Resilience and adjustment trajectories amongst children in displacement-affected communities in Zarqa, Jordan

From Crossref journal articles via Jisc Publications RouterBackground: The experiences of protracted conflict and displacement are clear threats to children’s developmental progress. Understanding the factors that shape the trajectories of children’s well-being and adjustment in such contexts is important for informing interventions.Methods: We collected data at three time points from a sample of Syrian refugee and Jordanian children (n=650) residing in Zarqa, Jordan who met eligibility criteria for humanitarian programming. We assessed primary outcomes of protection concerns, caregiver stress, mental health, and developmental assets at three time points: baseline (T1), three months later (T2), and fifteen months after baseline (T3).Results: Over the fifteen-month study period (T1-T3) child protection concerns and mental health symptoms improved, caregiver stress remained constant, and developmental assets deteriorated. School attendance was independently associated with improvements in protection concerns (β = -1.05, P=0.01), caregiver stress (β = -0.66, P =0.02), and developmental assets (β = 3.84, P =0.02). Concern over lost livelihoods significantly predicted higher protection concerns (β = 4.08, P <0.001) and caregiver stress (β = 2.32, P <0.001). Attending child-focused programming did not significantly impact primary outcomes.Conclusions: This study documents the capacity for adjustment and adaptation of children in the context of protracted displacement. The significant influences of attending school and concern over lost livelihoods on observed trajectories indicate the importance of addressing structural factors, such as education and employment, in supporting processes of resilience in these populations. Programmatic activities for children may secure valuable shorter-term impacts but here, as elsewhere, failed to impact outcomes longer-term.4pubpu

Child friendly spaces impact across five humanitarian settings: a meta-analysis

Background Humanitarian crises present major threats to the wellbeing of children. These threats include risks of violence, abduction and abuse, emotional distress and the disruption of development. Humanitarian response efforts frequently address these threats through psychosocial programming. Systematic reviews have demonstrated the weak evidence-base regarding the impact of such interventions. This analysis assesses the impact of Child Friendly Spaces (CFS), one such commonly implemented intervention after humanitarian emergencies. Methods We completed baseline and endline (three-six months post-baseline) assessments regarding protection concerns, psychosocial wellbeing, developmental assets and community resources for a total of 1010 children and 1312 carers in catchment areas for interventions with humanitarian populations in Ethiopia, Uganda, Iraq, Jordan, and Nepal. We estimated intervention effect-sizes with Cohen’s d for difference in mean difference scores between attenders and non-attenders – who proved comparable on baseline measures – by site. We then pooled findings for a meta-analysis summarizing overall impacts across domains. Results Amongst children aged 6–11, significant intervention impacts were observed through site-level analysis for protection concerns (Ethiopia, Cohen’s d = 0.48, 95% CI 0.08–0.88), psychosocial wellbeing (Ethiopia, d = 0.51, 95% CI 0.10–0.91; and Uganda, d = 0.21, 95% CI 0.02–0.40), and developmental assets (Uganda, d = 0.37, 95% CI 0.15–0.59; and Iraq, d = 0.86, 95% CI 0.18–1.54). Pooled analyses for this age group found impacts of intervention to be significant only for psychosocial wellbeing (d = 0.18, 95% CI 0.03–0.33). Among children aged 12–17, site-level analysis indicated intervention impact for protection concerns in one site (Iraq, d = 0.58, 95% CI 0.07–1.09), with pooled analysis indicating no significant impacts. Conclusion CFS can provide – albeit inconsistently - a protective and promotive environment for younger children. CFS show no impact with older children and in connecting children and carers with wider community resources. A major reappraisal of programming approaches and quality assurance mechanisms is required

Determinants of perceived quality of obstetric care in rural Tanzania: a cross-sectional study

Patients’ reported opinions of the health system need to be understood in order to provide patient-centered care. We investigated determinants of women’s ratings of the quality of care during their most recent facility delivery. We conducted a census of all deliveries in the 6 weeks to 12 months preceding the survey, in villages served by 24 primary care clinics in rural Pwani Region, Tanzania. Women who had delivered children in a study facility were included in this analysis (n = 855). We interviewed women about demographic and obstetric factors and the quality of their obstetric care using a structured questionnaire. We created a composite index of perceived quality from six quality questions. We also assessed the functioning of the local health clinic using structured surveys. We used a multi-level model to analyze factors associated with women’s rating of the quality of care during delivery. 14% of respondents rated the overall quality of care received during delivery as excellent. Women who listened to the radio daily reported lower quality composite scores (β: -0.99, p < 0.001). Women who reported receiving more services in ANC had higher quality scores (β: 0.46, p = 0.001), as did women receiving more delivery services (β: 0.55, p < 0.001). Women who reported disrespect and abuse during delivery had significantly lower quality scores (β: -4.13, p < 0.001). A woman’s expectations and prior and current experiences influence her perception of the quality of care she received. Health facility characteristics did not influence ratings of overall quality. Focusing on improving the process rather than inputs of service delivery during ANC visits and delivery may increase perceived quality of delivery care in low-resource settings. Trial registration: ISRCTN1710776

