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Tafesse W, Jemutai J, Mayora C, Margini F. Scoping Review of Health Economics Research on Refugee Health in Sub-Saharan Africa. Value Health Reg Issues 2024; 39:98-106. [PMID: 38064761 DOI: 10.1016/j.vhri.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 09/15/2023] [Accepted: 10/27/2023] [Indexed: 01/15/2024]
Abstract
OBJECTIVES Most refugees and internally displaced people (IDP) stay in low- and middle-income settings. A substantial proportion are hosted by countries in sub-Saharan African (SSA), which puts significant pressure on limited government healthcare budgets. As health economics may guide more optimal healthcare decision making, we scope the health economics literature on forcibly displaced populations in SSA to identify the nature and range of health economics evidence. METHODS We conducted a scoping review of peer-reviewed and gray literature in English published from 2000 to 2021. Our search terms comprised a combination of keywords related to refugees, SSA, and health economics. We followed a stepwise methodology consisting of the identification and selection of studies, extraction and charting of data. RESULTS We identified 29 health economics studies on refugees and IDPs in SSA covering different providers, interventions, and delivery platforms. Twenty-one articles studied the determinants of health, followed by 5 on the supply of healthcare and 2 concerned with economic evaluation and the demand for healthcare, respectively. We found an equal division of articles focusing on refugees and IDPs, as well as by settlement type. Mental health was the most frequently studied health area and Uganda was the most studied destination country. CONCLUSIONS The health economics literature on refugees in SSA remains limited. Our scoping review encourages future research to study a larger variety of healthcare systems and health economic topics such as economic evaluations, health financing and whole health systems to support resource allocation decisions and sustainable long-term solutions.
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Affiliation(s)
- Wiktoria Tafesse
- Centre for Health Economics, University of York, York, England, UK.
| | | | - Chrispus Mayora
- Department of Health Policy Planning and Management, School of Public Health, Makerere University, Central Region, Kampala, Uganda
| | - Federica Margini
- UNICEF Tanzania Country Office, Kinondoni, Dar es Salaam, Tanzania
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2
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Singh L, Abbas SM, Roberts B, Thompson N, Singh NS. A systematic review of the indirect impacts of COVID-19 on sexual and reproductive health services and outcomes in humanitarian settings. BMJ Glob Health 2023; 8:e013477. [PMID: 37984894 PMCID: PMC10660896 DOI: 10.1136/bmjgh-2023-013477] [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: 07/20/2023] [Accepted: 10/21/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Humanitarian settings, particularly those in low-income and middle-income countries (LMICs), present increased sexual and reproductive health (SRH) challenges for individuals and health systems. Previous infectious disease outbreaks in such settings have negatively impacted SRH services and outcomes, as fragmented health systems are further overstretched. The COVID-19 pandemic has magnified the SRH challenges in LMIC humanitarian settings on an unprecedented scale. However, understanding of the impacts of COVID-19 is lacking. This review aimed to understand how the COVID-19 pandemic has impacted SRH service coverage, utilisation and outcomes in LMIC humanitarian settings, to inform current and future humanitarian research, programming and practice. METHODS A systematic review methodology was followed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting standards. Three search fields related to humanitarian settings, SRH and COVID-19 were applied, and limited to LMIC settings only. Three bibliographic databases and nine grey literature sources were searched. Articles meeting inclusion criteria at full-text screening were critically appraised using standardised tools. Data extraction was undertaken on included articles and analysed through narrative synthesis. RESULTS In total, 7742 citations were screened and 42 were included in the review. All included studies were cross-sectional. The quality was mostly medium to high. Narrative synthesis identified the reduced provision of, and access to, SRH services, and increased morbidity including sexual and gender-based violence and unplanned pregnancies. Impacts on service uptake varied across and within settings. Adaptations to improve SRH service access including telemedicine were reported; however, implementation was hindered by resource constraints. CONCLUSIONS The COVID-19 pandemic has indirectly negatively impacted SRH at the individual and health system levels in LMIC humanitarian settings. Further research on the impacts on service uptake is required. SRH programmers should target interventions to meet the increased SRH needs identified. Policy-makers must incorporate SRH into emergency preparedness and response planning to mitigate indirect impacts on SRH in future outbreaks.
