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Kobeissi E, Menassa M, Honein-AbouHaidar G, El Achi N, Abdul-Sater Z, Farhat T, Al Mohtar D, Hajjar M, Abdul-Khalek RA, Chaya BF, Elamine A, Hettiaratchy S, Abu-Sittah G. Long-term burden of war injuries among civilians in LMICs: case of the July 2006 war in Lebanon. Front Public Health 2023; 11:1305021. [PMID: 38145076 PMCID: PMC10748398 DOI: 10.3389/fpubh.2023.1305021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 11/21/2023] [Indexed: 12/26/2023] Open
Abstract
Introduction Lebanon, a country located on the eastern shore of the Mediterranean Sea, is one of the world's smaller sovereign states. In the past few decades, Lebanon endured a perpetual political turmoil and several armed conflicts. July 12, 2006, marked the start of a one-month war in Lebanon, which resulted in thousands of casualties. Little is known about the long-term consequences of war injuries inflicted on civilians during the July 2006 war. Methods The objectives of this paper were to identify and evaluate: 1- civilians' access to healthcare and medicine under conditions of war; 2- the long-term socioeconomic burden on injured civilians; and 3- their quality of life more than a decade post-war. We adopted a mixed-method research design with an emphasis on the qualitative component. We conducted interviews with patients, collected clinical and financial data from hospital medical records, and administered a self-rated health questionnaire, the EQ-5D-5L. Simple descriptive statistics were calculated using Excel. NVivo 12® was used for data management and thematic analysis. Results We conducted 25 interviews. Injured civilians were mostly males, average age of 27. The most common mechanism of injury was blast injury. Most patients underwent multiple surgeries as well as revision surgeries. The thematic analysis revealed three themes: 1- recall of the time of the incident, the thousand miles journey, and patients' access to services; 2- post-trauma sequelae and services; and 3- long-term impact. Patients described the long-term burden including chronic pain, poor mobility, anxiety or depression, and limited activities of daily living. Discussion Civilians injured during the July 2006 war described the traumatising events they endured during the war and the limited access to medical care during and post-war. Up until this study was conducted, affected civilians were still experiencing physical, psychological, and financial sequelae. Acknowledging the limitations of this study, which include a small sample size and recall bias, the findings underscore the necessity for the expansion of services catering to civilians injured during wartime.
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Affiliation(s)
- Elsa Kobeissi
- Conflict Medicine Program, Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Marilyne Menassa
- Conflict Medicine Program, Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Gladys Honein-AbouHaidar
- Refugee Health Program, Global Health Institute, American University of Beirut, Beirut, Lebanon
- Hariri School of Nursing, American University of Beirut, Beirut, Lebanon
| | - Nassim El Achi
- Conflict Medicine Program, Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Zahi Abdul-Sater
- Conflict Medicine Program, Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Theresa Farhat
- Conflict Medicine Program, Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Dalia Al Mohtar
- Conflict Medicine Program, Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Marwan Hajjar
- Department of Surgery, Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Centre, Beirut, Lebanon
| | | | - Bachar F. Chaya
- Department of Surgery, Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Ahmad Elamine
- Department of Surgery, Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Shehan Hettiaratchy
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- St Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Ghassan Abu-Sittah
- Conflict Medicine Program, Global Health Institute, American University of Beirut, Beirut, Lebanon
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Ghebrehiwet S, Ogundare T, Owusu M, Harris BL, Ojediran B, Touma M, Durham MP, Hook K, Borba CPC, Henderson DC. Building a postgraduate psychiatry training program in Liberia through cross-country collaborations: initiation stages, challenges, and opportunities. Front Public Health 2023; 11:1020723. [PMID: 37727607 PMCID: PMC10505824 DOI: 10.3389/fpubh.2023.1020723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 08/17/2023] [Indexed: 09/21/2023] Open
Abstract
Background About 80% of the nearly 2 billion people experiencing psychiatric conditions worldwide do not have access to quality, affordable mental health care. In Africa, there are 0.004 psychiatrists per 10,000 people, with the shortage exacerbated by a limited number of postgraduate psychiatry training opportunities. As of 2018, there were only two psychiatrists in Liberia. Methods This paper aims to offer a framework for developing postgraduate (i.e., residency) psychiatry training in resource-constrained settings to disseminate best practices and lessons learned. This article describes the approach to developing the formal global academic partnership that supported the initiation of Liberia's first postgraduate psychiatry training program in July 2019. Results Authors describe strengths, challenges, and opportunities for improvement in the planning and initiation stages of the postgraduate program. Key strengths of the program planning process include: (1) collaboration with a coalition of local and national stakeholders committed to improving mental health care in Liberia; (2) early procurement of quality video conferencing equipment and internet service to facilitate remote learning and broaden access to digital materials; and (3) leveraging of intra-continental partnerships for subspecialty training. Challenges experienced include: (1) navigating the intricacies of local political and administrative processes; (2) recruiting candidates to a medical specialty with historically lower salaries; and (3) the added burden placed on the limited number of local specialists. Identified opportunities include building a monitoring, evaluation, and learning (MEL) framework, further diversifying subspecialty areas of psychiatric and neurological training, and obtaining full accreditation of the postgraduate psychiatry program through the West African College of Physicians (WACP). Conclusion The successful launch of the postgraduate psychiatry training program in Liberia is attributed to several factors, including a long-standing academic collaboration of over 10 years and support for mental health capacity-building efforts at national and local levels.
