Reproductive Health And Gender-Based Violence In Syrian Refugee Women

Background: The current conflict and humanitarian crisis in Syria continues to displace thousands of Syrians to neighboring countries, including Lebanon. There is a lack of information available to provide adequate health and related services to this displaced population, particularly women and adolescent girls, who comprise the majority of registered refugees. Methods: We conducted a rapid needs assessment from June-August 2012 in Lebanon by administering a cross-sectional survey in six health clinics and conducting three focus group discussions. Information was collected on reproductive and general health status and needs of displaced Syrian women, including exposure to violence and help-seeking behaviors. Results: We interviewed 452 displaced Syrian women ages 18-45 who had been in Lebanon for an average of 5.1 (± 3.7) months. Additionally, 29 women participated in three focus group discussions. Reported gynecologic conditions were common, including: menstrual irregularity, 54%; severe pelvic pain, 52%; and vaginal infections, 53%. Of our sample, 74 were pregnant at some point during the conflict, 40% of the currently pregnant had experienced pregnancy complications, and 37% of those who completed their pregnancies experienced delivery or abortion complications. The prevalence of adverse birth outcomes were: low birth weight, 12%; preterm delivery, 27%; and infant mortality, 3%. Of the entire sample, 31% experienced violence and 3% experienced sexual violence from armed people. Of those exposed to violence, 28% reported physical injury and 71% reported psychological difficulties. The majority of those exposed to violence did not seek medical care (65%). In multivariate models, exposure to violence was associated with menstrual irregularity (p=0.002), severe pelvic pain (p=0.005), and vaginal infections (p=0.002). In focus groups, participants revealed lack of access to basic services (including reproductive health care), high levels of stress in the home, and cases of intimate partner violence. Conclusions: This study contributes to a better understanding of health needs among conflict-affected women. High occurrence of pregnancy-related complications and gynecologic conditions, in addition to barriers to accessing care, indicate a need for better targeting of reproductive health services. The association between violence and reproductive health indicates a need for GBV-related and psychosocial services alongside standard reproductive healthcare

Adapting Dietary Guidelines to Client-Centered Preferences at the Downtown Evening Soup Kitchen (DESK)

The Downtown Evening Soup Kitchen (DESK) in New Haven, Connecticut exists to serve individuals who are food insecure, through the provision of meals. A majority of DESK’s food is sourced through donations and federal programs. A significant portion of these donations are from Yale University Dining, where trays of food from the dining hall are delivered multiple times a week. Connecticut faces a 6.4 percent prevalence of households with low food security, exceeding the 5.2 percent national average (Coleman-Jensen, 2017). Meals served at soup kitchens tend to contain high levels of fat and low levels of fiber, vitamins, and minerals (Lyles et al., 2013; Sisson, 2011), contributing to malnutrition, obesity, high blood pressure, and many other chronic conditions (Sisson, 2011). Currently, there are no national guidelines to regulate the nutrition of meals served specifically at these institutions, allowing for the continued distribution of meals with insufficient nutritional value (Koh et al., 2015; Kourgialis et al., 2001). The objectives of this study were as follows: Conduct a nutritional assessment of the dinners served by DESK, establish effective principles for the DESK menu based on the 2015-2020 Dietary Guidelines for Americans, and incorporate client food preferences in menu adaptations.https://elischolar.library.yale.edu/ysph_pbchrr/1018/thumbnail.jp

A Community-Based School Nutrition Intervention Improves Diet Diversity and School Attendance in Palestinian Refugee Schoolchildren in Lebanon.

BACKGROUND: School feeding programs have the potential to supply children with healthy school food, alleviate short-term hunger, and improve children's educational outcomes. OBJECTIVES: We linked community kitchens to a subsidized school snack intervention and assessed the impact of this intervention on nutritional (diet diversity, hemoglobin, and anthropometry) and educational (attendance and academic performance) outcomes of Palestinian refugee schoolchildren. METHODS: We collected data from 1362 students (aged 5-15 y) and their parents at baseline, and at an 8-mo follow-up in 2 control and 2 intervention schools. We conducted linear, logistic, and negative binomial regression analyses to assess changes in outcomes of children participating in the intervention schools compared with children in control schools (intention-to-treat). We also assessed the impact of the snack intervention in children who participated ≥50% of the time (HP, high-participation) compared with those who participated <50% (LP, low-participation), or who only received nutrition education (control) (per protocol). All the analyses were adjusted for child age and gender, maternal education, household expenditure, and school-level clustering effect. RESULTS: At endline, there were 648 children in the control group, and within the intervention group, 260 children were LP and 454 were HP. There was a significantly greater increase in overall diet diversity score and dairy consumption in the HP group compared with controls. Both LP and HP groups were more likely to consume proteins, and less likely to consume desserts than controls. Furthermore, the HP group had a significant increase in hemoglobin, and both LP and HP groups had a significant decrease in school absenteeism compared with controls. CONCLUSIONS: This community-based school nutrition intervention had a positive impact on diet diversity, hemoglobin, and school attendance of children

A mixed-methods evaluation of community-based healthy kitchens as social enterprises for refugee women.

