Psychosocial support for adolescent girls in post-conflict settings: beyond a health systems approach

Adaptive and adequately resourced health systems are necessary to achieve good health outcomes in post-conflict settings, however domains beyond the health system are also critical to ensure broader wellbeing. This paper focuses on the importance of psychosocial support services for adolescent girls in fragile contexts. Its starting point is that adolescence is a pivotal time in the life course but given the physical, cognitive and emotional changes triggered by the onset of puberty, it can also be a period of heightened sensitivity and vulnerability to trauma, social isolation, bullying by peers, a lack of supportive adults and gender-based and sexual violence. Our findings highlight why humanitarian and biomedical approaches in their current form are inadequate to address these complexities. Drawing on qualitative fieldwork (consisting of in-depth and key informant interviews as well as group discussions in Gaza, Liberia and Sri Lanka involving a total of 386 respondents across the three countries), we argue that going beyond biomedical approaches and considering the social determinants of health, including approaches to tackle discriminatory gendered norms and barriers to service access, are critical for achieving broader health and wellbeing. While all three case study countries are classified as post-conflict, the political economy dynamics vary with associated implications for experiences of psychosocial vulnerabilities and the service environment. The study concludes by reflecting on actions to address psychosocial vulnerabilities facing adolescent girls. These include: tailoring services to ensure gender and age-sensitivity; investing in capacity building of service providers to promote service uptake; and enhancing strategies to regulate and coordinate actors providing mental health and psychosocial support services.Acknowledgements We would like to acknowledge the support of a number of people. In Liberia, The Liberia Center for Outcomes Research led this work supported by Janice Cooper, with Abayomi Cole and Elton Gbollie as research coordinators. In Sri Lanka the work was led by the Good Practice Group and in particular Kusala Wettesinghe, Sarala Emmanuel and Ananda Galappatti. In Gaza the study was led by Bassam Abu Hamad and Nadja Al Bayoumi from Al Quds University. We would also like to thank all the data collectors in the three countries. We also want to acknowledge support from Maria Stavropoulou for her work on the background literature review and Ingrid Gercama for support on data analysis. The Research in Gender and Ethics (RinGs): Building Stronger Health Systems Partnership (funded by DFID) provided invaluable inputs during the development and revision of this paper. Finally, we would like to thank all respondents for giving us their time and sharing their stories with us. Funding This study was funded by the ReBUILD consortium, a multi-year multi-country UK Department for International Development (DFID) funded research programme, and we would like to thank them for their ongoing support and contribution to this research. The views expressed within this paper are not necessarily those of DFID

Intersectionality as a framework for understanding adolescent vulnerabilities in low and middle income countries: Expanding our commitment to leave no one behind

Given increasing policy attention to the consequences of youth marginalisation for development processes, engaging with the experiences of socially marginalised adolescents in low- and middle-income countries (including those who are out of school, refugees, married, with disabilities or adolescent parents) is a pressing priority. To understand how these disadvantages—and adolescents’ abilities to respond to them—intersect to shape opportunities and outcomes, this Special Issue draws on the Gender and Adolescence: Global Evidence conceptual framework which accounts for gender roles and norms, family, community and political economy contexts in shaping adolescents’ capabilities. Implicitly critiquing a focus within youth studies on individual agency, the articles advance our understanding of how adolescents’ marginalisation is shaped by their experiences, social identities and the contexts in which they are growing up. An analytical framework foregrounding intersectionality and collective capabilities offers a means to politicise these findings and challenge uncritical academic celebration of individual agency as the means to address structural problems

Holistic Assessment of Community Palliative Care Needs Among Palestinian Cancer Patients

