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Agarwal A, Surti V, Terry MA. Recommendations to improve maternal mortality among Rohingya women in Bangladeshi refugee camps. Health Care Women Int 2024:1-12. [PMID: 38743403 DOI: 10.1080/07399332.2024.2349820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 04/26/2024] [Indexed: 05/16/2024]
Abstract
Despite current humanitarian efforts, The Rohingya in Bangladesh's refugee camps have among the highest maternal mortality worldwide. The authors review maternal mortality within Rohingya refugee populations in Bangladesh, citing the camp conditions and cultural norms that affect the Maternal Mortality Ratio (MMR). Next, the authors review current humanitarian efforts made by the UNFPA toward improving reproductive health. Finally, the authors recommend a three-pronged approach to reducing maternal mortality among the Rohingya in Bangladeshi refugee camps. We suggest using Maternity Waiting Homes, Mama Rickshaws, and Traditional Birth Attendants to improve maternal health. These solutions address the three-delays model and place ownership into the community. Ultimately, the authors address a much-needed gap in the literature addressing Rohingya maternal mortality.
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Affiliation(s)
| | - Vidya Surti
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Habboush A, Ekzayez A, Gilmore B. A framework for community health worker optimisation in conflict settings: prerequisites and possibilities from Northwest Syria. BMJ Glob Health 2023; 8:e011837. [PMID: 37407227 PMCID: PMC10335591 DOI: 10.1136/bmjgh-2023-011837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 06/05/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND The world will face a human resource gap of 10 million health workers in 2030. Community health workers (CHWs) can contribute to mitigating this workforce gap while improving equitable access to care and health outcomes. However, questions on how to best implement and optimise CHW programmes, especially across varied contexts, remain. As each context has its determinants for a successful CHW programme, this research identifies and assesses pertinent factors needed for optimal CHW programmes in conflict settings, specifically Northwest Syria. METHODS A mixed-methods study in Northwest Syria consisting of a literature and document review, semistructured interviews with CHWs' team leaders and programme managers, key informant interviews with policymakers and a survey with CHWs was conducted across three research phases from 2018 to 2022. The three phases aimed to identify, refine and finalise a framework for CHW optimisation in humanitarian conflict contexts, respectively. Qualitative data were analysed thematically, and quantitative data were statistically analysed to identify critical trends. RESULTS 16 interviews and 288 surveys were conducted, supplemented by key reports and literature. The framework underwent two iterative rounds of refinement, reflecting varying stakeholders' perceptions of CHW optimisation. The resulting framework presents important implementation factors with subthemes across identified topics of institutionalisation, integration and representation for CHW optimisation in Northwest Syria and other humanitarian conflict contexts. The presented factors are similar in various ways to other fragile low/middle-income country settings. However, in protracted conflict settings like Syria, careful consideration should be given to strategic dimensions such as integration and representation. CONCLUSION For CHW programmes to impact health outcomes in humanitarian conflict settings, they require a set of implementation and design factors relevant to the context. The dynamics of humanitarian funding restrictions, health system capacity and governance structures confront achieving these requirements. Nevertheless, pioneering projects which use available resources are possible. Evidence is needed to understand the impact of CHWs' interventions and further support implementation across humanitarian contexts.
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Affiliation(s)
- Ahmad Habboush
- Research for Health System Strengthening in Syria, UOSSM, Gaziantep, Turkey
- Health Systems, Syria Public Health Network, London, UK
| | - Abdulkarim Ekzayez
- Health Systems, Syria Public Health Network, London, UK
- War Studies, King's College London, London, UK
| | - Brynne Gilmore
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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Perera S, Maung C, Hla S, Moo Moo H, Than Lwin S, Bruck C, Smith T, Bakker M, Akhoon C, Sarkar IN. Access to community-based reproductive health services and incidence of low birthweight delivery among refugee and displaced mothers: a retrospective study in the Thailand-Myanmar border region. BMJ Open 2022; 12:e052571. [PMID: 35105627 PMCID: PMC8804650 DOI: 10.1136/bmjopen-2021-052571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Over 2.4 million people have been displaced within the Thailand-Myanmar border region since 1988. The efficacy of community-driven health models within displaced populations is largely unstudied. Here, we examined the relationship between maternal healthcare access and delivery outcomes to evaluate the impact of community-provided health services for marginalised populations. SETTING Study setting was the Thailand-Myanmar border region's single largest provider of reproductive health services to displaced mothers. PARTICIPANTS All women who had a delivery (n=34 240) between 2008 and 2019 at the study clinic were included in the performed retrospective analyses. PRIMARY AND SECONDARY OUTCOME MEASURES Low birth weight was measured as the study outcome to understand the relationship between antenatal care access, family planning service utilisation, demographics and healthy deliveries. RESULTS First trimester (OR=0.86; 95% CI=0.81 to 0.91) and second trimester (OR=0.86; 95% CI=0.83 to 0.90) antenatal care visits emerged as independent protective factors against low birthweight delivery, as did prior utilisation of family planning services (OR=0.82; 95% CI=0.73 to 0.92). Additionally, advanced maternal age (OR=1.36; 95% CI=1.21 to 1.52) and teenage pregnancy (OR=1.27, 95% CI=1.13 to 1.42) were notable risk factors, while maternal gravidity (OR=0.914; 95% CI=0.89 to 0.94) displayed a protective effect against low birth weight. CONCLUSION Access to community-delivered maternal health services is strongly associated with positive delivery outcomes among displaced mothers. This study calls for further inquiry into how to best engage migrant and refugee populations in their own reproductive healthcare, in order to develop resilient models of care for a growing displaced population globally.
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Affiliation(s)
- Sudheesha Perera
- Center for Biomedical Informatics, Brown University, Providence, Rhode Island, USA
| | | | | | | | | | | | | | | | | | - Indra Neil Sarkar
- Center for Biomedical Informatics, Brown University, Providence, Rhode Island, USA
- Rhode Island Quality Institute, Providence, Rhode Island, USA
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Cantor D, Swartz J, Roberts B, Abbara A, Ager A, Bhutta ZA, Blanchet K, Madoro Bunte D, Chukwuorji JC, Daoud N, Ekezie W, Jimenez-Damary C, Jobanputra K, Makhashvili N, Rayes D, Restrepo-Espinosa MH, Rodriguez-Morales AJ, Salami B, Smith J. Understanding the health needs of internally displaced persons: A scoping review. J Migr Health 2021; 4:100071. [PMID: 34820657 PMCID: PMC8600058 DOI: 10.1016/j.jmh.2021.100071] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 10/26/2021] [Accepted: 10/26/2021] [Indexed: 11/01/2022] Open
Abstract
We seek to strengthen understanding of the health needs of internally displaced persons (IDPs) in contexts of conflict or violence. Based upon a scoping review, our paper identified limited evidence on IDP health, but nevertheless indicates that IDPs tend to experience worse health outcomes than other conflict-affected populations across a range of health issues; and this is due to the particularly vulnerable situation of IDPs relative to these other populations, including reduced access to health services. Further research is required to better understand these needs and the interventions that can most effectively address these needs.