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Affiliation(s)
- Lucy Singh
- Faculty of Life Sciences & Medicine, King's College London, London, UK
| | | | - Bayard Roberts
- Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Neha S Singh
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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3
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Mizrachi M, Levy E, Dror AA, Sela E, Kutikov S, Barhoum M, Ronen O, Gruber M. Humanitarian Outpatient Pediatric Endeavor (HOPE): A Novel Specialist Ambulatory Health-Care Concept in Conflict Areas. Disaster Med Public Health Prep 2023; 17:e498. [PMID: 37781787 DOI: 10.1017/dmp.2023.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
With the collapse of the medical system in Syria, Israel began providing Syrians with humanitarian aid, first to the war-injured and then general medical treatment. We developed a novel specialist ambulatory care concept to provide medical care for Syrian children. Children with their caregivers were transported by bus across the border from Syria to our medical center in Israel for day-stay outpatient-clinic advanced evaluation and treatment due to coordination between Syrian, Red Cross, and Israeli authorities, including Israeli Defense Forces. This retrospective field report includes 371 Syrian children treated as outpatients at Galilee Medical Center between January 2016 and September 2018. In our experience, this novel pediatric ambulatory care concept has been feasible, efficient, and successful in providing specialist care for children in a crisis region devoid of access to health care. We believe it can also serve adult patients and be implemented in other crises and disasters scenarios.
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Affiliation(s)
- Matti Mizrachi
- Department of Otolaryngology - Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Einat Levy
- Department of Otolaryngology - Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Amiel A Dror
- Department of Otolaryngology - Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Eyal Sela
- Department of Otolaryngology - Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | | | - Masad Barhoum
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
- Administration, Galilee Medical Center, Nahariya, Israel
| | - Ohad Ronen
- Department of Otolaryngology - Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Maayan Gruber
- Department of Otolaryngology - Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
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Omam LA, Jarman E, O'Laughlin KN, Parkes-Ratanshi R. Primary healthcare delivery models in African conflict-affected settings: a systematic review. Confl Health 2023; 17:34. [PMID: 37454133 DOI: 10.1186/s13031-023-00533-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/12/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND In conflict-affected settings, access to primary healthcare for displaced populations is constrained by multiple challenges. These include geographical, cultural, communication, logistical and financial barriers, as well as risks posed to health workers and the population by insecurity. Different models of care are used to provide primary healthcare to affected communities. However, there is a paucity of evidence on how these models are selected and implemented by organisations working in conflict and displacement-affected settings. Our aim was to explore the different primary healthcare delivery models used in conflict-affected settings to understand gaps in existing healthcare delivery models. METHODS We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The review protocol was registered with the International Prospective Register of Systematic Reviews. We searched six databases for manuscripts published from January 1992 to December 2020. Publications were included if they reported primary healthcare models of care in conflict-affected settings of Africa. Data was analyzed descriptively and thematically using tables, charts and text. RESULTS Forty-eight primary research articles were included for analysis from which thirty-three were rated as "high" quality. The results showed that the models of care in place in these conflict-affected settings include health facility-based, community-based, mobile clinics, outreach and home visits. Primary healthcare for internally displaced persons and refugees is provided by a wide range of actors including national and international organisations. A range of services is offered, most commonly nutrition, mental health and sexual/reproductive health. Some organisations offer vertical (stand-alone) services, while others use an integrated service delivery model. Multiple cadres of healthcare workers provide services, frequently lay healthcare workers such as Community Health Workers. CONCLUSION Understanding the different modalities of primary healthcare delivery in conflict-affected settings is important to identify existing practices and gaps in service delivery. Service delivery using community health workers in conflict-affected settings is a low-cost primary care delivery strategy that may help optimize contributions of existing personnel through task shifting.
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Affiliation(s)
- Lundi-Anne Omam
- Department of Public Health and Primary Care, University of Cambridge, Cambridgeshire, UK.
- Department of Psychiatry, University of Cambridge, Cambridgeshire, UK.
