Showing papers in "Conflict and Health in 2009"
TL;DR: Mental health consequences of conflict remain long after the events are over, and therefore mental health intervention is as urgent for post-conflict migrant populations as physical health and other emergency interventions.
Abstract: Background
The aim of this study was to establish the prevalence of posttraumatic stress disorder (PTSD) and depression among Rwandese and Somali refugees resident in a Ugandan refugee settlement, as a measure of the mental health consequences of armed conflict, as well as to inform a subsequent mental health outreach program. The study population comprised a sample from 14400 (n = 519 Somali and n = 906 Rwandese) refugees resident in Nakivale refugee settlement in South Western Uganda during the year 2003.
143 citations
TL;DR: Special attention needs to be placed on the feasibility and necessity of doing research in conflict-settings, and the harm-benefit ratio for potential research participants.
Abstract: Humanitarian agencies are increasingly engaged in research in conflict and post-conflict settings. This is justified by the need to improve the quality of assistance provided in these settings and to collect evidence of the highest standard to inform advocacy and policy change. The instability of conflict-affected areas, and the heightened vulnerability of populations caught in conflict, calls for careful consideration of the research methods employed, the levels of evidence sought, and ethical requirements. Special attention needs to be placed on the feasibility and necessity of doing research in conflict-settings, and the harm-benefit ratio for potential research participants.
117 citations
TL;DR: It is documented that in the DRC conflict sexual violence has been – and continues to be – highly prevalent in a wide area in the East of the country.
Abstract: Background
Despite international acknowledgement of the linkages between sexual violence and conflict, reliable data on its prevalence, the circumstances, characteristics of perpetrators, and physical or mental health impacts is rare. Among the conflicts that have been associated with widespread sexual violence has been the one in the Democratic Republic of the Congo (DRC).
93 citations
TL;DR: The aim of this study was to explore the social determinants of overall physical and mental health of IDPs, including the response strategies used by IDPs to support their health needs, including a combination of biopsychosocial health services, traditional practices, religion, family and friends, and isolating.
Abstract: Social determinants of health describe the conditions in which people are born, grow, live, work and age and their influence on health. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels, which are themselves influenced by policy choices. Armed conflict and forced displacement are important influences on the social determinants of health. There is limited evidence on the social determinants of health of internally displaced persons (IDPs) who have been forced from their homes due to armed conflict but remain within the borders of their country. The aim of this study was to explore the social determinants of overall physical and mental health of IDPs, including the response strategies used by IDPs to support their health needs. Northern Uganda was chosen as a case-study, and 21 face-to-face semi-structured interviews with IDPs were conducted in fifteen IDP camps between November and December 2006.
68 citations
TL;DR: This project in a rural and remote conflict-affected setting demonstrates that integrated HIV programs can save lives and play a key role in helping to achieve universal access to ART in Africa.
Abstract: The Pool region of the Republic of Congo is an isolated, conflict-affected area with under-resourced and poorly functioning health care services. Despite significant AIDS-related mortality and morbidity in this area, and a national level commitment to universal HIV care, HIV has been largely neglected. In 2005 Medecins Sans Frontieres decided to introduce HIV care activities. However, in this setting of high basic health care needs, limited medical resources and competing medical priorities, a vertical HIV programme was not suitable. This paper describes the process of integrating HIV care and treatment into basic health services, the clinical outcomes of 222 patients started on antiretroviral treatment (ART), and the benefits to communities and health care systems. Key lessons learned include the use of multi-skilled human resources, the step-wise implementation of HIV activities, the initial engagement of an HIV experienced staff member, the use of simplified and adapted testing, clinical and monitoring protocols and drug regimens, the introduction of more complex monitoring tools to simplify clinical management decisions and intensive staff education regarding the benefits of HIV integration. This project in a rural and remote conflict-affected setting demonstrates that integrated HIV programs can save lives and play a key role in helping to achieve universal access to ART in Africa.
53 citations
TL;DR: During a period of humanitarian crisis, the vulnerable, HIV-infected pediatric population had disruptions in clinical care and in medication adherence, putting children at risk for viral resistance and increased morbidity, however, unique program strengths may have minimized these disruptions.