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Affiliation(s)
- David Cantor
- Internal Displacement Research Programme, School of Advanced Study, University of London, UK
| | | | - Bayard Roberts
- Health Services Research and Policy Department, London School of Hygiene and Tropical Medicine, UK
| | - Aula Abbara
- Department of Infectious Disease, Imperial College London, London, UK; Syria Public Health Network
| | - Alastair Ager
- Institute for Global Health & Development, Queen Margaret University, Edinburgh, UK
- Mailman School of Public Health, Columbia University, USA
| | | | - Karl Blanchet
- Geneva Centre of Humanitarian Studies, University of Geneva, Switzerland
| | | | | | - Nihaya Daoud
- Department of Public Health, Ben-Gurion University of the Negev, Israel
| | | | | | | | | | - Diana Rayes
- Johns Hopkins Bloomberg School of Public Health, USA
| | | | - Alfonso J. Rodriguez-Morales
- Grupo de Investigación Biomedicina, Fundacion Universitaria Autónoma de las Americas, Colombia
- Universidad Cientifica del Sur, Peru
| | | | - James Smith
- Elrha; Health in Humanitarian Crises Centre, London School of Hygiene and Tropical Medicine, UK
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Miller NP, Ardestani FB, Dini HS, Shafique F, Zunong N. Community health workers in humanitarian settings: Scoping review. J Glob Health 2021; 10:020602. [PMID: 33312508 PMCID: PMC7719274 DOI: 10.7189/jogh.10.020602] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background There is a need for greater understanding of experiences implementing community-based primary health care in humanitarian settings and of the adjustments needed to ensure continuation of essential services and utilization of services by the population, and to contribute to effective emergency response. We reviewed the evidence base on community health workers (CHWs) in humanitarian settings, with the goal of improving delivery of essential services to the most vulnerable populations. Methods We conducted a scoping review of published and grey literature related to health and nutrition services provided by CHWs in humanitarian settings. Extracted data from retained documents were analyzed inductively for key themes. Results Of 3709 documents screened, 219 were included in the review. Key findings from the literature include: 1) CHWs were often able to continue providing services during acute and protracted crises, including prolonged periods of conflict and insecurity and during population displacement. 2) CHWs carried out critical emergency response activities during acute crises. 3) Flexible funding facilitated transitions between development and humanitarian programming. 4) Communities that did not have a locally-resident CHW experienced reduced access to services when travel was limited. 5) Community selection of CHWs and engagement of respected local leaders were crucial for community trust and acceptance and high utilization of services. 6) Selection of local supervisors and use of mobile phones facilitated continued supervision. 7) Actions taken to maintain supplies included creating parallel supply chains, providing buffer stocks to CHWs, and storing commodities in decentralized locations. 8) When travel was restricted, reporting and data collection were continued using mobile phones and use of local data collectors. 9) CHWs and supervisors faced security threats and psychological trauma as a result of their work. Conclusions To achieve impact, policy makers and program implementers will have to address the bottlenecks to CHW service delivery common in stable low-income settings as well as the additional challenges unique to humanitarian settings. Future interventions should take into account the lessons learned from years of experience with implementation of community-based primary health care in humanitarian settings. There is also a need for rigorous assessments of community-based primary health care interventions in humanitarian settings.
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Affiliation(s)
- Nathan P Miller
- UNICEF, New York, USA.,Columbia University Mailman School of Public Health, New York, USA
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Munyuzangabo M, Gaffey MF, Khalifa DS, Als D, Ataullahjan A, Kamali M, Jain RP, Meteke S, Radhakrishnan A, Shah S, Siddiqui FJ, Bhutta ZA. Delivering maternal and neonatal health interventions in conflict settings: a systematic review. BMJ Glob Health 2021; 5:e003750. [PMID: 33608264 PMCID: PMC7903125 DOI: 10.1136/bmjgh-2020-003750] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 01/15/2021] [Accepted: 01/26/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND While much progress was made throughout the Millennium Development Goals era in reducing maternal and neonatal mortality, both remain unacceptably high, especially in areas affected by humanitarian crises. While valuable guidance on interventions to improve maternal and neonatal health in both non-crisis and crisis settings exists, guidance on how best to deliver these interventions in crisis settings, and especially in conflict settings, is still limited. This systematic review aimed to synthesise the available literature on the delivery on maternal and neonatal health interventions in conflict settings. METHODS We searched MEDLINE, Embase, CINAHL and PsycINFO databases using terms related to conflict, women and children, and maternal and neonatal health. We searched websites of 10 humanitarian organisations for relevant grey literature. Publications reporting on conflict-affected populations in low-income and middle-income countries and describing a maternal or neonatal health intervention delivered during or within 5 years after the end of a conflict were included. Information on population, intervention, and delivery characteristics were extracted and narratively synthesised. Quantitative data on intervention coverage and effectiveness were tabulated but no meta-analysis was undertaken. RESULTS 115 publications met our eligibility criteria. Intervention delivery was most frequently reported in the sub-Saharan Africa region, and most publications focused on displaced populations based in camps. Reported maternal interventions targeted antenatal, obstetric and postnatal care; neonatal interventions focused mostly on essential newborn care. Most interventions were delivered in hospitals and clinics, by doctors and nurses, and were mostly delivered through non-governmental organisations or the existing healthcare system. Delivery barriers included insecurity, lack of resources and lack of skilled health staff. Multi-stakeholder collaboration, the introduction of new technology or systems innovations, and staff training were delivery facilitators. Reporting of intervention coverage or effectiveness data was limited. DISCUSSION The relevant existing literature focuses mostly on maternal health especially around the antenatal period. There is still limited literature on postnatal care in conflict settings and even less on newborn care. In crisis settings, as much as in non-crisis settings, there is a need to focus on the first day of birth for both maternal and neonatal health. There is also a need to do more research on how best to involve community members in the delivery of maternal and neonatal health interventions. PROSPERO REGISTRATION NUMBER CRD42019125221.
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Affiliation(s)
- Mariella Munyuzangabo
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michelle F Gaffey
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Dina S Khalifa
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Daina Als
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Anushka Ataullahjan
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mahdis Kamali
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Reena P Jain
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sarah Meteke
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Amruta Radhakrishnan
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Shailja Shah
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Fahad J Siddiqui
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
- Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
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Rajbangshi PR, Nambiars D, Srivastava A. "We wish to have good medical care": findings from a qualitative study on reproductive and maternal health of internally displaced women in India. Sex Reprod Health Matters 2021; 29:2059324. [PMID: 35486074 PMCID: PMC9067944 DOI: 10.1080/26410397.2022.2059324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Internally displaced women are underserved by health schemes and policies, even as they may face greater risk of violence and unplanned pregnancies, among other burdens. There are an estimated 450,000 internally displaced persons in India, but they are not formally recognised as a group. Displacement has been a common feature in India's northeast region. This paper examines reproductive and maternal health (RMH) care-seeking among Bru displaced women in India. The study employed qualitative methodology: four focus group discussions (FGDs) were held with 49 displaced Bru women aged 18-45 between June and July 2018; three follow-up interviews with FGD participants and five in-depth interviews with community health workers (Accredited Social Health Activists - ASHAs) in camps for Bru displaced people in the Indian state of Tripura. All interviewees gave written or verbal informed consent; discussions were conducted in the local dialect, recorded, and transcribed. Data were indexed deductively from a dataset coded using grounded approaches. Most women were unaware of many of the RMH services provided by health facilities; very few accessed such care. ASHAs had helped increase institutional deliveries over the years. Women were aware of temporary contraceptive methods as well as medical abortion, but lacked awareness of the full range of contraceptive options. Challenges in accessing RMH services included distance of facilities from camps, and multiple costs (for transport, medicines, and informal payments to facility staff). The study highlighted a need for comprehensive intervention to improve RMH knowledge, attitudes, and practices among displaced women and to reduce access barriers.
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Affiliation(s)
- Preety R Rajbangshi
- Senior Research Fellow, Public Health Foundation of India, New Delhi, India. Correspondence:
| | - Devaki Nambiars
- Senior Research Scientist, Public Health Foundation of India, New Delhi, India
| | - Aradhana Srivastava
- Senior Research Scientist, Public Health Foundation of India, New Delhi, India
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Bou-Karroum L, El-Harakeh A, Kassamany I, Ismail H, El Arnaout N, Charide R, Madi F, Jamali S, Martineau T, El-Jardali F, Akl EA. Health care workers in conflict and post-conflict settings: Systematic mapping of the evidence. PLoS One 2020; 15:e0233757. [PMID: 32470071 PMCID: PMC7259645 DOI: 10.1371/journal.pone.0233757] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 05/13/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Health care workers (HCWs) are essential for the delivery of health care services in conflict areas and in rebuilding health systems post-conflict. OBJECTIVE The aim of this study was to systematically identify and map the published evidence on HCWs in conflict and post-conflict settings. Our ultimate aim is to inform researchers and funders on research gap on this subject and support relevant stakeholders by providing them with a comprehensive resource of evidence about HCWs in conflict and post-conflict settings on a global scale. METHODS We conducted a systematic mapping of the literature. We included a wide range of study designs, addressing any type of personnel providing health services in either conflict or post-conflict settings. We conducted a descriptive analysis of the general characteristics of the included papers and built two interactive systematic maps organized by country, study design and theme. RESULTS Out of 13,863 identified citations, we included a total of 474 studies: 304 on conflict settings, 149 on post-conflict settings, and 21 on both conflict and post-conflict settings. For conflict settings, the most studied counties were Iraq (15%), Syria (15%), Israel (10%), and the State of Palestine (9%). The most common types of publication were opinion pieces in conflict settings (39%), and primary studies (33%) in post-conflict settings. In addition, most of the first and corresponding authors were affiliated with countries different from the country focus of the paper. Violence against health workers was the most tackled theme of papers reporting on conflict settings, while workforce performance was the most addressed theme by papers reporting on post-conflict settings. The majority of papers in both conflict and post-conflict settings did not report funding sources (81% and 53%) or conflicts of interest of authors (73% and 62%), and around half of primary studies did not report on ethical approvals (45% and 41%). CONCLUSIONS This systematic mapping provides a comprehensive database of evidence about HCWs in conflict and post-conflict settings on a global scale that is often needed to inform policies and strategies on effective workforce planning and management and in reducing emigration. It can also be used to identify evidence for policy-relevant questions, knowledge gaps to direct future primary research, and knowledge clusters.
