Rehabilitating Health Systems in Post-Conflict Situations

Although baseline data for post-conflict situations are frequently unavailable, there is a clear deterioration in the health conditions of populations during and following conflict. Excess mortality and morbidity, displaced populations, and vulnerability to communicable diseases during and following conflict all call for immediate relief and restoration of basic services. As much as possible, short-term relief and assistance programmes should be implemented in a manner compatible with longer term health system rehabilitation. This paper presents a framework for analyzing the inputs and policies that make up post-conflict rehabilitation programmes in the health sector. Post-conflict ...health, conflict, war, institutions

Safe Water Systems: An Evaluation of the Zambia Clorin Program

Clorin is a household water treatment product (a sodium hypochlorite disinfectant) that Society for Family Health launched in Zambia in 1998. This report provides a external assessment of Clorin use in light of the Centers for Disease Control and Pan American Health Organization's overall Safe Water Systems initiative. The intervention took a social marketing approach, targeting low-income households with Clorin at a subsidized price, and sales steadily increased from 1998 to 2004. This involved training for health center staff , neighborhood volunteers, and pharmacists; and promotions through radio, television, newspapers, and posters. The study found that active marketing through community-level personal was very important, while the role of mass media messages was unclear. Collaboration with the government health sector, retailers, and community agents was advised, as was strengthening the water management side of the program

Health needs and care seeking behaviours of Yazidis and other minority groups displaced by ISIS into the Kurdistan Region of Iraq

Background During the summer of 2014, ISIS overran Nineveh governorate in Northern Iraq. Yazidis and other religious minorities were subjected to brutal attacks and forced to seek refuge into the neighbouring Kurdistan Region, where they remain living in local communities or in camps. This survey provides a population-based assessment of the health needs and care seeking behaviours of Yazidis and other groups currently residing in camps. Methods The survey covered 13 camps managed by the Kurdish Board of Relief and Humanitarian Affairs. A systematic random sample of 1,300 households with a total of 8,360 members were interviewed between November and December 2015. Participants were asked if any household members had needed care for a health condition in the two weeks preceding the survey, and whether care was obtained from the camp primary health care centre, an outside public hospital or a private clinic. If care was received, the out-of-pocket payment was recorded; otherwise, the reason for not seeking care was queried. Results In 33.9% (CI: 31.0–37.0) of households one or more members had needed care for a health condition in the two weeks preceding the survey. The most likely to have needed care were older persons (18.5%; CI: 13.6–24.6) and infants (18.0%; CI: 11.6–26.8). The reported health conditions revealed a complex picture of communicable and non-communicable diseases as well as mental health problems and physical injuries. Care was primarily sought from private clinics (41.8%; CI: 36.4–47.4) or public hospitals (27.3%; CI: 22.6–32.7) rather than from the camp primary health care clinics (23.6%; CI: 19.5–28.2). The mean out-ofpocket payment for care received was nearly 3 times higher in public hospitals than in the camp primary health care clinics and nearly 11 times higher in private clinics. Cost was the main perceived barrier to obtaining health services. Conclusion Demand for health services was high among Yazidis and other minorities living in camps. Private services were preferred in spite of the tenuous economic circumstances of displaced households. Declines in public sector funding may further restrict access from camp clinics stressing the need for alternative access strategies

Prevalence of non-communicable diseases and access to health care and medications among Yazidis and other minority groups displaced by ISIS into the Kurdistan region of Iraq

The increasing caseload of non-communicable diseases (NCDs) in displaced populations poses new challenges for humanitarian agencies and host country governments in the provision of health care, diagnostics and medications. This study aimed to characterise the prevalence of NCDs and better understand issues related to accessing care among Yazidis and other minority groups displaced by ISIS and currently residing in camps in the Kurdistan Region of Iraq

Living in Mosul during the time of ISIS and the military liberation: results from a 40-cluster household survey

Background In June 2014, an estimated 1500 fighters of the Islamic State of Iraq and Syria (ISIS) seized control of Mosul, Iraq’s second city. Although many residents fled, others stayed behind, enduring the restrictive civil and social policies of ISIS. In December 2016, the military activity, known as the liberation campaign, began in east Mosul, concluding in west Mosul in June 2017. Methods To assess life in Mosul under ISIS, and the consequences of the military campaign to retake Mosul we conducted a 40 cluster-30 household survey in Mosul, starting in March 2017. All households included were present in Mosul throughout the entire time of ISIS control and military action. Results In June 2014, 915 of 1139 school-age children (80.3%) had been in school, but only 28 (2.2%) attended at least some school after ISIS seized control. This represented a decision of families. Injuries to women resulting from intimate partner violence were reported in 415 (34.5%) households. In the surveyed households, 819 marriages had occurred; 688 (84.0%) among women. Of these women, 89 (12.9%) were aged 15 years and less, and 253 (49.7%) were aged under 18 at the time of marriage. With Mosul economically damaged by ISIS control and physically during the Iraqi military action, there was little employment at the time of the survey, and few persons were bringing cash into households. The liberation of Mosul in 2017 caused extensive damage to dwellings. Overall only a quarter of dwellings had not sustained some damage. In west Mosul, only 21.7% of houses had little or no damage from the conflict, with 98 (21.7%) households reporting their house had been destroyed, forcing its occupants to move. No houses had regular electricity and there was limited piped water. Inadequate fuel for cooking was reported by 996 (82.9%) households. Conclusion The physical, and social damage occurring during ISIS occupation of Mosul and during the subsequent military action (liberation) was substantial and its impact is unlikely to be erased soon