Background: Palliative care focuses on improving the quality of life of terminally ill patients and their families. Objectives: This cross-sectional study aims to assess the level of community palliative care among terminally ill Palestinian cancer patients and the needs of their families in the West-Bank and Gaza strip. Methodology: A cross-sectional survey was conducted among cancer patients. Patients were recruited through five hospitals that provide cancer care in the West Bank and Gaza Strip (Al-Hussein Hospital, Beit Jala; Augusta Victoria Hospital, Jerusalem; Istishari Arab Hospital, Ramallah; European Hospital and Abd Al-Aziz Al-Rantisi Hospital; Gaza). Data were collected using an interview-based questionnaire. The questionnaire focused on assessment of physical, psychosocial, emotional, and spiritual components of palliative care. In addition, the questionnaire assessed caregiver’s needs. Results: A total of 238 patients were interviewed. The mean age of the participants was 53.8±15 years. The most common types of cancer among patients were breast cancer (51 [21.4%]) and colorectal cancer (33 [13.9%]). Fifty percent of the patients had their children as their primary caregivers. Overall, the majority of the patients had good psychosocial, spiritual, and emotional scores. On the other hand, >80% had moderate to poor physical functioning scores. Psychosocial and emotional scores decreased significantly as the disease progressed. More than 33% of the patients reported that their caregivers were in need of financial, legal, and work-related support. In addition, other commonly reported unmet needs included support in understanding what to expect in the future and dealing with the feelings and worries of the patient. Conclusions: Cancer patients suffer mostly from their physical symptoms in addition to financial problems. On the other hand, assessment of the emotional, spiritual and psychological functioning of Palestinian patients indicates that the strength of religious beliefs and the support of the family and the friends in the Palestinian community had a great impact on the patients and help reduced the gap in palliative care services

Creating a better post-pandemic future for adolescents with disabilities

Adolescents with disabilities must have their needs prioritised in recovery and future pandemic responses to improve health, educational, and social outcomes, argue Sarah Baird and colleagues

SARS-CoV-2 Infection Is at Herd Immunity in the Majority Segment of the Population of Qatar.

BACKGROUND: Qatar experienced a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic that disproportionately affected the craft and manual worker (CMW) population, who comprise 60% of the total population. This study aimed to assess ever and/or current infection prevalence in this population. METHODS: A cross-sectional population-based survey was conducted during July 26 to September 09, 2020, to assess both anti-SARS-CoV-2 positivity through serological testing and current infection positivity through polymerase chain reaction (PCR) testing. Associations with antibody and PCR positivity were identified through regression analyses. RESULTS: The study included 2641 participants, 69.3% of whom were <40 years of age. Anti-SARS-CoV-2 positivity was 55.3% (95% CI, 53.3%-57.3%) and was significantly associated with nationality, geographic location, educational attainment, occupation, and previous infection diagnosis. PCR positivity was 11.3% (95% CI, 9.9%-12.8%) and was significantly associated with nationality, geographic location, occupation, contact with an infected person, and reporting 2 or more symptoms. Infection positivity (antibody and/or PCR positive) was 60.6% (95% CI, 58.6%-62.5%). The proportion of antibody-positive CMWs who had a prior SARS-CoV-2 diagnosis was 9.3% (95% CI, 7.9%-11.0%). Only seven infections were ever severe, and only 1 was ever critical-an infection severity rate of 0.5% (95% CI, 0.2%-1.0%). CONCLUSIONS: Six in every 10 CMWs in Qatar have been infected, suggestive of reaching the herd immunity threshold. Infection severity was low, with only 1 in every 200 infections progressing to be severe or critical. Only 1 in every 10 infections had been previously diagnosed, which is suggestive of mostly asymptomatic or mild infections

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Automated Detection of Left Bundle Branch Block from ECG Signal Utilizing the Maximal Overlap Discrete Wavelet Transform with ANFIS

Left bundle branch block (LBBB) is a common disorder in the heart’s electrical conduction system that leads to the ventricles’ uncoordinated contraction. The complete LBBB is usually associated with underlying heart failure and other cardiac diseases. Therefore, early automated detection is vital. This work aimed to detect the LBBB through the QRS electrocardiogram (ECG) complex segments taken from the MIT-BIH arrhythmia database. The used data contain 2655 LBBB (abnormal) and 1470 normal signals (i.e., 4125 total signals). The proposed method was employed in the following steps: (i) QRS segmentation and filtration, (ii) application of the Maximal Overlapped Discrete Wavelet Transform (MODWT) on the ECG R wave, (iii) selection of the detailed coefficients of the MODWT (D2, D3, D4), kurtosis, and skewness as extracted features to be fed into the Adaptive Neuro-Fuzzy Inference System (ANFIS) classifier. The obtained results proved that the proposed method performed well based on the achieved sensitivity, specificity, and classification accuracies of 99.81%, 100%, and 99.88%, respectively (F-Score is equal to 0.9990). Our results showed that the proposed method was robust and effective and could be used in real clinical situations

