explores perceived health, barriers to access to healthcare, caring practices, food security, and overall financial situation of mothers and young children displaced by the conflict in Ukraine. This is a qualitative study, which collected data through semi-structured in-depth interviews with nine IDP mothers via Skype and Viber with a convenience sample of participants selected through snowball technique. Contrary to the expectations, the perceived physical health of mothers and their children was found not to be affected by conflict and displacement, while psychological distress was often reported. A weak healthcare system, Ukraine's proneness to informal payments, and heavy bureaucracy to register as an IDP were reported in our study. A precarious social safety net to IDP mothers in Ukraine, poor dietary diversity, and a generalized rupture of vaccine stocks, with halted or delayed vaccinations in children were identified. Increasing social allowances and their timely delivery to IDP mothers might be the most efficient policy measure to improve health and nutrition security. Reestablishment and sustainability of vaccine stocks in Ukraine is urgent to avoid the risks of a public health crisis. Offering psychological support for IDP mothers is recommended.
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  20. 20
    Peer Reviewed

    Incarceration and exposure to internally displaced persons camps associated with reproductive rights abuses among sex workers in northern Uganda.

    Erickson M; Goldenberg SM; Akello M; Muzaaya G; Nguyen P; Birungi J; Shannon K

    Journal of Family Planning and Reproductive Health Care. 2017 Jul; 43(3):201-209.

    Background While female sex workers (FSWs) face a high burden of violence and criminalisation, coupled with low access to safe, non-coercive care, little is known about such experiences among FSWs in conflict-affected settings, particularly as they relate to sexual and reproductive health (SRH) and rights. We explored factors associated with lifetime abortions among FSWs in northern Uganda; and separately modelled the independent effect of lifetime exposures to incarceration and living in internally displaced persons (IDP) camps on coerced and unsafe abortions. Methods Analyses are based on a community-based cross-sectional research project in Gulu District, northern Uganda (2011-2012) with The AIDS Support Organization (TASO) Gulu, FSWs, and other community organisations. We conducted questionnaires, sex worker/community-led outreach to sex work venues, and voluntary HIV testing by TASO. Results Of 400 FSWs, 62 had ever accessed an abortion. In a multivariable model, gendered violence, both childhood mistreatment/or abuse at home [adjusted odds ratio (AOR) 1.96; 95% confidence interval (95% CI) 0.99-3.90] and workplace violence by clients (AOR 3.57; 95% CI 1.31-9.72) were linked to increased experiences of abortion. Lifetime exposure to incarceration retained an independent effect on increased odds of coerced abortion (AOR 5.16; 95% CI 1.39-19.11), and living in IDP camps was positively associated with unsafe abortion (AOR 4.71; 95% CI 1.42-15.61). Discussion and conclusions These results suggest a critical need for removal of legal and social barriers to realizing the SRH rights of all women, and ensuring safe, voluntary access to reproductive choice for marginalized and criminalized populations of FSWs.
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  21. 21

    Encampment of communities in war-affected areas and its effect on their livelihood security and reproductive health: The case of Northern Uganda.

    Mulumba D

    Eastern Africa Social Science Research Review. 2011 Jan; 27(1):107-129.

    This paper seeks to assess the effect of encampment on the livelihood security and reproductive health needs of IDPs in war affected areas of northern Uganda. The research design was exploratory and descriptive in nature and was largely qualitative, although a small amount of quantitative data are included. Primary and secondary data were collected from a representative sample of 125 women and 66 men. Results show the prevalence of negative effects on their reproductive health, while the effect on their livelihood security in camps is ambivalent. Food rations were supplied by the World Food Programme (WFP). The study found that women and youth fared better than men as they could find income generating activities to do in the camps. However, camp congestion and idleness resulted in heavy alcohol consumption trends that generated poor attitudes towards work and was characterized by gender-based violence.
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  22. 22

    Deprivation HIV and AIDS in Northern Uganda.

    Atekyereza PR

    African Sociological Review. 2014; 18(1):91-111.

    This study focuses on HIV infection within the context of poverty and deprivation. The study used both quantitative and qualitative methods from a stratified random sample of 98 respondents, Key Informant Interviews and six Focus Group discussions, to investigate risk of HIV infection in Paimol Internally Displaced People’s camp in Pader district, Uganda between 2008 and 2009. This district in Northern Uganda was characterised by war and insecurity physical aggression, deprivation, hunger and family separation, among others, for over twenty years. The Study shows that in spite of the relatively high levels of HIV/AIDS awareness, some people are at risk to HIV infection as a result of these. Significantly, with resettlement after the war, most people are still deprived of basic source of livelihood, which still continues as a factor in the spread of HIV infection.
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  23. 23

    Policy statement on HIV testing and counselling for refugees and other persons of concern to UNHCR.

