Resilience actions of Internally Displaced Persons (IDPs) living in camp-like settings: a Northern Nigeria case study

Background: There are about 55 million Internally Displaced Persons (IDP), and some live in camp settlements, often for protracted periods. However, there is limited evidence on camp management and self-management strategies adopted by camp-dwelling IDPs. This paper reflects on the camp management and health resilience strategies practised by IDPs settled in camp-like settings, based on the first strategic objective of the International Organisation for Migration (IOM) Progressive Resolution of Displacement Situations (PRDS). Methods: Eight focus group discussions were conducted with 49 IDP camp leaders across eight camp-like settings in Northern Nigeria. Issues explored included community structure, leadership, public interaction, communication, and health management. Data were analysed using a framework approach under five factors related to the IOM PRDS first objective. Findings: IDPs exhibited resilience by adapting to their current locations, establishing internal camp and health management structures, and advocating with external organisations. Supportive communal relationships were an integral element in their adaptation. Methods of resilience involved social cohesion, setting up camp leadership committees, and seeking alternative means of income, protection, and healthcare management. Additionally, selecting representatives who could advocate for their well-being allowed them to request support and exercise their rights. Conclusion: Despite resource shortages, the IDPs adapted by setting up techniques for managing their affairs and available resources, finding innovative ways to cater for themselves, advocating for their needs, and supporting each other. These observations showed how displaced populations can be active actors in their change and development if basic and essential management support is provided. Engaging IDPs in camp management could reduce long-term dependency on humanitarian aid.</p

Essential healthcare services provided to conflict-affected internally displaced populations in low and middle-income countries: A systematic review

Background: Conflict and violent crises have resulted in over 40 million of internally displaced persons (IDPs). Most affected regions lack access to basic health resources and generally rely on humanitarian support. The objective of this review was to appraise primary health service interventions among conflict-induced internally displaced populations in low and middle-income countries between 2000 and 2019. Methods: A systematic review of literature in the following databases: Embase, MEDLINE, PsyArticles, PsycINFO, Scopus, Web of Science, LILAC and CAB Articles, was performed to identify interventions implemented in conflict IDP settings. Results: Initial searches yielded 4578 papers and 30 studies met the inclusion criteria. Descriptive synthesis analysis was used, and the final selections were assessed using a customised Critical Appraisal Skills Programme (CASP) checklist. Included papers were from Sub-Saharan Africa, South Asia and the Middle East regions. Most studies were on prevention interventions, especially water treatment and maternal health. Treatment interventions mostly focused on malaria and mental health. Only one food and nutrition study with outcome data was identified, indicating limitations in IDP health-related intervention publications. Reported interventions were conducted between one week to five years, and the study qualities were moderate. The most effective interventions were integrated programmes and common challenges were weak study methodology and data reporting. Conclusion: Regardless of the intervention types and durations, the services offered were beneficial to the IDPs. More intervention evidence are, however required as shown in gaps around food and nutrition, health education and disease surveillance

Association between ethnicity and migration status with the prevalence of single and multiple long-term conditions in UK healthcare workers

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Exploring the influence of health management processes on health outcomes among internally displaced persons (IDPs)

Background: Despite global action and policy initiatives, internally displaced persons (IDPs) experience poor living conditions and lack healthcare access compared to refugees. This study sought to understand the relationship between health management processes and health outcomes among camp-dwelling IDPs in northern Nigeria. Method: 73 individuals participated in either a focus group (n = 49) or one-to-one interview (n = 24), comprising IDPs (n = 49), camp managers (n = 9), health workers (n = 7) and government administrative authorities (n = 8). Interviews explored IDP health management processes, partners and perceptions around camp management. Data were analysed using an inductive thematic approach. Results: Four main themes were identified: opinions about healthcare organisation and management, service availability, interventions and information management, and IDP health outcomes. Though many stakeholders, partnerships, and national and international government agencies were involved in the provision of healthcare services, respondents described efforts as disjointed. Reports suggested that the coordination and management of health services and resources were not tailored to the needs of those living in all camps. And because so many national and international agencies were involved, but under weak coordination, access to services was less than optimal and adequate management of critical public health interventions was lacking. Varied allocation of resources such as funding, medication and medically trained staff were viewed as key factors in the availability and the ability to access what was considered as essential healthcare services. Conclusion: The health of IDPs in camp-like settings was compromised by uncoordinated management, treatment, and control of communicable and non-communicable diseases. Government authorities need to be aware and consider the complexity of the multiagency involvement in the management and provision of IDP healthcare services. Introducing systems to streamline, monitor and support IDP healthcare management could be cost-effective strategies for achieving optimal health care

Perinatal health outcomes of women from Gypsy, Roma and Traveller communities: A systematic review