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Affiliation(s)
- Lama Bou-Karroum
- Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Amena El-Harakeh
- Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
- Clinical Research Institute (CRI), American University of Beirut Medical Center, Beirut, Lebanon
| | - Inas Kassamany
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Hussein Ismail
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Nour El Arnaout
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Rana Charide
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Farah Madi
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Sarah Jamali
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Tim Martineau
- Department of International Public Health, Liverpool School of Tropical Medicine, United Kingdom
| | - Fadi El-Jardali
- Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
| | - Elie A. Akl
- Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
- Clinical Research Institute (CRI), American University of Beirut Medical Center, Beirut, Lebanon
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
- Department of Internal Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
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McGowan CR, Baxter L, Deola C, Gayford M, Marston C, Cummings R, Checchi F. Mobile clinics in humanitarian emergencies: a systematic review. Confl Health 2020; 14:4. [PMID: 32021649 PMCID: PMC6993397 DOI: 10.1186/s13031-020-0251-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/22/2020] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Despite the widespread reliance on mobile clinics for delivering health services in humanitarian emergencies there is little empirical evidence to support their use. We report a narrative systematic review of the empirical evidence evaluating the use of mobile clinics in humanitarian settings. METHODS We searched MEDLINE, EMBASE, Global Health, Health Management Information Consortium, and The Cochrane Library for manuscripts published between 2000 and 2019. We also conducted a grey literature search via Global Health, Open Grey, and the WHO publication database. Empirical studies were included if they reported on at least one of the following evaluation criteria: relevance/appropriateness, connectedness, coherence, coverage, efficiency, effectiveness, and impact. FINDINGS Five studies met the inclusion criteria: all supported the use of mobile clinics in the particular setting under study. Three studies included controls. Two studies were assessed as good quality. The studies reported on mobile clinics providing non-communicable disease interventions, mental health services, sexual and reproductive health services, and multiple primary health care services in Afghanistan, the Democratic Republic of the Congo , Haiti, and the Occupied Palestinian Territories. Studies assessed one or more of the following evaluation domains: relevance/appropriateness, coverage, efficiency, and effectiveness. Four studies made recommendations including: i) ensure that mobile clinics are designed to complement clinic-based services; ii) improve technological tools to support patient follow-up, improve record-keeping, communication, and coordination; iii) avoid labelling services in a way that might stigmatise attendees; iv) strengthen referral to psychosocial and mental health services; v) partner with local providers to leverage resources; and vi) ensure strong coordination to optimise the continuum of care. Recommendations regarding the evaluation of mobile clinics include carrying out comparative studies of various modalities (including fixed facilities and community health workers) in order to isolate the effects of the mobile clinics. In the absence of a sound evidence base informing the use of mobile clinics in humanitarian crises, we encourage the integration of: i) WASH services, ii) nutrition services, iii) epidemic surveillance, and iv) systems to ensure the quality and safety of patient care. We recommend that future evaluations report against an established evaluation framework. CONCLUSION Evidence supporting the use of mobile clinics in humanitarian emergencies is limited. We encourage more studies of the use of mobile clinics in emergency settings. FUNDING Salary support for this review was provided under the RECAP project by United Kingdom Research and Innovation as part of the Global Challenges Research Fund, grant number ES/P010873/1.
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Affiliation(s)
- Catherine R. McGowan
- Humanitarian Public Health Technical Unit, Save the Children UK, London, UK
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH, London, UK
| | - Louisa Baxter
- Humanitarian Public Health Technical Unit, Save the Children UK, London, UK
| | - Claudio Deola
- Humanitarian Public Health Technical Unit, Save the Children UK, London, UK
| | - Megan Gayford
- Humanitarian Public Health Technical Unit, Save the Children UK, London, UK
| | - Cicely Marston
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH, London, UK
| | - Rachael Cummings
- Humanitarian Public Health Technical Unit, Save the Children UK, London, UK
| | - Francesco Checchi
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Kotsadam A, Østby G. Armed conflict and maternal mortality: A micro-level analysis of sub-Saharan Africa, 1989-2013. Soc Sci Med 2019; 239:112526. [PMID: 31520880 DOI: 10.1016/j.socscimed.2019.112526] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 08/06/2019] [Accepted: 08/29/2019] [Indexed: 11/19/2022]
Abstract
There is existing country-level evidence that countries with more severe armed conflict tend to have higher Maternal Mortality Rates (MMR). However, during armed conflict, the actual fighting is usually confined to a limited area within a country, affecting a subset of the population. Hence, studying the link between country-level armed conflict and MMR may involve ecological fallacies. We provide a more direct, nuanced test of whether local exposure to armed conflict impacts maternal mortality, building on the so-called "sisterhood method". We combine geo-coded data on different types of violent events from the Uppsala Conflict Data Program with geo-referenced survey data from the Demographic and Health Surveys (DHS) on respondents' reports on sisters dying during pregnancy, childbirth, or the puerperium. Our sample covers 1,335,161 adult sisters aged 12-45 by 539,764 female respondents in 30 countries in sub-Saharan Africa. Rather than aggregating the deaths of sisters to generate a maternal mortality ratio, we analyze the sisters' deaths at the individual level. We use a sister fixed-effects analysis to estimate the impact of recent organized violence events within a radius of 50 km of the home of each respondent on the likelihood that her sister dies during pregnancy, childbirth, or the puerperium. Our results show that local exposure to armed conflict events indeed increases the risk of maternal deaths. Exploring potential moderators, we find larger differences in rural areas but also in richer and more educated areas.
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Affiliation(s)
| | - Gudrun Østby
- Peace Research Institute Oslo (PRIO), PO Box 9229 Grønland, NO-0134, Oslo, Norway.
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Alexakis LC, Athanasiou M, Konstantinou A. Refugee camp health services utilisation by non-camp residents as an indicator of unaddressed health needs of surrounding populations: a perspective from Mae La refugee camp in Thailand during 2006 and 2007. Pan Afr Med J 2019; 32:188. [PMID: 31312300 PMCID: PMC6620057 DOI: 10.11604/pamj.2019.32.188.16780] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 04/05/2019] [Indexed: 11/11/2022] Open
Abstract
Introduction This study explored the differences on the level of medical care required by camp and non-camp resident patients during utilisation of the health services in Mae La refugee camp, Tak province, Thailand during the years 2006 and 2007. Methods Data were extracted from camp registers and the Health Information System used during the years 2006 and 2007 and statistical analysis was performed. Results The analysis showed that during 2006 and 2007 non-camp resident patients, coming from Thailand as well as Myanmar, who sought care in the outpatient department (OPD) of the camp required at a significantly higher proportion admission to the inpatient department (IPD) or referral to the district hospital compared to camp resident patients. Although there was a statistically significant increased mortality of the non-camp resident patients admitted in the IPD compared to camp resident patients, there was no significant difference in mortality among these two groups when the referrals to the district hospital were analysed. Conclusion Non-camp resident patients tended to need a more advanced level of medical care compared to camp resident patients. Provided that this it is further validated, the above observed pattern might be potentially useful as an indirect indicator of unaddressed health needs of populations surrounding a refugee camp.
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Affiliation(s)
- Lykourgos Christos Alexakis
- Médecins Sans Frontières, 15 Xenias Street, 11527 Athens, Greece.,Première Urgence-Aide Médicale Internationale, Mae Sot, Tak 63110, Thailand
| | - Maria Athanasiou
- National School of Public Health, 196 Alexandras Avenue, 11521 Athens, Greece
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12
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Østby G, Urdal H, Tollefsen AF, Kotsadam A, Belbo R, Ormhaug C. Organized Violence and Institutional Child Delivery: Micro-Level Evidence From Sub-Saharan Africa, 1989-2014. Demography 2019; 55:1295-1316. [PMID: 29949085 PMCID: PMC6060989 DOI: 10.1007/s13524-018-0685-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The conditions under which a mother gives birth greatly affect the health risk of both the mother and the child. This article addresses how local exposure to organized violence affects whether women give birth in a health facility. We combine geocoded data on violent events from the Uppsala Conflict Data Program with georeferenced survey data on the use of maternal health care services from the Demographic and Health Surveys. Our sample covers 569,201 births by 390,574 mothers in 31 countries in sub-Saharan Africa. We use a mother fixed-effects analysis to estimate the effect of recent organized violence events within a radius of 50 km of the home of each mother on the likelihood that her child is born in a health facility. The results indicate that geographical and temporal proximity to organized violence significantly reduces the likelihood of institutional births. Although the level of maternal health care overall is lower in rural areas, the negative effect of violence appears to be stronger in urban areas. The study further underscores the importance of household and individual resilience, indicating that the effect of organized violence on institutional child delivery is greater among poor and less-educated mothers.