| | | | - Kelli N O'Laughlin
- Departments of Emergency Medicine and Global Health, University of Washington, Seattle, USA
| | - Rosalind Parkes-Ratanshi
- Department of Psychiatry, University of Cambridge, Cambridgeshire, UK
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
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Omam LA, O’Laughlin K, Tendongfor N, Wudiri Z, Hassan MN, Metuge A, Oluwafemi O, Omam E, Parkes-Ratanshi R. Exploring factors influencing the selection of primary health care delivery models in conflict-affected settings of North West and South West regions of Cameroon and North-East Nigeria: A study protocol. PLoS One 2023; 18:e0284957. [PMID: 37134075 PMCID: PMC10155952 DOI: 10.1371/journal.pone.0284957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 04/12/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND In conflict-affected settings, access to health care for displaced populations is constrained by barriers including geographical, cultural, communication, logistical, financial and insecurity. A six year humanitarian crises in the North West and South West regions of Cameroon has caused 27% of health facilities to be non-functional. The eleven year crisis in North-East Nigeria, has caused the closure of 26% of health facilities. These closure of health facilities and population displacement led to health care delivery using humanitarian funding by multiple different agencies. However, there is a paucity of evidence on the selection and design of the primary health care delivery models used in humanitarian settings. To ensure efficient use of resources and quality of services, model of care selection should be evidence based and informed by the specific humanitarian context. This research protocol aims to explore how primary health care models are selected by humanitarian organizations. METHODS We will conduct a cross sectional quantitative survey to map the range of primary health care delivery models used by humanitarian organisations in Cameroon and Nigeria. Using in-depth interviews and focus group discussions with staff from humanitarian organizations and internally displaced persons, we will explore the factors influencing the selection of primary health care models in these settings and determine the coverage and gaps in services across the different primary health care models. Quantitative data will be analysed in a descriptive manner and qualitative data will be analysed thematically. DISCUSSION Different models of care have been reported to be used by humanitarian organisations in conflict-affected settings, yet evidence on how different models are selected is lacking. A detailed understanding of the rationale for selection, the design and quality considerations of the strategies used to deliver health care will be obtained using a survey, in-depth interviews and focus group discussions.
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Affiliation(s)
- Lundi-Anne Omam
- Department of Public Health and Primary Care, University of Cambridge, Cambridgeshire, Cambridge, United Kingdom
- Department of Psychiatry, Clinical School, University of Cambridge, Cambridge, United Kingdom
| | - Kelli O’Laughlin
- Departments of Emergency Medicine and Global Health, University of Washington, Seattle, WA, United States of America
| | - Nicholas Tendongfor
- Department of Community Medicine, University of Maiduguri, Maiduguri, Nigeria
| | - Zara Wudiri
- Herwa Community Development Initiative, Maiduguri, Nigeria
| | | | | | - Ooju Oluwafemi
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Rosalind Parkes-Ratanshi
- Department of Psychiatry, Clinical School, University of Cambridge, Cambridge, United Kingdom
- Department of Public Health and Hygiene, University of Buea, Buea, Cameroon
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6
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Procureur F, Estifanos AS, Keraga DW, Kiflie Alemayehu AK, Hailemariam NW, Schellenberg J, Magge H, Hill Z. "Quality teaches you how to use water. It doesn't provide a water pump": a qualitative study of context and mechanisms of action in an Ethiopian quality improvement program. BMC Health Serv Res 2023; 23:381. [PMID: 37076845 PMCID: PMC10116784 DOI: 10.1186/s12913-023-09341-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/25/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Quality improvement collaboratives are a common approach to bridging the quality-of-care gap, but little is known about implementation in low-income settings. Implementers rarely consider mechanisms of change or the role of context, which may explain collaboratives' varied impacts. METHODS To understand mechanisms and contextual influences we conducted 55 in-depth interviews with staff from four health centres and two hospitals involved in quality improvement collaboratives in Ethiopia. We also generated control charts for selected indicators to explore any impacts of the collaboratives. RESULTS The cross facility learning sessions increased the prominence and focus on quality, allowed learning from experts and peers and were motivational through public recognition of success or a desire to emulate peers. Within facilities, new structures and processes were created. These were fragile and sometimes alienating to those outside the improvement team. The trusted and respected mentors were important for support, motivation and accountability. Where mentor visits were infrequent or mentors less skilled, team function was impacted. These mechanisms were more prominent, and quality improvement more functional, in facilities with strong leadership and pre-existing good teamwork; as staff had shared goals, an active approach to problems and were more willing and able to be flexible to implement change ideas. Quality improvement structures and processes were more likely to be internally driven and knowledge transferred to other staff in these facilities, which reduced the impact of staff turnover and increased buy-in. In facilities which lacked essential inputs, staff struggled to see how the collaborative could meaningfully improve quality and were less likely to have functioning quality improvement. The unexpected civil unrest in one region strongly disrupted the health system and the collaborative. These contextual issues were fluid, with multiple interactions and linkages. CONCLUSIONS The study confirms the need to carefully consider context in the implementation of quality improvement collaboratives. Facilities that implement quality improvement successfully may be those that already have characteristics that foster quality. Quality improvement may be alienating to those outside of the improvement team and implementers should not assume the organic spread or transfer of quality improvement knowledge.