Abstract: Kenya experienced a political and humanitarian crisis following presidential elections on 27 December 2007. Over 1,200 people were killed and 300,000 displaced, with disproportionate violence in western Kenya. We sought to describe the immediate impact of this conflict on return to clinic and medication adherence for HIV-infected children cared for within the USAID-Academic Model Providing Access to Healthcare (AMPATH) in western Kenya. We conducted a mixed methods analysis that included a retrospective cohort analysis, as well as key informant interviews with pediatric healthcare providers. Eligible patients were HIV-infected children, less than 14 years of age, seen in the AMPATH HIV clinic system between 26 October 2007 and 25 December 2007. We extracted demographic and clinical data, generating descriptive statistics for pre- and post-conflict antiretroviral therapy (ART) adherence and post-election return to clinic for this cohort. ART adherence was derived from caregiver-report of taking all ART doses in past 7 days. We used multivariable logistic regression to assess factors associated with not returning to clinic. Interview dialogue from was analyzed using constant comparison, progressive coding and triangulation. Between 26 October 2007 and 25 December 2007, 2,585 HIV-infected children (including 1,642 on ART) were seen. During 26 December 2007 to 15 April 2008, 93% (N = 2,398) returned to care. At their first visit after the election, 95% of children on ART (N = 1,408) reported perfect ART adherence, a significant drop from 98% pre-election (p < 0.001). Children on ART were significantly more likely to return to clinic than those not on ART. Members of tribes targeted by violence and members of minority tribes were less likely to return. In qualitative analysis of 9 key informant interviews, prominent barriers to return to clinic and adherence included concerns for personal safety, shortages of resources, hanging priorities, and hopelessness. During a period of humanitarian crisis, the vulnerable, HIV-infected pediatric population had disruptions in clinical care and in medication adherence, putting children at risk for viral resistance and increased morbidity. However, unique program strengths may have minimized these disruptions.
43 citations
TL;DR: As the DRC stabilizes, IRC and CARE are improving RH services by providing necessary equipment and renovations to health facilities; improving supply management systems; providing comprehensive competency-based training for health providers in RH and infection prevention; and providing technical assistance for monitoring and evaluation of key RH indicators.
Abstract: Background
Prolonged exposure to war has severely impacted the provision of health services in the Democratic Republic of the Congo (DRC). Health infrastructure has been destroyed, health workers have fled and government support to health care services has been made difficult by ongoing conflict. Poor reproductive health (RH) indicators illustrate the effect that the prolonged crisis in DRC has had on the on the reproductive health (RH) of Congolese women. In 2007, with support from the RAISE Initiative, the International Rescue Committee (IRC) and CARE conducted baseline assessments of public hospitals to evaluate their capacities to meet the RH needs of the local populations and to determine availability, utilization and quality of RH services including emergency obstetric care (EmOC) and family planning (FP).
37 citations
TL;DR: Describing the population attending during 2005-2008, in both urban and rural settings, as well as the psychological treatment provided during this period and its outcomes, suggest that further studies should be conducted to examine the role of short-term psychotherapy, adapted specifically to the context.
Abstract: Colombia has been seriously affected by an internal armed conflict for more than 40 years affecting mainly the civilian population, who is forced to displace, suffers kidnapping, extortion, threats and assassinations. Between 2005 and 2008, Medecins Sans Frontieres-France provided psychological care and treatment in the region of Tolima, a strategic place in the armed conflict. The mental health program was based on a short-term multi-faceted treatment developed according to the psychological and psychosomatic needs of the population. Here we describe the population attending during 2005-2008, in both urban and rural settings, as well as the psychological treatment provided during this period and its outcomes.
23 citations
TL;DR: The conflict had its most profound impact on Dili, the capital city, in which tens of thousands of people were displaced from their homes, but there were no outbreaks of malaria.
Abstract: Background
Malaria is a major global health problem, often exacerbated by political instability, conflict, and forced migration.
19 citations
TL;DR: A cross-sectional, random-sample survey among the conflict-affected populations living in Cité Soleil and Martissant found that violence had lasting effects in terms of physical and mental health and loss of property and possessions.