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Affiliation(s)
- Gudrun Østby
- Peace Research Institute Oslo (PRIO), PO Box 9229, Grønland, NO-0134, Oslo, Norway.
| | - Henrik Urdal
- Peace Research Institute Oslo (PRIO), PO Box 9229, Grønland, NO-0134, Oslo, Norway
| | | | - Andreas Kotsadam
- Peace Research Institute Oslo (PRIO), PO Box 9229, Grønland, NO-0134, Oslo, Norway.,The Ragnar Frisch Centre for Economic Research, University of Oslo, Gaustadalléen 21, 0349, Oslo, Norway
| | - Ragnhild Belbo
- Peace Research Institute Oslo (PRIO), PO Box 9229, Grønland, NO-0134, Oslo, Norway
| | - Christin Ormhaug
- Noragric, International Environment and Development Studies, Norwegian University of Life Sciences, PO Box 5003, NO-1432, Ås, Norway
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13
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Khan A, DeYoung SE. Maternal health services for refugee populations: Exploration of best practices. Glob Public Health 2018; 14:362-374. [DOI: 10.1080/17441692.2018.1516796] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Aishah Khan
- Department of Health Policy and Management, University of Georgia College of Public Health, Athens, GA, USA
| | - Sarah E. DeYoung
- Department of Health Policy and Management, University of Georgia College of Public Health, Athens, GA, USA
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14
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Zhao Y, Zeng J, Zhao Y, Liu Q, He Y, Zhang J, Yang Z, Fan Q, Wang Q, Cui L, Cao Y. Risk factors for asymptomatic malaria infections from seasonal cross-sectional surveys along the China-Myanmar border. Malar J 2018; 17:247. [PMID: 29973194 PMCID: PMC6032786 DOI: 10.1186/s12936-018-2398-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 06/22/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Border malaria, a shared phenomenon in the Greater Mekong Sub-region of Southeast Asia, is a major obstacle for regional malaria elimination. Along the China-Myanmar border, an additional problem arose as a result of the settlement of internally displaced people (IDP) in the border region. Since asymptomatic malaria significantly impacts transmission dynamics, assessment of the prevalence, dynamics and risk factors of asymptomatic malaria infections is necessary. METHODS Cross-sectional surveys were carried out in 3 seasons (March and April, July and November) and 2 sites (villages and IDP camps) in 2015. A total of 1680 finger-prick blood samples were collected and used for parasite detection by microscopy and nested RT-PCR (nRT-PCR). Logistic regression models were used to explore the risk factors associated with asymptomatic malaria at individual and household levels. RESULTS The prevalence of asymptomatic Plasmodium infections was 23.3% by nRT-PCR, significantly higher than that detected by microscopy (1.5%). The proportions of Plasmodium vivax, Plasmodium falciparum and mixed-species infections were 89.6, 8.1 and 2.3%, respectively. Asymptomatic infections showed obvious seasonality with higher prevalence in the rainy season. Logistic regression analysis identified males and school children (≤ 15 years) as the high-risk populations. Vector-based interventions, including bed net and indoor residual spray, were found to have significant impacts on asymptomatic Plasmodium infections, with non-users of these measures carrying much higher risks of infection. In addition, individuals living in poorly constructed households or farther away from clinics were more prone to asymptomatic infections. CONCLUSIONS Sub-microscopic Plasmodium infections were highly prevalent in the border human populations from IDP camps and surrounding villages. Both individual- and household-level risk factors were identified, which provides useful information for identifying the high-priority populations to implement targeted malaria control.
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Affiliation(s)
- Yan Zhao
- Department of Immunology, College of Basic Medical Sciences, China Medical University, Shenyang, 110122, Liaoning, China
| | - Jie Zeng
- Department of Immunology, College of Basic Medical Sciences, China Medical University, Shenyang, 110122, Liaoning, China
| | - Yonghong Zhao
- Department of Immunology, College of Basic Medical Sciences, China Medical University, Shenyang, 110122, Liaoning, China
| | - Qingyang Liu
- Department of Immunology, College of Basic Medical Sciences, China Medical University, Shenyang, 110122, Liaoning, China
| | - Yang He
- Department of Immunology, College of Basic Medical Sciences, China Medical University, Shenyang, 110122, Liaoning, China
| | - Jiaqi Zhang
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, China
| | - Zhaoqing Yang
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, China
| | - Qi Fan
- Dalian Institute of Biotechnology, Dalian, Liaoning, China
| | - Qinghui Wang
- Department of Immunology, College of Basic Medical Sciences, China Medical University, Shenyang, 110122, Liaoning, China.
| | - Liwang Cui
- Department of Immunology, College of Basic Medical Sciences, China Medical University, Shenyang, 110122, Liaoning, China. .,Department of Entomology, Pennsylvania State University, University Park, State College, PA, 16802, USA.
| | - Yaming Cao
- Department of Immunology, College of Basic Medical Sciences, China Medical University, Shenyang, 110122, Liaoning, China.
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15
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Khan MS, Schwanke-Khilji S, Yoong J, Tun ZM, Watson S, Coker RJ. Large funding inflows, limited local capacity and emerging disease control priorities: a situational assessment of tuberculosis control in Myanmar. Health Policy Plan 2018; 32:i22-i31. [PMID: 29028226 DOI: 10.1093/heapol/czx062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2017] [Indexed: 11/13/2022] Open
Abstract
There are numerous challenges in planning and implementing effective disease control programmes in Myanmar, which is undergoing internal political and economic transformations whilst experiencing massive inflows of external funding. The objective of our study-involving key informant discussions, participant observations and linked literature reviews-was to analyse how tuberculosis (TB) control strategies in Myanmar are influenced by the broader political, economic, epidemiological and health systems context using the Systemic Rapid Assessment conceptual and analytical framework. Our findings indicate that the substantial influx of donor funding, in the order of one billion dollars over a 5-year period, may be too rapid for the country's infrastructure to effectively utilize. TB control strategies thus far have tended to favour medical or technological approaches rather than infrastructure development, and appear to be driven more by perceived urgency to 'do something' rather informed by evidence of cost-effectiveness and sustainable long-term impact. Progress has been made towards ambitious targets for scaling up treatment of drug-resistant TB, although there are concerns about ensuring quality of care. We also find substantial disparities in health and funding allocation between regions and ethnic groups, which are related to the political context and health system infrastructure. Our situational assessment of emerging TB control strategies in this transitioning health system indicates that large investments by international donors may be pushing Myanmar to scale up TB and drug-resistant TB services too quickly, without due consideration given to the health system (service delivery infrastructure, human resource capacity, quality of care, equity) and epidemiological (evidence of effectiveness of interventions, prevention of new cases) context.