BACKGROUND: The aim of this study is to investigate the potential impact of a community-based intervention - the Healthy Kitchens, Healthy Children (HKHC) intervention - on participating women's household's economics and food security status, decision making, mental health and social support. METHODS: We established two healthy kitchens in existing community-based organizations in Palestinian camps in Lebanon. These were set up as small business enterprises, using participatory approaches to develop recipes and train women in food preparation, food safety and entrepreneurship. We used a mixed-methods approach to assess the impact of participating in the program on women's economic, food security, decision making, social and mental health outcomes. A questionnaire was administered to women at baseline and at an 8-month endpoint. The end line survey was complemented by a set of embedded open-ended questions. RESULTS: Thirty-two Palestinian refugee women were employed within the kitchens on a rotating basis. Participating women had a 13% increase in household expenditure. This was translated into a significant increase in food (p < 0.05) and clothing expenditures (p < 0.01), as well as a reduction in food insecurity score (p < 0.01). These findings were supported by qualitative data which found that the kitchens provided women with financial support in addition to a space to form social bonds, discuss personal issues and share experiences. CONCLUSIONS: This model created a social enterprise using the concept of community kitchens linked to schools and allowed women to significantly contribute to household expenditure and improve their food security

Assessing Low-Income Community Members\u27 Views on Food Access and Farmers\u27 Markets in New Haven

In 2004, CitySeed Inc. was formed to oversee and operate farmers’ markets (FMs) in New Haven. Since then, they have grown through a series of programs and incentives aimed at increasing availability of fresh fruits and vegetables (F&V) to all residents of New Haven. CitySeed has implemented the SNAP Double Value incentive program, which allows SNAP recipients to double the value of their purchases (i.e. $1 buys$2 worth of F&V) at FMs for up to $20. CitySeed has also implemented a SNAP customer Loyalty Program, Farmers Market Nutrition Coupon redemption, and F&V prescription program. With information from CitySeed and past studies in major cities that employed similar double-value programs, the authors focused on three primary objectives: Evaluate availability and accessibility of healthy food choices for low-income residents in New Haven, assess perspectives on barriers to CitySeed’s farmers’ markets among low-income community members, and recommend steps for CitySeed to tailor markets and programming to community needs and interests.https://elischolar.library.yale.edu/ysph_pbchrr/1017/thumbnail.jp

Funding Community Health Workers: Best Practices and the Way Forward (Southwestern Area Health Education Center)

Community health workers (CHWs), in their delivery of culturally competent care, play an integral role in promoting the health of communities. Many states have successfully utilized CHWs to reduce health disparities and promote health among low-income communities. Connecticut, in contrast, has a fragmented CHW workforce that is poorly understood and likely underutilized. Southwestern Area Health Education Center (SWAHEC), Inc. partnered with a student team at the Yale School of Public Health to identify initiatives and progress made by various states around the US related to funding mechanisms for CHW positions. Key informant interviews were conducted with representatives from Massachusetts, Vermont, Rhode Island, New York, California, and Texas to identify best practices and challenges faced when organizations and other agencies seek funds to pay CHWs. CHWs and those who work with CHWs are still facing poor recognition and lack of understanding, which contributes to difficulty in paying CHWs; as they are not a recognized professional workforce, it is challenging to identify funding sources for CHW positions. When funding for CHW positions is available, it is often in the form of short-term, soft money from sources such as grants. This theme appeared in the majority of interviews, suggesting that this remains a challenge in many, if not the majority, of states in the US. An important consequence for this type of funding is that positions for CHWs are often temporary and unstable, which affects their ability to work continuously within their communities. This is detrimental for both the CHWs and the communities they work in. Those working towards organizing CHWs in CT should ensure CHWs are the primary driving force behind CHW initiatives. In addition to educating health care professionals about the capacity of CHWs, establishment of formal training/certification programs may help facilitate the recognition and acceptance of CHWs as not only cost saving but integral to promoting the health of communities.https://elischolar.library.yale.edu/ysph_pbchrr/1043/thumbnail.jp