Medical Relief Trips...What’s Missing? Exploring Ethical Issues and the Physician-Patient Relationship

"The welcome ceremony alone will leave you breathless as you become inspired by their overwhelming joy at you arrival. Here you will participate with the community and provide much needed medical care. The team will also provide care for the Talibe boys in Theis who go without medical care and are left to face disease on their own (Senegal, 2009).

Authorship representation in global emergency medicine: a bibliometric analysis from 2016 to 2020

Introduction: High-income country (HIC) authors are disproportionately represented in authorship bylines compared with those affiliated with low and middle-income countries (LMICs) in global health research. An assessment of authorship representation in the global emergency medicine (GEM) literature is lacking but may inform equitable academic collaborations in this relatively new field. Methods: We conducted a bibliometric analysis of original research articles reporting studies conducted in LMICs from the annual GEM Literature Review from 2016 to 2020. Data extracted included study topic, journal, study country(s) and region, country income classification, author order, country(s) of authors\u27 affiliations and funding sources. We compared the proportion of authors affiliated with each income bracket using Χ2 analysis. We conducted logistic regression to identify factors associated with first or last authorship affiliated with the study country. Results: There were 14 113 authors in 1751 articles. Nearly half (45.5%) of the articles reported work conducted in lower middle-income countries (MICs), 23.6% in upper MICs, 22.5% in low-income countries (LICs). Authors affiliated with HICs were most represented (40.7%); 26.4% were affiliated with lower MICs, 17.4% with upper MICs, 10.3% with LICs and 5.1% with mixed affiliations. Among single-country studies, those without any local authors (8.7%) were most common among those conducted in LICs (14.4%). Only 31.0% of first authors and 21.3% of last authors were affiliated with LIC study countries. Studies in upper MICs (adjusted OR (aOR) 3.6, 95% CI 2.46 to 5.26) and those funded by the study country (aOR 2.94, 95% CI 2.05 to 4.20) had greater odds of having a local first author. Conclusions: There were significant disparities in authorship representation. Authors affiliated with HICs more commonly occupied the most prominent authorship positions. Recognising and addressing power imbalances in international, collaborative emergency medicine (EM) research is warranted. Innovative methods are needed to increase funding opportunities and other support for EM researchers in LMICs, particularly in LICs

"It will be a weapon in my hand": The Protective Potential of Education for Adolescent Syrian Refugee Girls in Lebanon

This study uses over 140 first-person narratives from adolescent Syrian girls and Syrian parents displaced to Lebanon and literature from the Education in Emergencies (EiE) field to examine the concept of the protective potential of education. The findings illustrate the interplay between the risks taken to obtain education versus the protective potential of education for this vulnerable group. For this study population, protection risks frequently outweighed the protective potential of education and ultimately influenced decision-making at the individual level on continuation of education in Lebanon.Cette étude s’appuie sur plus de 140 récits à la première personne d’adolescentes et de parents syriens déplacés au Liban ainsi que sur la littérature existante dans le champ de l’éducation en situations d’urgence afin d’examiner le concept du potentiel protecteur de l’éducation. Les résultats illustrent l’interaction dynamique entre les risques pris pour obtenir une éducation et le potentiel protecteur de l’éducation pour ce groupe vulnérable. Pour la population étudiée, les risques en matière de protection l’emportaient fréquemment sur le potentiel protecteur de l’éducation et avaient ultimement une influence sur la prise de décision des individus concernant la poursuite d’une éducation au Liban

Perceptions toward Ebola vaccination and correlates of vaccine uptake among high-risk community members in North Kivu, Democratic Republic of the Congo.