Child friendly spaces impact across five humanitarian settings: A meta-analysis

Alastair Ager - ORCID 0000-0002-9474-3563 https://orcid.org/0000-0002-9474-3563Background: Humanitarian crises present major threats to the wellbeing of children. These threats include risks of violence, abduction and abuse, emotional distress and the disruption of development. Humanitarian response efforts frequently address these threats through psychosocial programming. Systematic reviews have demonstrated the weak evidence-base regarding the impact of such interventions. This analysis assesses the impact of Child Friendly Spaces (CFS), one such commonly implemented intervention after humanitarian emergencies.Methods: We completed baseline and endline (three-six months post-baseline) assessments regarding protection concerns, psychosocial wellbeing, developmental assets and community resources for a total of 1010 children and 1312 carers in catchment areas for interventions with humanitarian populations in Ethiopia, Uganda, Iraq, Jordan, and Nepal. We estimated intervention effect-sizes with Cohen’s d for difference in mean difference scores between attenders and non-attenders – who proved comparable on baseline measures – by site. We then pooled findings for a meta-analysis summarizing overall impacts across domains.Results: Amongst children aged 6–11, significant intervention impacts were observed through site-level analysis for protection concerns (Ethiopia, Cohen’s d = 0.48, 95% CI 0.08–0.88), psychosocial wellbeing (Ethiopia, d = 0.51, 95% CI 0.10–0.91; and Uganda, d = 0.21, 95% CI 0.02–0.40), and developmental assets (Uganda, d = 0.37, 95% CI 0.15–0.59; and Iraq, d = 0.86, 95% CI 0.18–1.54). Pooled analyses for this age group found impacts of intervention to be significant only for psychosocial wellbeing (d = 0.18, 95% CI 0.03–0.33). Among children aged 12–17, site-level analysis indicated intervention impact for protection concerns in one site (Iraq, d = 0.58, 95% CI 0.07–1.09), with pooled analysis indicating no significant impacts.Conclusion: CFS can provide – albeit inconsistently - a protective and promotive environment for younger children. CFS show no impact with older children and in connecting children and carers with wider community resources. A major reappraisal of programming approaches and quality assurance mechanisms is required.The research was funded by World Vision International, an elrha Research for Health in Humanitarian Crises (R2HC; elrha.org/r2hc) award funded equally by the Wellcome Trust and the UK Department for International Development, and additional funding from the National Institute of Mental Health T32MH096724. The funding sources had no role in the analysis or interpretation of this study.https://doi.org/10.1186/s12889-019-6939-219pubpu

The Child PTSD Symptom Scale: Psychometric properties among earthquake survivors

From PubMed via Jisc Publications RouterEvidence for a single underlying factor structure of posttraumatic stress disorder (PTSD) in children remains elusive. We assessed the underlying factor structure of the Child PTSD Symptom Scale through exploratory (EFA) and confirmatory factor analyses (CFA) in 570 survivors of the 2015 Gorkha earthquake in Nepal. The EFA suggests that the three-factor DSM-IV model fit these data best. The CFA suggests that while the DSM-IV model adequately fit these data, the four-factor King model fit them better. There was no evidence of differential item functioning by age or gender, and internal consistency of the scale was high. PTSD (overall or by factor) was not correlated with functional impairment. Inconsistent psychometric results across contexts and methodologies suggest that our current theoretical conceptualizations and empirical models of posttraumatic stress are lacking. Future studies must both document the instrument properties to assure internal validity and cross-study comparisons and, bolstered by increased psychometric data and analyses, rework theoretical models of PTSD with improved cross-cultural validity.The research was funded by World Vision International (ended 2015), an elrha R2HC award from the Wellcome Trust and DFID (ended 2016), and additional funding from the National Institute of Mental Health (T32MH096724 and R01MH110872). The funding sources had no role in the analysis or interpretation of this study. Dr. Sabrina Hermosilla received funding from the National Institute of Mental Health (T32MH096724 and R01MH110872) to complete analytic and dissemination-related activities on this manuscript.pubpu

Tuberculosis in Kazakhstan: analysis of risk determinants in national surveillance data