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Affiliation(s)
- Mishal S Khan
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore 117549, Singapore.,Communicable Diseases Policy Research Group, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Sara Schwanke-Khilji
- Division of Hospital Medicine, Oregon Health and Science University, Oregon, USA
| | - Joanne Yoong
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore 117549, Singapore.,Center for Economic and Social Research, University of Southern California, Los Angeles, CA, USA
| | - Zaw Myo Tun
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore 117549, Singapore
| | | | - Richard James Coker
- Communicable Diseases Policy Research Group, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.,Faculty of Public Health, Mahidol University, Bangkok, Thailand
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Affiliation(s)
- Rebecca Y. Du
- Texas Children’s Hospital Center for Vaccine Development, Departments of Pediatrics and Molecular Virology and Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Jeffrey D. Stanaway
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Peter J. Hotez
- Texas Children’s Hospital Center for Vaccine Development, Departments of Pediatrics and Molecular Virology and Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America
- Department of Biology, Baylor University, Waco, Texas, United States of America
- James A Baker III Institute, Rice University, Houston, Texas, United States of America
- Scowcroft Institute for International Affairs, Bush School of Public Policy and Public Service, College Station, Texas, United States of America
- * E-mail:
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17
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Zhou G, Lo E, Zhong D, Wang X, Wang Y, Malla S, Lee MC, Yang Z, Cui L, Yan G. Impact of interventions on malaria in internally displaced persons along the China-Myanmar border: 2011-2014. Malar J 2016; 15:471. [PMID: 27628040 PMCID: PMC5024476 DOI: 10.1186/s12936-016-1512-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 09/02/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Internally displaced persons (IDP) represent vulnerable populations whose public health conditions merit special attention. In the China-Myanmar border area, human movement and resettlements of IDP can influence malaria transmission. Comparison of disease incidence and vector densities between IDP camps and surrounding local villages allows for better understanding of current epidemiology and to evaluate the effectiveness of interventions in the region. METHODS Malaria and vector surveillance was conducted in three IDP camps and three local villages neighbouring the camps along the China-Myanmar border in Myanmar. Clinical malaria cases were collected from seven hospitals/clinics from April 2011 to December 2014. Malaria vector population dynamics were monitored using CDC light traps. The use of malaria preventive measures and information on aid agencies and their activities was obtained through questionnaire surveys. RESULTS Malaria was confirmed in 1832 patients. Of these cases, 85.4 % were Plasmodium vivax and 11.4 % were Plasmodium falciparum malaria. Annual malaria incidence rates were 38.8 and 127.0 cases/1000 person year in IDP camps and local villages, respectively. Older children of 5-14 years had the highest incidence rate in the camps regardless of gender, while male adults had significantly higher incidence rates than females in local villages and females child-bearing age had significantly lower risk to malaria in IDP camps compare to local villages. Seasonal malaria outbreaks were observed both in the IDP camps and in the local villages from May to August 2013. The proportion of P. vivax remained unchanged in local villages but increased by approximately tenfold in IDP camps from 2011 to 2014. Anopheles vector density was tenfold higher in local villages compared to IDP camps (2.0:0.2 females/trap/night). Over 99 % of households in both communities owned bed nets. While long-lasting insecticidal nets accounted for 61 % of nets used in IDPs, nearly all residents of local villages owned regular nets without insecticide-impregnation. There were more active aid agencies in the camps than in local villages. CONCLUSION Malaria in IDP camps was significantly lower than the surrounding villages through effective control management. The observation of P. vivax outbreaks in the study area highlights the need for increased control efforts. Expansion of malaria intervention strategies in IDP camps to local surrounding villages is critical to malaria control in the border area.
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Affiliation(s)
- Guofa Zhou
- University of California, Irvine, CA USA
| | - Eugenia Lo
- University of California, Irvine, CA USA
| | | | - Xiaoming Wang
- University of California, Irvine, CA USA
- Southern Medical University, Guangzhou, China
| | - Ying Wang
- Third Military Medical University, Chongqing, China
| | | | | | | | - Liwang Cui
- Pennsylvania State University, University Park, PA USA
| | - Guiyun Yan
- University of California, Irvine, CA USA
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18
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Oguro M, Horiuchi S. A Cross-Sectional Study of Community-Based Maternal and Child Health Interventions Involving Women's Health Volunteer Groups in Rural Myanmar. Public Health Nurs 2016; 33:449-59. [PMID: 27283211 DOI: 10.1111/phn.12275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study identified the relationship between interventions with women's health volunteer groups in two Myanmar villages and maternal and child health outcomes. DESIGN AND SAMPLE This cross-sectional study included 188 women aged 15-49 years old with at least one ≤5-year-old child. The women were randomly selected from two control and two experimental villages. MEASURES Data were collected via structured interview with a questionnaire based on the UNICEF Multiple Indicator Cluster Survey. RESULTS Logistic regression analyses confirmed that women's health volunteer group intervention was related to the participants' receiving any antenatal care (OR: 6.99, p < .01) and having knowledge regarding danger signs during the perinatal period (OR: 15.08, p < .001), modern contraceptive methods (OR: 44.52, p < .001), acceptable first aid (OR: 14.04, p < .001), and malaria prevention (OR: 40.30, p < .001). A skilled midwife had the most significant relationship with patients' receiving any antenatal care (OR: 65.18, p < .001). Distance from urban area negatively related to appropriate disposal of the child's stool (i.e., flushed in a latrine; OR: 7.51, p < .05). CONCLUSIONS This study shows that women's health volunteer groups may positively affect the diffusion of the need to seek antenatal care and health knowledge in rural Myanmar. The importance of skilled midwives is also highlighted, especially in resource-limited settings.
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Affiliation(s)
- Michiko Oguro
- Women's Health and Midwifery, St. Luke's International University, Tokyo, Japan.
| | - Shigeko Horiuchi
- Women's Health and Midwifery, St. Luke's International University, Tokyo, Japan
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Sudhinaraset M, Diamond-Smith N, Thet MM, Aung T. Influence of internal migration on reproductive health in Myanmar: results from a recent cross-sectional survey. BMC Public Health 2016; 16:246. [PMID: 26961883 PMCID: PMC4784279 DOI: 10.1186/s12889-016-2915-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 03/01/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maternal and reproductive health remains a significant public health issue in Myanmar. Little data exists on women's health issues, including social and demographic influences. While past studies have demonstrated rural/urban health disparities, an increasingly important population resulting from urban growth in Myanmar is the internal migrant population, individuals moving within the country for better job or educational opportunities. Past studies suggest that women make up more than half of internal migrants, yet there is a dearth of information on this new wave of migration, particularly on women's reproductive health issues. The objective of this study is to assess the influence of women's migration in Myanmar on reproductive health outcomes, including delivering in a facility, using a skilled birth attendant, and using a modern method of family planning. METHODS Data from a cross-sectional household survey using multistage cluster sampling design conducted between September to October 2014 was used to assess the accessibility and the use of maternal and child health products and services. A total of 1800 currently married women of reproductive age, including 348 from urban and 1452 from rural areas, were recruited to complete surveys. A set of multivariable regressions was performed to assess reproductive health outcomes and predictors. RESULTS Across health indicators, female migrants had better health outcomes compared to non-migrants. Controlling for demographic characteristics, migrants were 1.60 times more likely to use a modern form of family planning compared to non-migrants (p < 0.01) and use antenatal care during pregnancy (p < 0.05). While not statistically significant, migrants were 1.29 times more likely to deliver with a skilled attendant and 1.08 times more likely to deliver in a facility. CONCLUSIONS This study found that female migrants in Myanmar reported better health outcomes compared to non-migrant women in regards to family planning and maternal health. Future research should focus on monitoring the outcomes of migrants and their children over time to assess long-term impacts.
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Affiliation(s)
- May Sudhinaraset
- Global Health Group, Global Health Sciences, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94116, USA. .,Department of Epidemiology and Biostatistics, University of California, San Francisco, USA.
| | - Nadia Diamond-Smith
- Global Health Group, Global Health Sciences, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94116, USA.
| | - May Me Thet
- Population Services International, Myanmar, No. 16, Shwe Gon Taing, Street 4, Yangon, Myanmar.
| | - Tin Aung
- Population Services International, Myanmar, No. 16, Shwe Gon Taing, Street 4, Yangon, Myanmar.
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Sebert Kuhlmann AK, Altman L, Galavotti C. The importance of community mobilization in interventions to improve sexual, reproductive, and maternal health outcomes: A review of the evidence. Health Care Women Int 2016; 37:1028-66. [PMID: 26785861 DOI: 10.1080/07399332.2016.1141911] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Community participation, engagement, and mobilization are common components of many sexual, reproductive, and maternal health (SRMH) programs, but little consensus exists among researchers on how critical these program components are. Using principles of realist review, we reviewed a spectrum of community mobilization interventions to evaluate their use in improving five SRMH areas. Consistent with theoretical assumptions, we found that actively involving community members in leading intervention activities and/or taking ownership tends to produce better SRMH outcomes than simply relying on community members as implementers. Despite this, many fewer programs exist with this meaningful level of engagement than with more cursory engagement.
