A systematic review of factors influencing the psychological health of conflict-affected populations in low- and middle-income countries.

BACKGROUND: Elevated levels of poor mental health have been recorded amongst populations affected by armed conflict. The aim of this study was to systematically review existing evidence on the factors influencing general psychological health of conflict-affected populations in low- and middle-income countries. METHODS: Quantitative studies that described statistically significant associations with general psychological health of adult conflict-affected persons in low- and middle-income countries were included. Bibliographic databases and humanitarian agency websites were searched, and a screening, selection and review process was applied. The findings are described using commonly recurring categories of demographic characteristics, socio-economic factors and exposure to traumatic events. RESULTS: Fifteen studies met the inclusion criteria. Factors with an association with worse general psychological health were demographic factors of gender (women), older age and not being married; socio-economic factors, such as low education level, low income and assets, not working, residential status, living conditions and insecurity; and a number of violent and traumatic events including forced displacement - particularly internal displacement. CONCLUSIONS: The evidence base was weak and methodological limitations were noted. Further research is required to better understand the factors influencing general psychological health amongst conflict-affected populations in low- and middle-income countries

The comorbidity of hypertension and psychological distress: a study of nine countries in the former Soviet Union.

BACKGROUND: Mental health problems in those with physical ailments are often overlooked, especially in the former Soviet Union (fSU) where this comorbidity has received little attention. Our study examines the comorbidity of psychological distress and hypertension in the fSU. METHODS: Nationally representative household survey data from Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia and Ukraine in 2001 and 2010 were analysed to compare the levels of psychological distress in people with and without self-reported hypertension. Multivariate regression analysed determinants of psychological distress in hypertensive respondents, and prevalence rate ratios were calculated to compare the change in distress between the two groups. RESULTS: There were significantly higher levels of psychological distress among hypertensive respondents (9.9%) than in the general population (4.9%), and a significant association between the two conditions [odds ratio (OR) = 2.27 (1.91; 2.70)]. Characteristics associated with distress among hypertensive respondents included residing in Armenia or Kyrgyzstan, being female, over age 50, with a poor economic situation, lower education, poor emotional support and limited access to medical drugs. Levels of distress declined between 2001 and 2010, but at a lesser rate in hypertensive respondents [rate ratio (RR) = 0.85 (0.75; 0.95)] than non-hypertensive respondents [RR = 0.65 (0.56; 0.75)]. CONCLUSIONS: There is a significant association between psychological distress and hypertension in the region

User and researcher collaborations in mental health in low and middle income countries: a case study of the EMPOWER project.

BACKGROUND: Increasing recognition has been given to the interaction of users and researchers in shaping the perspective and practice of mental health care. However, there remains very little evidence exploring how this interaction works, particularly in low and middle income countries. The aim of this study was to explore experiences of how users and researchers worked together to communicate research, using a case study of the EMPOWER project. METHODS: The study followed a case-study approach. EMPOWER was a project that sought to strengthen the capacity of user organizations in India, Kenya, Nepal and Zambia by encouraging user-researcher collaborations to communicate research findings in the four countries. A qualitative research method was applied for this study, with semi-structured interviews conducted with seven people: two researchers, one communications developer, and four user group members (one from each of the four countries). Data were analyzed using thematic analysis. RESULTS: The findings indicated positive perceptions of the collaboration between researchers and users. Key themes were partnership and support, the value of the personal experience of users and their knowledge of the target audiences, and empowerment. Key challenges related to differences in levels of education and technical knowledge and the lack of payments to users. CONCLUSIONS: This exploratory study provides insight to help understand collaborative processes for communicating mental health research. It highlights many positive outcomes from the EMPOWER collaboration but also highlights the need for more in-depth research on this issue

The effect of health on labour supply in nine former Soviet Union countries.

This paper examines for the first time the consequences of ill health on labour supply for a sample of nine countries from the former Soviet Union (FSU), using a unique multicountry household survey specifically designed for this region. We control for a wide range of individual, household, and community factors, using both standard regression techniques and instrumental variable estimation to address potential endogeneity. Specifically, we find in our baseline ordinary least squares specification that poor health is associated with a decrease in the probability of working of about 13 %. Controlling for community-level unobserved variables slightly increases the magnitude of this effect, to about 14 %. Controlling for endogeneity with the instrumental variable approach further supports this finding, with the magnitude of the effect ranging from 12 to 35 %. Taken together, our findings confirm the cost that the still considerable adult health burden in the FSU is imposing on its population, not only in terms of the disease burden itself, but also in terms of individuals' labour market participation, as well as potentially in terms of increased poverty risk. Other things being equal, this would increase the expected "return on investment" to be had from interventions aimed at improving health in this region

Implementing a Basic Package of Health Services in post-conflict Liberia: perceptions of key stakeholders.