Abstract: Background
Towards the end of 2006 open conflict broke out between United Nations forces and armed militia in Port-au-Prince, Haiti. Fighting was most intense in the district of Cite Soleil.
14 citations
TL;DR: Moves to ensure sound survey design and conduct must be implemented by operational organisations to improve data quality and reporting and training in data interpretation would also be useful.
Abstract: Survey estimates of mortality and malnutrition are commonly used to guide humanitarian decision-making. Currently, different methods of conducting field surveys are the subject of debate among epidemiologists. Beyond the technical arguments, decision makers may find it difficult to conceptualize what the estimates actually mean. For instance, what makes this particular situation an emergency? And how should the operational response be adapted accordingly. This brings into question not only the quality of the survey methodology, but also the difficulties epidemiologists face in interpreting results and selecting the most important information to guide operations. As a case study, we reviewed mortality and nutritional surveys conducted in North Kivu, Democratic Republic of Congo (DRC) published from January 2006 to January 2009. We performed a PubMed/Medline search for published articles and scanned publicly available humanitarian databases and clearinghouses for grey literature. To evaluate the surveys, we developed minimum reporting criteria based on available guidelines and selected peer-review articles. We identified 38 reports through our search strategy; three surveys met our inclusion criteria. The surveys varied in methodological quality. Reporting against minimum criteria was generally good, but presentation of ethical procedures, raw data and survey limitations were missed in all surveys. All surveys also failed to consider contextual factors important for data interpretation. From this review, we conclude that mechanisms to ensure sound survey design and conduct must be implemented by operational organisations to improve data quality and reporting. Training in data interpretation would also be useful. Novel survey methods should be trialled and prospective data gathering (surveillance) employed wherever feasible.
TL;DR: An inter-disciplinary symposium to examine the topic among epidemiologists, demographers, forensic scientists and legal and human rights investigators aimed to strengthen the scientific understanding of mortality estimation by reviewing progress across fields and building inter-ciplinary bridges.
Abstract: The use of epidemiology in documenting the mortality experience in complex emergencies has become pervasive in humanitarian practice. Recent assessments in Iraq and Darfur have provoked much discussion on the assessment of mortality in scientific and policy spheres. In this context, the Centre for Research on the Epidemiology of Disasters and the Harvard Humanitarian Initiative held an inter-disciplinary symposium to examine the topic among epidemiologists, demographers, forensic scientists and legal and human rights investigators.
TL;DR: A search of newspapers reports found that U.S. newspapers report more events and tallies related to Coalition deaths than Iraqi civilian deaths, although there are substantially different proportions amongst the different U.s. newspapers.
Abstract: In February, 2007, the Associated Press (AP) conducted a poll of 1,002 adults in the United States about their attitudes towards the war in Iraq. Respondents were remarkably accurate estimating the current death toll of US soldiers, yet were grossly inaccurate in estimating the current death toll of Iraqi civilians. We conducted a search of newspapers reports to determine the extent of the discrepancy between reporting Coalition and Iraqi civilian deaths, hypothesizing that there would be an over-representation of Coalition deaths compared to Iraqi civilian deaths. We examined 11 U.S. newspapers and 5 non-U.S. newspapers using electronic databases or newspaper web-archives, to record any reports between March 2003 and March 2008 of Coalition and Iraqi deaths that included a numeric indicator. Reports were described as "events" where they described a specific occurrence involving fatalities and "tallies" when they mentioned the number of deaths over a period of time. We recorded the number of events and tallies related to Coalition deaths, Iraqi civilian deaths, and Iraqi combatant deaths U.S. newspapers report more events and tallies related to Coalition deaths than Iraqi civilian deaths, although there are substantially different proportions amongst the different U.S. newspapers. In four of the five non-US newspapers, the pattern was reversed. This difference in reporting trends may partly explain the discrepancy in how well people are informed about U.S. and Iraqi civilian fatalities in Iraq. Furthermore, this calls into question the role of the media in reporting and sustaining armed conflict, and the extent to which newspaper and other media reports can be used as data to assess fatalities or trends in the time of war.