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Affiliation(s)
- Anne K Sebert Kuhlmann
- a MANILA Consulting Group, Inc. , McLean , Virginia , USA.,b College for Public Health & Social Justice, Saint Louis University , St. Louis , Missouri , USA
| | - Lara Altman
- a MANILA Consulting Group, Inc. , McLean , Virginia , USA.,c CARE USA , Atlanta , Georgia , USA
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Lunze K, Higgins-Steele A, Simen-Kapeu A, Vesel L, Kim J, Dickson K. Innovative approaches for improving maternal and newborn health--A landscape analysis. BMC Pregnancy Childbirth 2015; 15:337. [PMID: 26679709 PMCID: PMC4683742 DOI: 10.1186/s12884-015-0784-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 12/09/2015] [Indexed: 12/31/2022] Open
Abstract
Background Essential interventions can improve maternal and newborn health (MNH) outcomes in low- and middle-income countries, but their implementation has been challenging. Innovative MNH approaches have the potential to accelerate progress and to lead to better health outcomes for women and newborns, but their added value to health systems remains incompletely understood. This study’s aim was to analyze the landscape of innovative MNH approaches and related published evidence. Methods Systematic literature review and descriptive analysis based on the MNH continuum of care framework and the World Health Organization health system building blocks, analyzing the range and nature of currently published MNH approaches that are considered innovative. We used 11 databases (MedLine, Web of Science, CINAHL, Cochrane, Popline, BLDS, ELDIS, 3ie, CAB direct, WHO Global Health Library and WHOLIS) as data source and extracted data according to our study protocol. Results Most innovative approaches in MNH are iterations of existing interventions, modified for contexts in which they had not been applied previously. Many aim at the direct organization and delivery of maternal and newborn health services or are primarily health workforce interventions. Innovative approaches also include health technologies, interventions based on community ownership and participation, and novel models of financing and policy making. Rigorous randomized trials to assess innovative MNH approaches are rare; most evaluations are smaller pilot studies. Few studies assessed intervention effects on health outcomes or focused on equity in health care delivery. Conclusions Future implementation and evaluation efforts need to assess innovations’ effects on health outcomes and provide evidence on potential for scale-up, considering cost, feasibility, appropriateness, and acceptability. Measuring equity is an important aspect to identify and target population groups at risk of service inequity. Innovative MNH interventions will need innovative implementation, evaluation and scale-up strategies for their sustainable integration into health systems. Electronic supplementary material The online version of this article (doi:10.1186/s12884-015-0784-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Karsten Lunze
- Department of Medicine Boston, Boston University, Boston, MA, USA. .,Health Section, UNICEF, 3 United Nations Plaza, New York, NY, 10017, USA.
| | - Ariel Higgins-Steele
- Health Section, UNICEF, 3 United Nations Plaza, New York, NY, 10017, USA. .,Concern Worldwide, 355 Lexington Avenue, New York, NY, 10017, USA.
| | - Aline Simen-Kapeu
- Health Section, UNICEF, 3 United Nations Plaza, New York, NY, 10017, USA.
| | - Linda Vesel
- Health Section, UNICEF, 3 United Nations Plaza, New York, NY, 10017, USA. .,Concern Worldwide, 355 Lexington Avenue, New York, NY, 10017, USA.
| | - Julia Kim
- Health Section, UNICEF, 3 United Nations Plaza, New York, NY, 10017, USA. .,GNH Centre Bhutan, Jaffa's Commercial Building, Room 302, Thimphu, Bhutan.
| | - Kim Dickson
- Health Section, UNICEF, 3 United Nations Plaza, New York, NY, 10017, USA.
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Pyone T, Dickinson F, Kerr R, Boschi-Pinto C, Mathai M, van den Broek N. Data collection tools for maternal and child health in humanitarian emergencies: a systematic review. Bull World Health Organ 2015; 93:648-658A-M. [PMID: 26478629 PMCID: PMC4581640 DOI: 10.2471/blt.14.148429] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 05/01/2015] [Accepted: 05/07/2015] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To describe tools used for the assessment of maternal and child health issues in humanitarian emergency settings. METHODS We systematically searched MEDLINE, Web of Knowledge and POPLINE databases for studies published between January 2000 and June 2014. We also searched the websites of organizations active in humanitarian emergencies. We included studies reporting the development or use of data collection tools concerning the health of women and children in humanitarian emergencies. We used narrative synthesis to summarize the studies. FINDINGS We identified 100 studies: 80 reported on conflict situations and 20 followed natural disasters. Most studies (76/100) focused on the health status of the affected population while 24 focused on the availability and coverage of health services. Of 17 different data collection tools identified, 14 focused on sexual and reproductive health, nine concerned maternal, newborn and child health and four were used to collect information on sexual or gender-based violence. Sixty-nine studies were done for monitoring and evaluation purposes, 18 for advocacy, seven for operational research and six for needs assessment. CONCLUSION Practical and effective means of data collection are needed to inform life-saving actions in humanitarian emergencies. There are a wide variety of tools available, not all of which have been used in the field. A simplified, standardized tool should be developed for assessment of health issues in the early stages of humanitarian emergencies. A cluster approach is recommended, in partnership with operational researchers and humanitarian agencies, coordinated by the World Health Organization.
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Affiliation(s)
- Thidar Pyone
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, E3 5QA, England
| | - Fiona Dickinson
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, E3 5QA, England
| | - Robbie Kerr
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, E3 5QA, England
| | - Cynthia Boschi-Pinto
- Department of Maternal, Newborn, Child & Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Matthews Mathai
- Department of Maternal, Newborn, Child & Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Nynke van den Broek
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, E3 5QA, England
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Davis WW, Mullany LC, Shwe Oo EK, Richards AK, Iacopino V, Beyrer C. Health and Human Rights in Karen State, Eastern Myanmar. PLoS One 2015; 10:e0133822. [PMID: 26308850 PMCID: PMC4550474 DOI: 10.1371/journal.pone.0133822] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 07/02/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Decades of conflict in eastern Myanmar have resulted in high prevalence of human rights violations and poor health outcomes. While recent ceasefire agreements have reduced conflict in this area, it is unknown whether this has resulted in concomitant reductions in human rights violations. METHODS AND FINDINGS We conducted a two-stage cluster survey of 686 households in eastern Myanmar to assess health status, access to healthcare, food security, exposure to human rights violations and identification of alleged perpetrators over the 12 months prior to January 2012, a period of near-absence of conflict in this region. Household hunger (FANTA-2 scale) was moderate/high in 91 (13.2%) households, while the proportion of households reporting food shortages in each month of 2011 ranged from 19.9% in December to 47.0% in September, with food insecurity peaking just prior to the harvest. Diarrhea prevalence in children was 14.2% and in everyone it was 5.8%. Forced labor was the most common human rights violation (185 households, 24.9%), and 210 households (30.6%) reported experiencing one or more human rights violations in 2011. Multiple logistic regression analysis identified associations between human rights violations and poor health outcomes. CONCLUSION Human rights violations and their health consequences persist despite reduced intensity of conflict in eastern Myanmar. Ceasefire agreements should include language that protects human rights, and reconciliation efforts should address the health consequences of decades of human rights violations.
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Affiliation(s)
- William W. Davis
- Center for Public Health and Human Rights, Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
| | - Luke C. Mullany
- Center for Public Health and Human Rights, Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | - Adam K. Richards
- Division of General Internal Medicine and Health Services Research, University of California Los Angeles, Los Angeles, California, United States of America
- Community Partners International, 2550 Ninth St. Suite 111, Berkeley, California, 94710, United States of America
| | - Vincent Iacopino
- Physicians for Human Rights, New York City, New York, United States of America
- University of Minnesota Medical School, Minneapolis, Minnesota, United States of America
- Human Rights Center, University of California, Berkeley, California, United States of America
| | - Chris Beyrer
- Center for Public Health and Human Rights, Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Parmar PK, Barina CC, Low S, Tun KT, Otterness C, Mhote PP, Htoo SN, Kyaw SW, Lwin NA, Maung C, Moo NM, Oo EKS, Reh D, Mon NC, Singh N, Goyal R, Richards AK. Health and human rights in eastern Myanmar after the political transition: a population-based assessment using multistaged household cluster sampling. PLoS One 2015; 10:e0121212. [PMID: 25970445 PMCID: PMC4430217 DOI: 10.1371/journal.pone.0121212] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 02/11/2015] [Indexed: 11/19/2022] Open
Abstract
Background Myanmar transitioned to a nominally civilian parliamentary government in March 2011. Qualitative reports suggest that exposure to violence and displacement has declined while international assistance for health services has increased. An assessment of the impact of these changes on the health and human rights situation has not been published. Methods and Findings Five community-based organizations conducted household surveys using two-stage cluster sampling in five states in eastern Myanmar from July 2013-September 2013. Data was collected from 6, 178 households on demographics, mortality, health outcomes, water and sanitation, food security and nutrition, malaria, and human rights violations (HRV). Among children aged 6-59 months screened, the prevalence of global acute malnutrition (representing moderate or severe malnutrition) was 11.3% (8.0 – 14.7). A total of 250 deaths occurred during the year prior to the survey. Infant deaths accounted for 64 of these (IMR 94.2; 95% CI 66.5-133.5) and there were 94 child deaths (U5MR 141.9; 95% CI 94.8-189.0). 10.7% of households (95% CI 7.0-14.5) experienced at least one HRV in the past year, while four percent reported 2 or more HRVs. Household exposure to one or more HRVs was associated with moderate-severe malnutrition among children (14.9 vs. 6.8%; prevalence ratio 2.2, 95% CI 1.2-4.2). Household exposure to HRVs was associated with self-reported fair or poor health status among respondents (PR 1.3; 95% CI 1.1 – 1.5). Conclusion This large survey of health and human rights demonstrates that two years after political transition, vulnerable populations of eastern Myanmar are less likely to experience human rights violations compared to previous surveys. However, access to health services remains constrained, and risk of disease and death remains higher than the country as a whole. Efforts to address these poor health indicators should prioritize support for populations that remain outside the scope of most formal government and donor programs.