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Affiliation(s)
- Senait Ghebrehiwet
- Department of Psychiatry, Boston Medical Center, Boston, MA, United States
| | - Temitope Ogundare
- Department of Psychiatry, Boston Medical Center, Boston, MA, United States
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States
| | - Micaela Owusu
- Department of Psychiatry, Boston Medical Center, Boston, MA, United States
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States
| | - Benjamin L. Harris
- A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia
| | - Babawale Ojediran
- A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia
| | - Mia Touma
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States
| | - Michelle P. Durham
- Department of Psychiatry, Boston Medical Center, Boston, MA, United States
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States
| | - Kimberly Hook
- Department of Psychiatry, Boston Medical Center, Boston, MA, United States
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States
| | - Christina P. C. Borba
- Department of Psychiatry, Boston Medical Center, Boston, MA, United States
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States
| | - David C. Henderson
- Department of Psychiatry, Boston Medical Center, Boston, MA, United States
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States
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Hlophe SD, Jooste K. Self-management guidelines for youth who have lost a family provider through HIV/AIDS. Health SA 2023; 28:2171. [PMID: 37670745 PMCID: PMC10476501 DOI: 10.4102/hsag.v28i0.2171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 05/26/2023] [Indexed: 09/07/2023] Open
Abstract
Background When parents die from HIV/AIDS-related causes, children often experience emotional instability and are given additional obligations, such as caring for siblings. Youths may react in a variety of ways, including increasing alcohol consumption, and their relationships with their siblings may be altered positively or negatively. Aim The purpose of this article is to examine the lived experiences of youths in managing themselves after losing a family member to HIV/AIDS and suggest developed guidelines for nurses to advise youths on self-management after losing a family member to HIV/AIDS. Setting Khayelitsha, Western Cape province, South Africa. Method A descriptive phenomenological design for this study was followed. The researcher conducted 11 semi-structured interviews with participants. The study was conducted with participants that were youth aged between 18 and 25 years. Results The study revealed that the death of a family provider can be difficult for the youth left behind to deal with the changes in their daily lives. Conclusion The findings demonstrated that the death of a family member has a significant impact on the family. One of the more senior family members must assume charge and remain strong to help their siblings focus on the future. The death of a family member might result in a cascade of forced changes that necessitate new behaviours to maintain stability. Contribution This study's context-based data focuses on how the Community Health Centre (CHC) may assist young people in managing themselves after a family provider has died from HIV/AIDS, using the developed guidelines.
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Affiliation(s)
- Siphesihle D Hlophe
- Department of Nursing Science, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Karien Jooste
- Department of Nursing Science, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town, South Africa
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Parviniannasab AM, Rakhshan M, Momennasab M, Soltanian M, Rambod M, Akbarzadeh M. The mediating role of Courageous coping in the relations between spirituality and social support with resilience among adolescents with hemophilia. Clin Child Psychol Psychiatry 2022; 27:1141-1154. [PMID: 35037784 DOI: 10.1177/13591045211055081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In addition to physical disorders, people with hemophilia face complex psychological problems. Hence, protective factors such as coping strategies, social support, and spirituality to improve psychological health should be determined. This study examined the role of courageous coping as a mediator in the interrelationships between spirituality as well as social support and resilience among adolescents with hemophilia. In this descriptive-analytical study, the participants were 372 adolescents with hemophilia aged 11-21 years. Connor-Davidson resilience scale, Jalowiec Coping scale, Perceived Social Support Scale, and spirituality scale were the instruments used in this study. The analysis results of Pearson correlation revealed a significant positive relationship between spirituality as well as social support and resilience. Also, it was determined that courageous coping is a thorough mediator between spirituality and resilience. The mediating role of courageous coping did not reach meaningful levels between social support and resilience, meaning that zero was included in bootstrap interval, CI 95% (β =.026, CI [-.002, .089]). Social support, adopting a spiritual strategy, and using coping strategies played a crucial role among the adolescents to promote their level of resilience to cope with hemophilia.