Mortality and kidnapping estimates for the Yazidi population in the area of Mount Sinjar, Iraq, in August 2014: a retrospective household survey

In August 2014, the so-called Islamic State of Iraq and Syria (ISIS) attacked the Yazidi religious minority living in the area of Mount Sinjar in Nineveh governorate, Iraq. We conducted a retrospective household survey to estimate the number and demographic profile of Yazidis killed and kidnapped

Factors Associated with Missed Vaccination during Mass Immunization Campaigns

Achieving a high percentage of vaccination coverage with polio vaccine, while necessary, is not sufficient to eliminate or eradicate polio. The existence of pockets of under-vaccinated children has allowed outbreaks of polio in countries that have achieved high levels of vaccination coverage and in countries with no cases for many years. In a literature review, 35 articles were identified that described factors associated with missed vaccination in mass immunization campaigns. An annotated bibliography was developed for each article; these were then coded using the AnSWR program, and codes were organized into three larger thematic categories. These thematic areas were: (a) organization and implementation of mass campaigns; (b) population characteristics; and (c) knowledge and practices of caretakers. If these factors were geographically clustered, it was suspected that these clusters might have higher likelihood of becoming pockets of unvaccinated children. Immunization programme managers can target resources to identify if such clusters exist. If so, they can then ensure supervision of vaccination efforts in those sites and take further action, if indicated, to prevent or mitigate pockets of unvaccinated children

Evaluating the Experience of GAPS—A Methodology for Improving Quality of Mass Immunization Campaigns in Developing Countries

The existence of pockets of under-vaccinated persons has allowed outbreaks of disease in countries that have achieved high levels of vaccination coverage. A field-based methodology—GAPS (Geographic Assessment of Planning and Services)—was developed to predict, in advance of an immunization campaign, the sites of which are most likely to have a pocket of unvaccinated persons and then use this information to improve planning, supervision, and evaluation of the campaign. At this time, there have been two applications of GAPS (Nepal and Ethiopia). The purpose of this paper was to evaluate these two applications of GAPS and make recommendations regarding its future use. Structured, expert interviews were conducted with at least three campaign organizers to evaluate each application of GAPS using purposive sampling. An evaluation of an individual campaign was considered positive when at least two of the three campaign organizers considered GAPS to be useful and worthwhile. The three campaign organizers interviewed following the GAPS application in Ethiopia responded that GAPS was useful and worth the effort. In Nepal, all four campaign organizers responded that GAPS was useful and worth the effort. Some suggestions for improvement were also identified. Although this evaluation was limited in the number of applications evaluated, GAPS appears to have promise as a practical method to help improve the quality of mass immunization campaigns. And even if no pockets of unvaccinated persons are found, the method may serve as a rapid quality-check of administrative estimates of coverage. Further applications in different settings are needed to confirm these findings or under what circumstances GAPS might best be used. GAPS may also be considered for improving other types of health campaigns, such as distribution of insecticide-treated bednets, vitamin A capsules, and deworming medications

Epidemiological analysis of spatially misaligned data: a case of highly pathogenic avian influenza virus outbreak in Nigeria

This research is focused on the epidemiological analysis of the transmission of the highly pathogenic avian influenza (HPAI) H5N1 virus outbreak in Nigeria. The data included 145 outbreaks together with the locations of the infected farms and the date of confirmation of infection. In order to investigate the environmental conditions that favoured the transmission and spread of the virus, weather stations were realigned with the locations of the infected farms. The spatial Kolmogorov–Smirnov test for complete spatial randomness rejects the null hypothesis of constant intensity (P < 0·0001). Preliminary exploratory analysis showed an increase in the incidence of H5N1 virus at farms located at high altitude. Results from the Poisson log-linear conditional intensity function identified temperature (−0·9601) and wind speed (0·6239) as the ecological factors that influence the intensity of transmission of the H5N1 virus. The model also includes distance from the first outbreak (−0·9175) with an Akaike’s Information Criterion of −103·87. Our analysis using a point process model showed that geographical heterogeneity, seasonal effects, temperature, wind as well as proximity to the first outbreak are very important components of spread and transmission of HPAI H5N1.Web of Scienc