Background GRT communities are disadvantaged minority groups in Europe and experience some of the poorest health outcomes, including maternal and child health. This systematic review aimed to assess the maternal, perinatal and infant health outcomes of women from GRT communities and the factors associated with the reported outcomes. Methods Database searches were conducted from inception to June 2023 in 4 bibliographic databases supplemented with an additional Google Scholar search. Studies with quantitative data on maternal outcomes published in English were considered. A narrative synthesis was performed, and data were presented in text, figures and tables. Findings Forty-five studies from 13 European countries were included. Outcome factors related to mothers showing low healthcare engagement, high fertility rates and shorter gestation periods among GRT women. Child wantedness was also noted to influence pregnancy completeness, which included abortion and miscarriage. More negative infant outcomes were seen in GRT infants than non-GRT infants; this included higher preterm births, lower birth weight, higher rates of intrauterine growth restriction and infant mortality. Risk factors of poorer maternal outcomes were early reproduction, education, smoking, alcohol consumption, deprivation, poor nutrition and perinatal care. Conclusion This review provides evidence that GRT women and children experience more negative outcomes than general populations. It also highlights the gaps in ethnicity and health inequalities more broadly. The significant importance of this research is the need for increased focus on reducing health inequalities, especially among the GRT community.</p

The views of ethnic minority and vulnerable communities towards participation in COVID-19 vaccine trials.

The COVID-19 pandemic has disproportionately affected Black, Asian and minority ethnic populations and vulnerable groups.1 Ethnic minority communities have 10–50% higher mortality risk compared with those of white ethnicity in the UK and USA.2,3 Those with mental health conditions, homeless people and vulnerable migrants are also at high risk.4,5 If successful, vaccination will provide protection and management of COVID-19, and to ensure optimal uptake and efficacy of vaccination programmes, the involvement of high-risk groups in vaccine trials is crucial. Ethnic minority individuals are, however, generally underrepresented in medical research, and researchers are actively seeking approaches to include more ethnic minorities in COVID-19 vaccine trials.6 There is, therefore, a pressing need to explore perceptions towards participation in vaccine trials amongst ethnic minority and vulnerable communities towards achieving higher recruitment rates

The burden of chronic respiratory diseases in adults in Nepal: A systematic review

While chronic lung disease causes substantial global morbidity and mortality, global estimates have primarily been based on broad assumptions. Specific country data from low-income countries such as Nepal are limited. This review assessed primary evidence on chronic respiratory disease burden among adults in Nepal. A systematic search was performed in June 2019 (updated May 2020) for studies through nine databases. High levels of heterogeneity deemed a narrative synthesis appropriate. Among 27 eligible studies identified, most were low-moderate quality with cross-sectional and retrospective study design. Chronic lung diseases identified were chronic obstructive pulmonary disease (COPD), asthma, bronchiectasis and restrictive lung diseases. Studies were categorised as: (i) community-based, (ii) hospital-based and (iii) comorbidity-related and disease burden. Reported disease prevalence varied widely (COPD, 1.67–14.3%; asthma, 4.2–8.9%). The prevalence of airflow obstruction was higher among rural dwellers (15.8%) and those exposed to household air pollution from domestic biomass burning as opposed to liquid petroleum gas users (Odds Ratio: 2.06). Several comorbidities, including hypertension and diabetes mellitus added to the disease burden. The review shows limited literature on lung disease burden in Nepal. Publications varied in terms of overall quality. Good quality research studies with prospective cohorts related to respiratory conditions are required

Sexual and Reproductive Service Interventions for Menstrual Regulation, Safe Abortion and Post-Abortion Care and Their Effectiveness During Disaster Response: A Global Systematic Review

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Promoting inclusion in clinical trials-a rapid review of the literature and recommendations for action

Background: Without inclusion of diverse research participants, it is challenging to understand how study findings will translate into the real world. Despite this, a lack of inclusion of those from under-served groups in research is a prevailing problem due to multi-faceted barriers acting at multiple levels. Therefore, we rapidly reviewed international published literature, in relation to clinical trials, on barriers relating to inclusion, and evidence of approaches that are effective in overcoming these.  Methods: A rapid literature review was conducted searching PubMed for peer-reviewed articles that discussed barriers to inclusion or strategies to improve inclusion in clinical trial research published between 2010 and 2021. Grey literature articles were excluded.  Results: Seventy-two eligible articles were included. The main barriers identified were language and communication, lack of trust, access to trials, eligibility criteria, attitudes and beliefs, lack of knowledge around clinical trials, and logistical and practical issues. In relation to evidence-based strategies and enablers, two key themes arose: [1] a multi-faceted approach is essential [2]; no single strategy was universally effective either within or between trials. The key evidence-based strategies identified were cultural competency training, community partnerships, personalised approach, multilingual materials and staff, communication-specific strategies, increasing understanding and trust, and tackling logistical barriers.  Conclusions: Many of the barriers relating to inclusion are the same as those that impact trial design and healthcare delivery generally. However, the presentation of these barriers among different under-served groups may be unique to each population’s particular circumstances, background, and needs. Based on the literature, we make 15 recommendations that, if implemented, may help improve inclusion within clinical trials and clinical research more generally. The three main recommendations include improving cultural competency and sensitivity of all clinical trial staff through training and ongoing personal development, the need to establish a diverse community advisory panel for ongoing input into the research process, and increasing recruitment of staff from under-served groups. Implementation of these recommendations may help improve representation of under-served groups in clinical trials which would improve the external validity of associated findings.</p