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Affiliation(s)
| | - Mahnaz Rakhshan
- Community Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Marzieh Momennasab
- Associate Professor of Nursing, Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mitra Soltanian
- Community Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masoume Rambod
- Community Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahdi Akbarzadeh
- PhD of Biostatistics, Assistant Professor, Researcher in Statistical Genetics, Cellular and Molecular Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Levey EJ, Harris BL, Laird LD, Kekulah I, Borba CPC, Henderson DC, Becker AE. Orphans in post-conflict Liberia: Seeking care in fractured communities. Transcult Psychiatry 2022; 59:235-248. [PMID: 35021921 PMCID: PMC9250424 DOI: 10.1177/13634615211066696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Orphans in post-conflict settings have unique needs that have not been well-characterized. In post-conflict Liberia, maternal orphans are more likely to be without care than paternal orphans. This study examined the experiences of maternal orphans in Liberia, as they attempted to care for themselves and seek care from others, and the barriers they faced. In-depth interviews were conducted with 75 post-conflict Liberian orphans. We performed a secondary narrative analysis of interview transcripts from all maternal or double orphans (n = 17). We identified similar elements across narratives: traumatic loss, disconnection from family and community, and the desire for a savior. Female high-risk orphans were more likely to have formal substitute caregiving arrangements in which they were living with someone who was a relative or had been selected by a relative. Male orphans more commonly lacked arranged substitute care, but this allowed them to form relationships with substitute caregivers of their choosing. Sex also played a role in the provision of caregiving; substitute care was provided by women. Findings highlighted the syndemic relationship between poverty, violence, transactional sex, trauma, and substance use that traps high-risk Liberian orphans. Interventions are needed to improve access to mental health care, sober communities, housing, and education support. The need to integrate these services into indigenous institutions and address barriers related to stigma is explored.
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Affiliation(s)
- Elizabeth J Levey
- The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital.,Department of Psychiatry, Harvard Medical School.,Department of Psychiatry, University of Illinois College of Medicine
| | | | - Lance D Laird
- Department of Family Medicine, 12259Boston University School of Medicine
| | - Isaac Kekulah
- Department of Psychiatry, University of Illinois College of Medicine
| | - Christina P C Borba
- Department of Psychiatry, 12259Boston University School of Medicine.,Department of Psychiatry, 1836Boston Medical Center
| | - David C Henderson
- Department of Psychiatry, 12259Boston University School of Medicine.,Department of Psychiatry, 1836Boston Medical Center
| | - Anne E Becker
- The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital.,Department of Psychiatry, Harvard Medical School.,Department of Global Health and Social Medicine, Harvard T.H. Chan School of Public Health
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Sileo KM, Kershaw TS, Gilliam S, Taylor E, Kommajosula A, Callands TA. Trauma Exposure and Intimate Partner Violence Among Young Pregnant Women in Liberia. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:10101-10127. [PMID: 31625468 PMCID: PMC7778451 DOI: 10.1177/0886260519881533] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Intimate partner violence (IPV) is a global threat to women's health and may be elevated among those exposed to traumatic events in post-conflict settings, such as Liberia. The purpose of this study was to examine potential mediators between lifetime exposure to traumatic events (i.e., war-related trauma, community violence) with recent experiences of IPV among 183 young, pregnant women in Monrovia, Liberia. Hypothesized mediators included mental health (depression, posttraumatic stress symptoms), insecure attachment style (anxious and avoidant attachment), and attitudes indicative of norms of violence (attitudes justifying wife beating). We tested a parallel multiple mediation model using the PROCESS method with bias-corrected and accelerated bootstrapping to test confidence intervals (CI). Results show that 45% of the sample had experienced any physical, sexual, or emotional IPV in their lifetime, and 32% in the 2 months prior to the interview. Exposure to traumatic events was positively associated with recent IPV severity (β = .40, p < .01). Taken together, depression, anxious attachment style, and justification of wife beating significantly mediated the relationship between exposure to traumatic events and experience of IPV (β = .15, 95% CI = [0.03, 0.31]). Only anxious attachment style (β = .07, 95% CI = [0.03, 0.16]) and justification of wife beating (β = .05, 95% CI = [0.01, 0.16]) were identified as individual mediators. This study reinforces pregnancy as an important window for both violence and mental health screening and intervention for young Liberian women. Furthermore, it adds to our theoretical understanding of mechanisms in which long-term exposure to traumatic events may lead to elevated rates of IPV in Liberia, and points to the need for trauma-informed counseling and multilevel gender transformative public health approaches to address violence against women.