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Affiliation(s)
- F Procureur
- Institute for Global Health, University College London, Guilford St, London, WC1N 1EH, UK
| | - A S Estifanos
- Department of Reproductive, Family and Population Health, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - D W Keraga
- Department of Reproductive, Family and Population Health, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | - J Schellenberg
- Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - H Magge
- Institute for Healthcare Improvement, Addis Ababa, Ethiopia
- Brigham and Women's Hospital, Division of Global Health Equity, 75 Francis Street, Boston, MA, 02115, USA
| | - Z Hill
- Institute for Global Health, University College London, Guilford St, London, WC1N 1EH, UK.
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7
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Kaseje N, Hassan K, Muriithi J, Burton J, Weswa B, Ojwando K, Chirchir C, Kinara S, Cunningham D, Okelo S. Partnering to deliver sustainable children's surgical care in Kakuma refugee camp. Lancet 2023; 401:328-331. [PMID: 35724669 DOI: 10.1016/s0140-6736(22)01105-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 06/13/2022] [Indexed: 02/06/2023]
Affiliation(s)
- Neema Kaseje
- Surgical Systems Research Group, Kisumu, Kenya; London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK.
| | - Khalid Hassan
- Turkana Ministry of Health, Lodwar County Referral Hospital, Lodwar, Turkana, Kenya
| | | | | | - Benjamin Weswa
- International Rescue Committee Kakuma, Kakuma, Turkana, Kenya
| | - Kefa Ojwando
- International Rescue Committee Kakuma, Kakuma, Turkana, Kenya
| | - Collins Chirchir
- Turkana Ministry of Health, Lodwar County Referral Hospital, Lodwar, Turkana, Kenya
| | | | | | - Stephen Okelo
- Kenya Society of Anaesthesiologists, KMA Centre, Nairobi, Kenya
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8
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Razavi S, Noorulhuda M, Marcela Velez C, Kapiriri L, Dreyse BA, Danis M, Essue B, Goold SD, Nouvet E, Williams I. Priority setting for pandemic preparedness and response: A comparative analysis of COVID-19 pandemic plans in 12 countries in the Eastern Mediterranean Region. HEALTH POLICY OPEN 2022; 3:100084. [PMID: 36415539 PMCID: PMC9673227 DOI: 10.1016/j.hpopen.2022.100084] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/28/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022] Open
Abstract
Background The COVID-19 pandemic has significantly disrupted health systems and exacerbated pre-existing resource gaps in the Eastern Mediterranean Region (WHO-EMRO). Active humanitarian and refugee crises have led to mass population displacement and increased health system fragility, which has implication for equitable priority setting (PS). We examine whether and how PS was included in national COVID-19 pandemic plans within EMRO. Methods An analysis of COVID-19 pandemic response and preparedness planning documents from a sample of 12/22 countries in WHO-EMRO. We assessed the degree to which documented PS processes adhere to twenty established quality parameters of effective PS. Results While all reviewed plans addressed some aspect of PS, none included all quality parameters. Yemen's plan included the highest number (9) of quality parameters, while Egypt's addressed the lowest (3). Most plans used evidence in their planning processes. While no plans explicitly identify equity as a criterion to guide PS; many identified vulnerable populations - a key component of equitable PS. Despite high concentrations of refugees, migrants, and IDPs in EMRO, only a quarter of the plans identified them as vulnerable. Conclusion PS setting challenges are exacerbated by conflict and the resulting health system fragmentation. Systematic and quality PS is essential to tackle long-term health implications of COVID-19 for vulnerable populations in this region, and to support effective PS and equitable resource allocation.