    United Nations High Commission for Refugees [UNHCR]. Division of Programme Support and Management

    Geneva, Switzerland, UNHCR, 2014. 16 p.

    This Policy Statement examines the role of HIV testing and counselling (HTC) in health facilities in increasing access to HIV prevention, treatment, care and support services for refugees, asylum-seekers, internally displaced persons (IDPs) and stateless persons (see Glossary for definitions). It also identifies specific issues regarding HTC amongst these populations and issues recommendations for future action. This policy statement complements and should be used in conjunction with existing World Health Organization guidance, specifically Guidance on Provider-Initiated HIV Testing and Counselling in Health Facilities (1) and Service delivery approaches to HIV testing and counselling (HTC): A strategic policy framework (2). Information on an enabling environment and training of workers in health care facilities are all found in the above mentioned World Health Organization & Joint United Nations Programme on HIV/AIDS (UNAIDS) guidance. Guidance provides descriptions of HTC service delivery approaches, and HIV testing strategies and algorithms. Recommendations in this document are anticipated to be valid until 2018. At that time UNHCR will review this document and issue its recommendations.
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  24. 24
    Peer Reviewed

    Evidence from cluster surveys on the association between home-based counseling and use of family planning in conflict-affected Darfur.

    Adam IF

    International Journal of Gynecology and Obstetrics. 2016 May; 133(2):221-225.

    Objective To examine the association between home counseling and awareness and use of modern family planning (FP) methods among women in internally displaced person (IDP) camps in conflict-affected West Darfur, Sudan. Methods In a community-based cross-sectional study, two questionnaire-based surveys were performed in three camps. Home-based counseling had been introduced in March 2006. An initial survey (February 2007) and a follow-up survey (April 2009) targeted women of child-bearing age. A sample of 640 randomly selected women aged 15-49 years who had experienced pregnancy after joining the camp were interviewed for each survey. Results Overall, modern FP use increased from 10.9% (70/640) in 2007 to 21.6% (138/640) in 2009 (P < 0.001). As compared with the initial survey, women in the follow-up survey were more likely to be aware of and to use any modern FP method (adjusted odds ratio [aOR] 5.4, 95% confidence interval [CI] 3.9-7.4; and aOR 2.8, 95% CI 2.0-4.1, respectively). Contraceptive pills were the most common modern method used. Home counseling and loss of a child under 5 years were the most significant predictors of awareness and use of modern FP methods. Conclusion After the introduction of home-based FP counseling for couples and FP services in clinics, women’s awareness and use of modern FP methods increased in a conflict-affected setting.
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  25. 25
    Peer Reviewed

    'My body is mine': Qualitatively exploring agency among internally displaced women participants in a small-group intervention in Leogane, Haiti.

    Logie CH; Daniel C

    Global Public Health. 2016; 11(1-2):122-34.

    The 2010 earthquake resulted in the breakdown of Haiti's social, economic and health infrastructure. Over one-quarter of a million people remain internally displaced (ID). ID women experience heightened vulnerability to intimate partner violence (IPV) due to increased poverty and reduced community networks. Scant research has examined experiences of IPV among ID women in post-earthquake Haiti. We conducted a qualitative study to explore the impact of participating in Famn an Aksyon Pou Sante Yo (FASY), a small-group HIV prevention intervention, on ID women's agency in Leogane, Haiti. We conducted four focus groups with ID women, FASY participants (n = 40) and in-depth individual interviews with peer health workers (n = 7). Our study was guided by critical ethnography and paid particular attention to power relations. Findings highlighted multiple forms of IPV (e.g., physical, sexual). Participants discussed processes of intrapersonal (confidence), interpersonal (communication), relational (support) and collective (women's rights) agency. Yet structural factors, including patriarchal gender norms and poverty, silenced IPV discussions and constrained women's agency. Findings suggest that agency among ID women is a multi-level, non-linear and incremental process. To effectively address IPV among ID women in Haiti, interventions should address structural contexts of gender inequity and poverty and concurrently facilitate multi-level processes of agency.
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