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Affiliation(s)
- Katelyn M. Sileo
- The University of Texas at San Antonio, USA
- The Center for Interdisciplinary Research at Yale University, New Haven, CT, USA
| | - Trace S. Kershaw
- The Center for Interdisciplinary Research at Yale University, New Haven, CT, USA
- Yale School of Public Health, New Haven, CT, USA
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Hook K, Ando K, Ghebrehiwet S, Harris B, Ojediran B, Syeda H, Henderson D, Borba C. Current state of the literature on mental health in Liberia: A systematic review. S Afr J Psychiatr 2020; 26:1502. [PMID: 33240551 PMCID: PMC7670006 DOI: 10.4102/sajpsychiatry.v26i0.1502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 08/05/2020] [Indexed: 12/04/2022] Open
Abstract
Background The Republic of Liberia recently experienced several events that resulted in wide-ranging societal impacts, including long-term civil war and an outbreak of Ebola. These types of events are linked to higher prevalence of mental disorders and psychosocial distress. As a result, it is likely that there is an increased prevalence of mental health disorders in the population. Aim To assess and review the recent mental health literature in order to provide insight into existing mental health needs and effective or recommended interventions in post-conflict Liberia. Setting Articles included in this study enrolled Liberians living in Liberia. Methods A search of four databases was conducted for studies of any type that assessed mental health in Liberia between 01 January 2003 and 27 March 2019. After reviewing 363 articles, 21 articles were included in the final analysis. Articles were coded to identify common themes and needs. Results The majority of studies used qualitative designs and were conducted in Monrovia, the capital city of Liberia. Common topics included adolescent mental health, intervention and assessment and post-conflict impacts. One article focused on mental health impacts after recovery from Ebola. Conclusion Overall, there is a dearth of mental health literature that focuses on Liberia. This suggests ample opportunity for researchers to investigate mental health needs amongst the Liberian population and effective psychiatric interventions. Existing recommendations often focus on addressing adolescent health needs, including substance use practices. Opportunities for future research particularly related to needs of adult populations and to mental health impacts of Ebola, abound.
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Affiliation(s)
- Kimberly Hook
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States of America.,Department of Psychiatry, Boston Medical Center, Boston, MA, United States of America.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA,United States of America
| | - Kanako Ando
- Department of Psychiatry, Boston Medical Center, Boston, MA, United States of America
| | - Senait Ghebrehiwet
- Department of Psychiatry, Boston Medical Center, Boston, MA, United States of America
| | - Benjamin Harris
- A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia
| | - Babawale Ojediran
- A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia
| | - Haniya Syeda
- Department of Psychiatry, Boston Medical Center, Boston, MA, United States of America
| | - David Henderson
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States of America.,Department of Psychiatry, Boston Medical Center, Boston, MA, United States of America
| | - Christina Borba
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States of America.,Department of Psychiatry, Boston Medical Center, Boston, MA, United States of America
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Abstract
Between 1989 and 2003, Liberia experienced a brutal civil war characterized by ethnic killings, sexual violence and the use of child soldiers. Five years after the war ended, half the population of Liberia was under 18 years old. Understanding the needs of these youth is thus essential to the recovery of the nation. This study focuses on the narratives of two female adolescents, selected from 75 in-depth individual interviews with post-conflict Liberian youth conducted in 2012. A narrative analysis approach was employed to examine each interview for multiple layers of meaning. The aim of the study was to elucidate factors that may enable post-conflict youth to reclaim a sense of agency and return to normal developmental tasks. The study explores the ways in which these youth navigate complicated power dynamics in the post-conflict setting and how gender impacts their experiences of their own agency and capability. The dynamics between the participants and the interviewer are explored to further illustrate how power dynamics manifest. These narratives support the involvement of youth in projects that help others as an avenue for promoting agency and resilience for themselves.
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