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Affiliation(s)
- S.Donya Razavi
- Department of Health, Aging & Society, McMaster University, 1280 Main Street West, Kenneth Taylor Hall Room 226, Hamilton, Ontario L8S 4M4, Canada
| | - Mariam Noorulhuda
- Department of Bioethics, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20812, USA
| | - C. Marcela Velez
- Department of Health, Aging & Society, McMaster University, 1280 Main Street West, Kenneth Taylor Hall Room 226, Hamilton, Ontario L8S 4M4, Canada
| | - Lydia Kapiriri
- Department of Health, Aging & Society, McMaster University, 1280 Main Street West, Kenneth Taylor Hall Room 226, Hamilton, Ontario L8S 4M4, Canada
| | | | - Marion Danis
- Department of Bioethics, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20812, USA
| | - Beverly Essue
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, The University of Toronto, Toronto, ON, Canada
| | - Susan D. Goold
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, 2800 Plymouth Road Building 14, G016, Ann Arbor, MI 48109, USA
| | - Elysée Nouvet
- School of Health Studies, Western University, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
| | - Iestyn Williams
- Health Services Management Centre, University of Birmingham, 40 Edgbaston Park Road, Birmingham B15 2RT, UK
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9
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Kivlehan SM, Hexom BJ, Bonney J, Collier A, Nicholson BD, Quao NSA, Rybarczyk MM, Selvam A, Rees CA, Roy CM, Bhaskar N, Becker TK. Global emergency medicine: A scoping review of the literature from 2021. Acad Emerg Med 2022; 29:1264-1274. [PMID: 35913419 DOI: 10.1111/acem.14575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/17/2022] [Accepted: 07/26/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The objective was to identify the most important and impactful peer-reviewed global emergency medicine (GEM) articles published in 2021. The top articles are summarized in brief narratives and accompanied by a comprehensive list of all identified articles that address the topic during the year to serve as a reference for clinicians, researchers, and policy makers. METHODS A systematic PubMed search was carried out to identify all GEM articles published in 2021. Title and abstract screening was performed by trained reviewers and editors to identify articles in one of three categories based on predefined criteria: disaster and humanitarian response (DHR), emergency care in resource-limited settings (ECRLS), and emergency medicine development (EMD). Included articles were each scored by two reviewers using established rubrics for original (OR) and review (RE) articles. The top 5% of articles overall and the top 5% of articles from each category (DHR, ECRLS, EMD, OR, and RE) were included for narrative summary. RESULTS The 2021 search identified 44,839 articles, of which 444 articles screened in for scoring, 25% and 22% increases from 2020, respectively. After removal of duplicates, 23 articles were included for narrative summary. ECRLS constituted the largest category (n = 16, 70%), followed by EMD (n = 4, 17%) and DHR (n = 3, 13%). The majority of top articles were OR (n = 14, 61%) compared to RE (n = 9, 39%). CONCLUSIONS The GEM peer-reviewed literature continued to grow at a fast rate in 2021, reflecting the continued expansion and maturation of this subspecialty of emergency medicine. Few high-quality articles focused on DHR and EMD, suggesting a need for further efforts in those fields. Future efforts should focus on improving the diversity of GEM research and equitable representation.
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Affiliation(s)
- Sean M Kivlehan
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Humanitarian Initiative, Cambridge, Massachusetts, USA
| | - Braden J Hexom
- Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Joseph Bonney
- Department of Emergency Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.,Global Health and Infectious Disease Research Group, Kumasi Center for Collaborative Research in Tropical Medicine, Kumasi, Ghana
| | - Amanda Collier
- Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada
| | - Benjamin D Nicholson
- Department of Emergency Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Nana Serwaa A Quao
- Department of Emergency Medicine, Accident and Emergency Centre, Korle Bu Teaching Hospital, Accra, Ghana
| | - Megan M Rybarczyk
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Anand Selvam
- Department of Emergency Medicine, Yale University, New Haven, Connecticut, USA
| | - Chris A Rees
- Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Charlotte M Roy
- Department of Emergency Medicine, Loma Linda University, Loma Linda, California, USA
| | | | - Torben K Becker
- Department of Emergency Medicine, University of Florida, Gainesville, Florida, USA
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10
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Ramadan M, Tappis H, Brieger W. Primary Healthcare Quality in Conflict and Fragility: a subnational analysis of disparities using Population Health surveys. Confl Health 2022; 16:36. [PMID: 35706012 PMCID: PMC9202222 DOI: 10.1186/s13031-022-00466-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 05/24/2022] [Indexed: 11/10/2022] Open
Abstract
Background Recent global reports highlighted the importance of addressing the quality of care in all settings including fragile and conflict-affected situations (FCS), as a central strategy for the attainment of sustainable development goals and universal health coverage. Increased mortality burden in FCS reflects the inability to provide routine services of good quality. There is also paucity of research documenting the impact of conflict on the quality of care within fragile states including disparities in service delivery. This study addresses this measurement gap by examining disparities in the quality of primary healthcare services in four conflict-affected fragile states using proxy indicators. Methods A secondary analysis of publicly available data sources was performed in four conflict-affected fragile states: Cameroon, the Democratic Republic of Congo, Mali, and Nigeria. Two main databases were utilized: the Demographic Health Survey and the Uppsala Conflict Data Program for information on components of care and conflict events, respectively. Three equity measures were computed for each country: absolute difference, concentration index, and coefficients of mixed-effects logistic regression. Each computed measure was then compared according to the intensity of organized violence events at the neighborhood level. Results Overall, the four studied countries had poor quality of PHC services, with considerable subnational variation in the quality index. Poor quality of PHC services was not only limited to neighborhoods where medium or high intensity conflict was recorded but was also likely to be observed in neighborhoods with no or low intensity conflict. Both economic and educational disparities were observed in individual quality components in both categories of conflict intensity. Conclusion Each of the four conflict-affected countries had an overall poor quality of PHC services with both economic and educational disparities in the individual components of the quality index, regardless of conflict intensity. Multi-sectoral efforts are needed to improve the quality of care and disparities in these settings, without a limited focus on sub-national areas where medium or high intensity conflict is recorded. Supplementary Information The online version contains supplementary material available at 10.1186/s13031-022-00466-w.