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Affiliation(s)
- Parveen Kaur Parmar
- Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, 02118, United States of America
- * E-mail:
| | - Charlene C. Barina
- Community Partners International, Mae Sot, Thailand
- University of Washington, Seattle, Washington, United States of America
| | - Sharon Low
- Community Partners International, Mae Sot, Thailand
| | | | | | - Pue P. Mhote
- Burma Medical Association (BMA), Mae Sot, Thailand
- Health Information Systems Information Group (HISWG), Mae Sot, Thailand
| | - Saw Nay Htoo
- Burma Medical Association (BMA), Mae Sot, Thailand
| | | | - Nai Aye Lwin
- Burma Medical Association (BMA), Mae Sot, Thailand
- Back Pack Health Worker Team, Mae Sot, Thailand
- Mae Tao Clinic, Mae Sot, Thailand
| | - Cynthia Maung
- Burma Medical Association (BMA), Mae Sot, Thailand
- Back Pack Health Worker Team, Mae Sot, Thailand
- Mae Tao Clinic, Mae Sot, Thailand
| | - Naw Merry Moo
- Karen Department of Health and Welfare, Mae Sot, Thailand
- Health Information Systems Information Group (HISWG), Mae Sot, Thailand
| | | | - Daniel Reh
- Karenni Mobile Health Committee (KnMHC), Mae Hong Son, Thailand
| | - Nai Chay Mon
- Mon National Health Committee (MNHC), Sangkhlaburi, Thailand
| | - Nakul Singh
- Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Ravi Goyal
- Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Adam K. Richards
- Division of General Internal Medicine and Health Services Research, University of California Los Angeles, Los Angeles, California, United States of America
- Community Partners International, Berkeley, California, United States of America
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Tanabe M, Robinson K, Lee CI, Leigh JA, Htoo EM, Integer N, Krause SK. Piloting community-based medical care for survivors of sexual assault in conflict-affected Karen State of eastern Burma. Confl Health 2013; 7:12. [PMID: 23692964 PMCID: PMC3674936 DOI: 10.1186/1752-1505-7-12] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Accepted: 05/15/2013] [Indexed: 12/04/2022] Open
Abstract
Background Given the challenges to ensuring facility-based care in conflict settings, the Women’s Refugee Commission and partners have been pursuing a community-based approach to providing medical care to survivors of sexual assault in Karen State, eastern Burma. This new model translates the 2004 World Health Organization’s Clinical Management of Rape Survivors facility-based protocol to the community level through empowering community health workers to provide post-rape care. The aim of this innovative study is to examine the safety and feasibility of community-based medical care for survivors of sexual assault to contribute to building an evidence base on alternative models of care in humanitarian settings. Methods A process evaluation was implemented from July-October 2011 to gather qualitative feedback from trained community health workers, traditional birth attendants, and community members. Two focus group discussions were conducted among the highest cadre health care workers from the pilot and non-pilot sites. In Karen State, eight focus group discussions were convened among traditional birth attendants and 10 among women and men of reproductive age. Results Qualitative feedback contributed to an understanding of the model’s feasibility. Pilot site community health workers showed interest in providing community-based care for survivors of sexual assault. Traditional birth attendants attested to the importance of making this care available. Community health workers were deeply aware of the need to maintain confidentiality and offer compassionate care. They did not raise safety as an excess concern in the provision of treatment. Conclusions Data speak to the promising “feasibility” of community-based post-rape care. More time, awareness-raising, and a larger catchment population are necessary to answer the safety perspective. The pilot is an attempt to translate facility-based protocol to the community level to offer solutions for settings where traditional methods of post-rape care are not accessible for women and girls that need it most.
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Affiliation(s)
- Mihoko Tanabe
- Women's Refugee Commission, 122 East 42nd Street 11F, New York, NY 10168-1289, USA.
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Comprehensive On-site Medical and Public Health Training for Local Medical Practitioners in a Refugee Setting. Disaster Med Public Health Prep 2013; 7:82-8. [DOI: 10.1017/dmp.2013.2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectivesIn refugee settings, local medical personnel manage a broad range of health problems but commonly lack proper skills and training, which contributes to inefficient use of resources. To fill that gap, we designed, implemented, and evaluated a curriculum for a comprehensive on-site training for medical providers.MethodsThe comprehensive teaching curriculum provided ongoing on-site training for medical providers (4 physicians, 7 medical officers, 15 nurses and nurse aids, and 30 community health workers) in a sub-Saharan refugee camp. The curriculum included didactic sessions, inpatient and outpatient practice-based teaching, and case-based discussions, which included clinical topics, refugee public health, and organizational skills. The usefulness and efficacy of the training were evaluated through pretraining and posttraining tests, anonymous self-assessment surveys, focus group discussions, and direct clinical observation.ResultsPhysicians had a 50% (95% CI 17%-82%; range, 25%-75%) improvement in knowledge and skills. They rated the quality and usefulness of lectures 4.75 and practice-based teaching 5.0 on a 5-point scale (1=poor to 5=excellent). Evaluation of medical officers’ knowledge revealed improvements in (1) overall test scores (52% [SD 8%] to 80% [SD 5%]; P < .0001); (2) pediatric infectious diseases (44% [SD 9%] to 79% [SD 7%]; P < .001); and (3) noninfectious diseases (57% [SD 16%] to 81% [SD 10%] P < .01). Main barriers to effective learning were lack of training prioritization, time constraints, and limited ancillary support.ConclusionsA long-term, ongoing training curriculum for medical providers initiated by aid agencies but integrated into horizontal peer-to-peer education is feasible and effective in refugee settings. Such programs need prioritizing, practice and system-based personnel training, and a comprehensive curriculum to improve clinical decision making.(Disaster Med Public Health Preparedness. 2013;7:82-88)
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Mullany LC, Lee TJ, Yone L, Lee CI, Teela KC, Paw P, Shwe Oo EK, Maung C, Kuiper H, Masenior NF, Beyrer C. Impact of community-based maternal health workers on coverage of essential maternal health interventions among internally displaced communities in eastern Burma: the MOM project. PLoS Med 2010; 7:e1000317. [PMID: 20689805 PMCID: PMC2914639 DOI: 10.1371/journal.pmed.1000317] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Accepted: 06/23/2010] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Access to essential maternal and reproductive health care is poor throughout Burma, but is particularly lacking among internally displaced communities in the eastern border regions. In such settings, innovative strategies for accessing vulnerable populations and delivering basic public health interventions are urgently needed. METHODS Four ethnic health organizations from the Shan, Mon, Karen, and Karenni regions collaborated on a pilot project between 2005 and 2008 to examine the feasibility of an innovative three-tiered network of community-based providers for delivery of maternal health interventions in the complex emergency setting of eastern Burma. Two-stage cluster-sampling surveys among ever-married women of reproductive age (15-45 y) conducted before and after program implementation enabled evaluation of changes in coverage of essential antenatal care interventions, attendance at birth by those trained to manage complications, postnatal care, and family planning services. RESULTS Among 2,889 and 2,442 women of reproductive age in 2006 and 2008, respectively, population characteristics (age, marital status, ethnic distribution, literacy) were similar. Compared to baseline, women whose most recent pregnancy occurred during the implementation period were substantially more likely to receive antenatal care (71.8% versus 39.3%, prevalence rate ratio [PRR] = 1.83 [95% confidence interval (CI) 1.64-2.04]) and specific interventions such as urine testing (42.4% versus 15.7%, PRR = 2.69 [95% CI 2.69-3.54]), malaria screening (55.9% versus 21.9%, PRR = 2.88 [95% CI 2.15-3.85]), and deworming (58.2% versus 4.1%, PRR = 14.18 [95% CI 10.76-18.71]. Postnatal care visits within 7 d doubled. Use of modern methods to avoid pregnancy increased from 23.9% to 45.0% (PRR = 1.88 [95% CI 1.63-2.17]), and unmet need for contraception was reduced from 61.7% to 40.5%, a relative reduction of 35% (95% CI 28%-40%). Attendance at birth by those trained to deliver elements of emergency obstetric care increased almost 10-fold, from 5.1% to 48.7% (PRR = 9.55 [95% CI 7.21-12.64]). CONCLUSIONS Coverage of maternal health interventions and higher-level care at birth was substantially higher during the project period. The MOM Project's focus on task-shifting, capacity building, and empowerment at the community level might serve as a model approach for similarly constrained settings.