Compounding inequalities: Adolescent psychosocial wellbeing and resilience among refugee and host communities in Jordan during the COVID-19 pandemic

PURPOSE: The COVID-19 pandemic and associated risk-mitigation strategies have altered the social contexts in which adolescents in low- and middle-income countries live. Little is known, however, about the impacts of the pandemic on displaced populations, and how those impacts differ by gender and life stage. We investigate the extent to which the pandemic has compounded pre-existing social inequalities among adolescents in Jordan, and the role support structures play in promoting resilience. METHODS: Our analysis leverages longitudinal quantitative survey data and in-depth qualitative interviews, collected before and after the onset of COVID-19, with over 3,000 Syrian refugees, stateless Palestinians and vulnerable Jordanians, living in camps, host communities and informal tented settlements. We utilize mixed-methods analysis combining multivariate regression with deductive qualitative tools to evaluate pandemic impacts and associated policy responses on adolescent wellbeing and mental health, at three and nine months after the pandemic onset. We also explore the role of support systems at individual, household, community, and policy levels. FINDINGS: We find the pandemic has resulted in severe economic and service disruptions with far-reaching and heterogenous effects on adolescent wellbeing. Nine months into the pandemic, 19.3% of adolescents in the sample presented with symptoms of moderate-to severe depression, with small signs of improvement (3.2 percentage points [pp], p\u3c0.001). Two thirds of adolescents reported household stress had increased during the pandemic, especially for Syrian adolescents in host communities (10.7pp higher than any other group, p\u3c0.001). Social connectedness was particularly low for girls, who were 13.4 percentage points (p\u3c0.001) more likely than boys to have had no interaction with friends in the past 7 days. Adolescent programming shows signs of being protective, particularly for girls, who were 8.8 percentage points (p\u3c0.01) more likely to have a trusted friend than their peers who were not participating in programming. CONCLUSIONS: Pre-existing social inequalities among refugee adolescents affected by forced displacement have been compounded during the COVID-19 pandemic, with related disruptions to services and social networks. To achieve Sustainable Development Goal targets to support healthy and empowered development in adolescence and early adulthood requires interventions that target the urgent needs of the most vulnerable adolescents while addressing population-level root causes and determinants of psychosocial wellbeing and resilience for all adolescent girls and boys

Compounding inequalities: Adolescent psychosocial wellbeing and resilience among refugee and host communities in jordan during the COVID-19 pandemic

Purpose: The COVID-19 pandemic and associated risk-mitigation strategies have altered the social contexts in which adolescents in low- and middle-income countries live. Little is known, however, about the impacts of the pandemic on displaced populations, and how those impacts differ by gender and life stage. We investigate the extent to which the pandemic has compounded pre-existing social inequalities among adolescents in Jordan, and the role support structures play in promoting resilience. Methods: Our analysis leverages longitudinal quantitative survey data and in-depth qualitative interviews, collected before and after the onset of COVID-19, with over 3,000 Syrian refugees, stateless Palestinians and vulnerable Jordanians, living in camps, host communities and informal tented settlements. We utilize mixed-methods analysis combining multivariate regression with deductive qualitative tools to evaluate pandemic impacts and associated policy responses on adolescent wellbeing and mental health, at three and nine months after the pandemic onset. We also explore the role of support systems at individual, household, community, and policy levels. Findings: We find the pandemic has resulted in severe economic and service disruptions with far-reaching and heterogenous effects on adolescent wellbeing. Nine months into the pandemic, 19.3% of adolescents in the sample presented with symptoms of moderate-to severe depression, with small signs of improvement (3.2 percentage points [pp], pConclusions: Pre-existing social inequalities among refugee adolescents affected by forced displacement have been compounded during the COVID-19 pandemic, with related disruptions to services and social networks. To achieve Sustainable Development Goal targets to support healthy and empowered development in adolescence and early adulthood requires interventions that target the urgent needs of the most vulnerable adolescents while addressing population-level root causes and determinants of psychosocial wellbeing and resilience for all adolescent girls and boys