Recovery of the health sector in post-conflict countries is increasingly initiated through a Basic Package of Health Services (BPHS) approach. The country government and partners, including international donors, typically contract international and local NGOs to deliver the BPHS. Evidence from routine data suggests that a BPHS approach results in rapid increases in service coverage, coordination, equity, and efficiency. However, studies also show progress may then slow down, the cause of which is not immediately obvious from routine data. Qualitative research can provide insight into possible barriers in the implementation process, particularly the role of health workers delivering the BPHS services. The aim of this study was to explore perceptions of health service providers and policy makers on the implementation of the BPHS in post-conflict Liberia, using SRH services as a tracer and Lipsky's work on "street-level bureaucrats" as a theoretical framework. In July-October 2010, 63 interviews were conducted with midwives, officers-in-charge, and supervisors in two counties of Liberia, and with policy makers in Monrovia. The findings suggest health workers had a limited understanding of the BPHS and associated it with low salaries, difficult working conditions, and limited support from policy makers. Health workers responded by sub-optimal delivery of certain services (such as facility-based deliveries), parallel private services, and leaving their posts. These responses risk distorting and undermining the BPHS implementation. There were also clear differences in the perspectives of health workers and policy makers on the BPHS implementation. The findings suggest the need for greater dialogue between policy makers and health workers to improve understanding of the BPHS and recognition of the working conditions in order to help achieve the potential benefits of the BPHS in Liberia

Using COVID-19 responses to help strengthen the mental health system in Lebanon.

This paper describes national-level mental health responses to COVID-19 in Lebanon. It then notes factors that have supported the mental health response, including how COVID-19 represents a window of opportunity to help strengthen the mental health system in Lebanon. (PsycInfo Database Record (c) 2020 APA, all rights reserved)

Prevalence and patterns of hazardous and harmful alcohol consumption assessed using the AUDIT among Bhutanese refugees in Nepal.

AIMS: This study sought to ascertain the prevalence of hazardous and harmful alcohol consumption among Bhutanese refugees in Nepal and to identify predictors of elevated risk in order to better understand intervention need. METHODS: Hazardous and harmful alcohol consumption was assessed using the Alcohol Use Disorder Identification Test (AUDIT) administered in a face-to-face interview in a census of two camps comprising ∼8000 refugees. RESULTS: Approximately 1/5 men and 1/14 women drank alcohol and prevalence of hazardous drinking among current drinkers was high and comparable to that seen in Western countries with longstanding alcohol cultures. Harmful drinking was particularly associated with the use of other substances including tobacco. CONCLUSIONS: Assessment of the alcohol-related needs of Bhutanese refugees has permitted the design of interventions. This study adds to the small international literature on substance use in forced migration populations, about which there is growing concern

Prevalence and factors associated with the use of alternative (folk) medicine practitioners in 8 countries of the former Soviet Union.

BACKGROUND: Research suggests that since the collapse of the Soviet Union there has been a sharp growth in the use of complementary and alternative medicine (CAM) in some former Soviet countries. However, as yet, comparatively little is known about the use of CAM in the countries throughout this region. Against this background, the aim of the current study was to determine the prevalence of using alternative (folk) medicine practitioners in eight countries of the former Soviet Union (fSU) and to examine factors associated with their use. METHODS: Data were obtained from the Living Conditions, Lifestyles and Health (LLH) survey undertaken in eight former Soviet countries (Armenia, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia and Ukraine) in 2001. In this nationally representative cross-sectional survey, 18428 respondents were asked about how they treated 10 symptoms, with options including the use of alternative (folk) medicine practitioners. Multivariate logistic regression analysis was used to determine the factors associated with the treatment of differing symptoms by such practitioners in these countries. RESULTS: The prevalence of using an alternative (folk) medicine practitioner for symptom treatment varied widely between countries, ranging from 3.5% in Armenia to 25.0% in Kyrgyzstan. For nearly every symptom, respondents living in rural locations were more likely to use an alternative (folk) medicine practitioner than urban residents. Greater wealth was also associated with using these practitioners, while distrust of doctors played a role in the treatment of some symptoms. CONCLUSIONS: The widespread use of alternative (folk) medicine practitioners in some fSU countries and the growth of this form of health care provision in the post-Soviet period in conditions of variable licensing and regulation, highlights the urgent need for more research on this phenomenon and its potential effects on population health in the countries in this region

Exploring the influence of the Global Fund and the GAVI Alliance on health systems in conflict-affected countries.

BACKGROUND: Global Health Initiatives (GHIs) respond to high-impact communicable diseases in resource-poor countries, including health systems support, and are major actors in global health. GHIs could play an important role in countries affected by armed conflict given these countries commonly have weak health systems and a high burden of communicable disease. The aim of this study is to explore the influence of two leading GHIs, the Global Fund and the GAVI Alliance, on the health systems of conflict-affected countries. METHODS: This study used an analytical review approach to identify evidence on the role of the Global Fund and the GAVI Alliance with regards to health systems support to 19 conflict-affected countries. Primary and secondary published and grey literature were used, including country evaluations from the Global Fund and the GAVI Alliance. The WHO heath systems building blocks framework was used for the analysis. RESULTS: There is a limited evidence-base on the influence of GHIs on health systems of conflict-affected countries. The findings suggest that GHIs are increasingly investing in conflict-affected countries which has helped to rapidly scale up health services, strengthen human resources, improve procurement, and develop guidelines and protocols. Negative influences include distorting priorities within the health system, inequitable financing of disease-specific services over other health services, diverting staff away from more essential health care services, inadequate attention to capacity building, burdensome reporting requirements, and limited flexibility and responsiveness to the contextual challenges of conflict-affected countries. CONCLUSIONS: There is some evidence of increasing engagement of the Global Fund and the GAVI Alliance with health systems in conflict-affected countries, but this engagement should be supported by more context-specific policies and approaches