The tenth Ebola Virus Disease (EVD) outbreak (2018-2020, North Kivu, Ituri, South Kivu) in the Democratic Republic of the Congo (DRC) was the second-largest EVD outbreak in history. During this outbreak, Ebola vaccination was an integral part of the EVD response. We evaluated community perceptions toward Ebola vaccination and identified correlates of Ebola vaccine uptake among high-risk community members in North Kivu, DRC. In March 2021, a cross-sectional survey among adults was implemented in three health zones. We employed a sampling approach mimicking ring vaccination, targeting EVD survivors, their household members, and their neighbors. Outbreak experiences and perceptions toward the Ebola vaccine were assessed, and modified Poisson regression was used to identify correlates of Ebola vaccine uptake among those offered vaccination. Among the 631 individuals surveyed, most (90.2%) reported a high perceived risk of EVD and 71.6% believed that the vaccine could reduce EVD severity; however, 63.7% believed the vaccine had serious side effects. Among the 474 individuals who had been offered vaccination, 397 (83.8%) received the vaccine, 180 (45.3%) of those vaccinated received the vaccine after two or more offers. Correlates positively associated with vaccine uptake included having heard positive information about the vaccine (RR 1.30, 95% CI 1.06-1.60), the belief that the vaccine could prevent EVD (RR 1.23, 95% CI 1.09-1.39), and reporting that religion influenced all decisions (RR 1.13, 95% CI 1.02-1.25). Ebola vaccine uptake was high in this population, although mixed attitudes and vaccine delays were common. Communicating positive vaccine information, emphasizing the efficacy of the Ebola vaccine, and engaging religious leaders to promote vaccination may aid in increasing Ebola vaccine uptake during future outbreaks

Sociodemographic characteristics of the surveyed community members, North Kivu, Democratic Republic of the Congo, 2021.

Sociodemographic characteristics of the surveyed community members, North Kivu, Democratic Republic of the Congo, 2021.</p

Inclusivity in global research questionnaire.

The tenth Ebola Virus Disease (EVD) outbreak (2018–2020, North Kivu, Ituri, South Kivu) in the Democratic Republic of the Congo (DRC) was the second-largest EVD outbreak in history. During this outbreak, Ebola vaccination was an integral part of the EVD response. We evaluated community perceptions toward Ebola vaccination and identified correlates of Ebola vaccine uptake among high-risk community members in North Kivu, DRC. In March 2021, a cross-sectional survey among adults was implemented in three health zones. We employed a sampling approach mimicking ring vaccination, targeting EVD survivors, their household members, and their neighbors. Outbreak experiences and perceptions toward the Ebola vaccine were assessed, and modified Poisson regression was used to identify correlates of Ebola vaccine uptake among those offered vaccination. Among the 631 individuals surveyed, most (90.2%) reported a high perceived risk of EVD and 71.6% believed that the vaccine could reduce EVD severity; however, 63.7% believed the vaccine had serious side effects. Among the 474 individuals who had been offered vaccination, 397 (83.8%) received the vaccine, 180 (45.3%) of those vaccinated received the vaccine after two or more offers. Correlates positively associated with vaccine uptake included having heard positive information about the vaccine (RR 1.30, 95% CI 1.06–1.60), the belief that the vaccine could prevent EVD (RR 1.23, 95% CI 1.09–1.39), and reporting that religion influenced all decisions (RR 1.13, 95% CI 1.02–1.25). Ebola vaccine uptake was high in this population, although mixed attitudes and vaccine delays were common. Communicating positive vaccine information, emphasizing the efficacy of the Ebola vaccine, and engaging religious leaders to promote vaccination may aid in increasing Ebola vaccine uptake during future outbreaks.</div

Map of health zones (Beni, Butembo, Mabalako) surveyed in North Kivu, Democratic Republic of the Congo, March 2021.

Source:https://data.humdata.org/dataset/rdc-statistiques-des-populations. (TIFF)</p

Ebola vaccine eligibility, uptake, and the number of offers prior to vaccine receipt, North Kivu, Democratic Republic of the Congo, 2021.

Ebola vaccine eligibility, uptake, and the number of offers prior to vaccine receipt, North Kivu, Democratic Republic of the Congo, 2021.</p

Reasons for declining vaccination among eligible but unvaccinated community members, North Kivu, Democratic Republic of the Congo, 2021.

Reasons for declining vaccination among eligible but unvaccinated community members, North Kivu, Democratic Republic of the Congo, 2021.</p

Correlates of Ebola vaccine uptake, using modified Poisson regression among community members eligible and offered vaccination during the tenth EVD outbreak, North Kivu, Democratic Republic of the Congo, 2021.

Correlates of Ebola vaccine uptake, using modified Poisson regression among community members eligible and offered vaccination during the tenth EVD outbreak, North Kivu, Democratic Republic of the Congo, 2021.</p