Development of tuberculosis (TB) is determined by various risk factors and the interactions of temporal and spatial distributions. The aim of this study was to identify the most salient risk factors for TB disease as well as multidrug resistant TB (MDR-TB) at the oblast (provincial) level in Kazakhstan

Actividad física, salud mental y apoyo psicosocial

La actividad física (incluido el deporte) es una estrategia con base empírica, aunque poco reconocida, para proteger y promover la SMAPS entre las poblaciones desplazadas

Identifying risk factors associated with smear positivity of pulmonary tuberculosis in Kazakhstan

Background Sputum smear-positive tuberculosis (TB) patients have a high risk of transmission and are of great epidemiological and infection control significance. Little is known about the smearpositive populations in high TB burden regions, such as Kazakhstan. The objective of this study is to characterize the smear-positive population in Kazakhstan and identify associated modifiable risk factors. Methods Data on incident TB cases’ (identified between April 2012 and March 2014) socio-demographic, risk behavior, and comorbidity characteristics were collected in four regions of Kazakhstan through structured survey and medical record review. We used multivariable logistic regression to determine factors associated with smear positivity. Results Of the total sample, 193 (34.3%) of the 562 study participants tested smear-positive. In the final adjusted multivariable logistic regression model, sex (adjusted odds ratio (aOR) = 2.0, 95% CI:1.3–3.1, p < 0.01), incarceration (aOR = 3.6, 95% CI:1.2–11.1, p = 0.03), alcohol dependence (aOR = 2.6, 95% CI:1.2–5.7, p = 0.02), diabetes (aOR = 5.0, 95% CI:2.4–10.7, p < 0.01), and physician access (aOR = 2.7, 95% CI:1.3–5.5p < 0.01) were associated with smear-positivity. Conclusions Incarceration, alcohol dependence, diabetes, and physician access are associated with smear positivity among incident TB cases in Kazakhstan. To stem the TB epidemic, screening, treatment and prevention policies should address these factors

Protocol for a caregiver psychosocial support intervention for populations affected by displacement in Uganda

Background Child psychological distress in refugee settings is a significant public health concern, which is exacerbated by poor caregiver mental health and functioning. However, there are limited studies about effective interventions to improve caregiver mental health in support of child wellbeing. The objective of the current study is to evaluate the effectiveness and implementation of the Journey of Life (JoL) intervention to improve caregiver mental health in a refugee camp in Western Uganda. Methods A waitlist-control quasi-experimental design is being implemented in the Kiryandongo refugee settlement (intervention n = 600, control n = 600). Caregiver mental distress, measured using the Kessler-6, was selected as the primary outcome. Secondary outcomes include (a) functioning measured by the World Health Organization Disability Assessment Schedule, (b) social support measured by the Medical Outcomes Study Social Support Survey, and (c) caregiving behaviors according to the Parental Acceptance and Rejection Questionnaire and the Child Protection Index. The study aims to examine the implementation of the JoL intervention through qualitative assessments of intervention feasibility, adaptations, and reach. Discussion This trial will add much-needed evidence for the implementation of caregiver psychosocial programming within the humanitarian community. Findings will be disseminated amongst local, regional, and global actors in order to guide potential scale up within humanitarian settings. Trial registration Clinical Trials NCT04817098 (Registered: 3/24/21)

Ensuring equity in mental health and psychosocial support during the COVID-19 pandemic and beyond

Populations affected by armed conflict and other humanitarian crises are at elevated risk for mental health problems. While the COVID-19 pandemic has had broadly deleterious effects on livelihoods, economic well-being, and population health worldwide, vulnerable groups have been disproportionately impacted by the pandemic. Providing mental health and psychosocial support (MHPSS) services during these times to vulnerable groups, especially in low- and middle-income countries and humanitarian settings, is essential. In an effort to comply with the public health response to the pandemic and mitigate COVID-19 transmission, significant implementation adaptations were made to service delivery during the pandemic. This short report describes several strategies to ensure that equity was central to these adaptations and public health responses, and provides recommendations for ensuring continuity of this progress post-pandemic. Examples and key lessons learned are given related to strategies to increase access to MHPSS services, improve meaningful stakeholder engagement, develop and support community networks, and implement community-based psychosocial support groups. They come from diverse settings of Bangladesh, Colombia, Ecuador, and Lebanon. The COVID-19 pandemic has highlighted the importance of preventing and treating MHPSS issues. It also has created opportunities for innovative programming to address overlooked problems, improve the quality of services provided, and increase focus on equity. It is vital that we use the momentum and attention generated around MHPSS services during the COVID-19 pandemic to continue to build and improve existing MHPSS services in more equitable ways for vulnerable populations