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Affiliation(s)
- Luke C Mullany
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health Bloomberg School of Public Health, Baltimore, Maryland, USA.
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Obstetric care in low-resource settings: what, who, and how to overcome challenges to scale up? Int J Gynaecol Obstet 2010; 107 Suppl 1:S21-44, S44-5. [PMID: 19815204 DOI: 10.1016/j.ijgo.2009.07.017] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Each year, approximately 2 million babies die because of complications of childbirth, primarily in settings where effective care at birth, particularly prompt cesarean delivery, is unavailable. OBJECTIVE We reviewed the content, impact, risk-benefit, and feasibility of interventions for obstetric complications with high population attributable risk of intrapartum-related hypoxic injury, as well as human resource, skill development, and technological innovations to improve obstetric care quality and availability. RESULTS Despite ecological associations of obstetric care with improved perinatal outcomes, there is limited evidence that intrapartum interventions reduce intrapartum-related neonatal mortality or morbidity. No interventions had high-quality evidence of impact on intrapartum-related outcomes in low-resource settings. While data from high-resource settings support planned cesarean for breech presentation and post-term induction, these interventions may be unavailable or less safe in low-resource settings and require risk-benefit assessment. Promising interventions include use of the partograph, symphysiotomy, amnioinfusion, therapeutic maneuvers for shoulder dystocia, improved management of intra-amniotic infections, and continuous labor support. Obstetric drills, checklists, and innovative low-cost devices could improve care quality. Task-shifting to alternative cadres may increase coverage of care. CONCLUSIONS While intrapartum care aims to avert intrapartum-related hypoxic injury, rigorous evidence is lacking, especially in the settings where most deaths occur. Effective care at birth could save hundreds of thousands of lives a year, with investment in health infrastructure, personnel, and research--both for innovation and to improve implementation.
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Lee CI, Smith LS, Shwe Oo EK, Scharschmidt BC, Whichard E, Kler T, Lee TJ, Richards AK. Internally displaced human resources for health: villager health worker partnerships to scale up a malaria control programme in active conflict areas of eastern Burma. Glob Public Health 2009; 4:229-41. [PMID: 19384681 DOI: 10.1080/17441690802676360] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Approaches to expand malaria control interventions in areas of active conflict are urgently needed. Despite international agreement regarding the imperative to control malaria in eastern Burma, there are currently no large-scale international malaria programmes operating in areas of active conflict. A local ethnic health department demonstrated that village health workers are capable of implementing malaria control interventions among internally displaced persons (IDPs). This paper describes how these internally displaced villagers facilitated rapid expansion of the programme. Clinic health workers received training in malaria diagnosis and treatment, vector control and education at training sites along the border. After returning to programme areas inside Burma, they trained villagers to perform an increasingly comprehensive set of interventions. This iterative training strategy to increase human resources for health permitted the programme to expand from 3000 IDPs in 2003 to nearly 40,000 in 2008. It was concluded that IDPs are capable of delivering essential malaria control interventions in areas of active conflict in eastern Burma. In addition, health workers in this area have the capacity to train community members to take on implementation of such interventions. This iterative strategy may provide a model to improve access to care in this population and in other conflict settings.
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Affiliation(s)
- C I Lee
- Global Health Access Program, Mae Sot, Tak, Thailand.
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Teela KC, Mullany LC, Lee CI, Poh E, Paw P, Masenior N, Maung C, Beyrer C, Lee TJ. Community-based delivery of maternal care in conflict-affected areas of eastern Burma: perspectives from lay maternal health workers. Soc Sci Med 2009; 68:1332-40. [PMID: 19232808 DOI: 10.1016/j.socscimed.2009.01.033] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2008] [Indexed: 10/21/2022]
Abstract
In settings where active conflict, resource scarcity, and logistical constraints prevail, provision of maternal health services within health centers and hospitals is unfeasible and alternative community-based strategies are needed. In eastern Burma, such conditions necessitated implementation of the "Mobile Obstetric Maternal Health Worker" (MOM) project, which has employed a community-based approach to increase access to essential maternal health services including emergency obstetric care. Lay Maternal Health Workers (MHWs) are central to the MOM service delivery model and, because they are accessible to both the communities inside Burma and to outside project managers, they serve as key informants for the project. Their insights can facilitate program and policy efforts to overcome critical delays and insufficient management of maternal complications linked to maternal mortality. Focus group discussions (n=9), in-depth interviews (n=18), and detailed case studies (n=14) were collected from MHWs during centralized project management meetings in February and October of 2007. Five case studies are presented to characterize and interpret the realities of reproductive health work in a conflict-affected setting. Findings highlight the process of building supportive networks and staff ownership of the MOM project, accessing and gaining community trust and participation to achieve timely delivery of care, and overcoming challenges to manage and appropriately deliver essential health services. They suggest that some emergency obstetric care services that are conventionally delivered only within healthcare settings might be feasible in community or home-based settings when alternatives are not available. This paper provides an opportunity to hear directly from community-based workers in a conflict setting, perspectives seldom documented in the scientific literature. A rights-based approach to service delivery and its suitability in settings where human rights violations are widespread is highlighted.
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Mullany LC, Lee CI, Yone L, Paw P, Oo EKS, Maung C, Lee TJ, Beyrer C. Access to essential maternal health interventions and human rights violations among vulnerable communities in eastern Burma. PLoS Med 2008; 5:1689-98. [PMID: 19108601 PMCID: PMC2605890 DOI: 10.1371/journal.pmed.0050242] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2008] [Accepted: 10/30/2008] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Health indicators are poor and human rights violations are widespread in eastern Burma. Reproductive and maternal health indicators have not been measured in this setting but are necessary as part of an evaluation of a multi-ethnic pilot project exploring strategies to increase access to essential maternal health interventions. The goal of this study is to estimate coverage of maternal health services prior to this project and associations between exposure to human rights violations and access to such services. METHODS AND FINDINGS Selected communities in the Shan, Mon, Karen, and Karenni regions of eastern Burma that were accessible to community-based organizations operating from Thailand were surveyed to estimate coverage of reproductive, maternal, and family planning services, and to assess exposure to household-level human rights violations within the pilot-project target population. Two-stage cluster sampling surveys among ever-married women of reproductive age (15-45 y) documented access to essential antenatal care interventions, skilled attendance at birth, postnatal care, and family planning services. Mid-upper arm circumference, hemoglobin by color scale, and Plasmodium falciparum parasitemia by rapid diagnostic dipstick were measured. Exposure to human rights violations in the prior 12 mo was recorded. Between September 2006 and January 2007, 2,914 surveys were conducted. Eighty-eight percent of women reported a home delivery for their last pregnancy (within previous 5 y). Skilled attendance at birth (5.1%), any (39.3%) or > or = 4 (16.7%) antenatal visits, use of an insecticide-treated bed net (21.6%), and receipt of iron supplements (11.8%) were low. At the time of the survey, more than 60% of women had hemoglobin level estimates < or = 11.0 g/dl and 7.2% were Pf positive. Unmet need for contraceptives exceeded 60%. Violations of rights were widely reported: 32.1% of Karenni households reported forced labor and 10% of Karen households had been forced to move. Among Karen households, odds of anemia were 1.51 (95% confidence interval [CI] 0.95-2.40) times higher among women reporting forced displacement, and 7.47 (95% CI 2.21-25.3) higher among those exposed to food security violations. The odds of receiving no antenatal care services were 5.94 (95% CI 2.23-15.8) times higher among those forcibly displaced. CONCLUSIONS Coverage of basic maternal health interventions is woefully inadequate in these selected populations and substantially lower than even the national estimates for Burma, among the lowest in the region. Considerable political, financial, and human resources are necessary to improve access to maternal health care in these communities.
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Affiliation(s)
- Luke C Mullany
- Center for Public Health and Human Rights, Bloomberg School of Public Health, Baltimore, Maryland, USA.
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Abstract
Macaya Douoguih discusses a retrospective household survey that characterized the relationships between access to care, health status, and human rights violations in eastern Burma.
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Affiliation(s)
- Macaya Douoguih
- Center for Research for Mothers & Children, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA.
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