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Affiliation(s)
- Marwa Ramadan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. .,Department of Community Medicine and Public Health, Alexandria University, Alexandria, Egypt.
| | - Hannah Tappis
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Technical leadership and Innovations Office, Jhpiego, Baltimore, MD, USA
| | - William Brieger
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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11
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Harsono D, Peterson H, Nyhan K, Khoshnood K. Factors associated with HIV acquisition in the context of humanitarian crises: a scoping review protocol. JBI Evid Synth 2022; 20:1852-1860. [PMID: 35249997 PMCID: PMC10395317 DOI: 10.11124/jbies-21-00135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this scoping review is to describe the global evidence on factors associated with HIV acquisition among individuals affected by humanitarian crises. INTRODUCTION Humanitarian crises are described as an event or series of events originating from natural causes or human intervention that represents a critical threat to the health, safety, security, and well-being of a community. Humanitarian crises have generated a continued rise in the number of displaced persons worldwide. This forcible displacement may increase the risk of acquiring human immunodeficiency virus (HIV) among the affected populations through poverty, food insecurity, social instability, and lack of access to health services during and after a crisis. Understanding factors that may contribute to HIV acquisition among these populations will allow stakeholders to be better equipped in providing HIV prevention services and programs in humanitarian settings and to prioritize research efforts. INCLUSION CRITERIA This review will consider studies containing empirical data published in peer-reviewed and gray literature that investigate factors associated with HIV acquisition in populations affected by humanitarian crises caused by natural disasters and human-made complex emergencies. METHODS MEDLINE, Embase, Global Health (all accessed via Ovid), Scopus, and gray literature will be systematically searched. Studies published in English from 1990 will be included. Titles and abstracts of identified citations will be screened independently and assessed for eligibility by two authors. Potentially relevant full-text studies and data will be extracted by these authors using a data extraction form. Data will be presented in tabular form, figures, and a narrative summary.
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Affiliation(s)
- Dini Harsono
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, Yale University, New Haven, CT, USA Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, USA Environmental Health Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA
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Chou VB, Stegmuller A, Vaughan K, Spiegel PB. The Humanitarian Lives Saved Tool: An evidence-based approach for reproductive, maternal, newborn, and child health program planning in humanitarian settings. J Glob Health 2022; 11:03102. [PMID: 35003707 PMCID: PMC8709894 DOI: 10.7189/jogh.11.03102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Victoria B Chou
- Institute for International Programs, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Angela Stegmuller
- Institute for International Programs, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Paul B Spiegel
- Johns Hopkins Center for Humanitarian Health, Johns Hopkins University, Baltimore, Maryland, USA
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Arnott G, Otema C, Obalim G, Odallo B, Nakubulwa T, Okello SBT. Human rights-based accountability for sexual and reproductive health and rights in humanitarian settings: Findings from a pilot study in northern Uganda. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000836. [PMID: 36962804 PMCID: PMC10021271 DOI: 10.1371/journal.pgph.0000836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 07/22/2022] [Indexed: 11/18/2022]
Abstract
Ensuring accountability for the realization of sexual and reproductive health and rights is a human rights obligation and central tenet of strategies to improve health systems and outcomes in humanitarian settings. This pilot study explored the feasibility and acceptability of deploying human rights strategies, specifically through a participatory community-led complaints mechanism, to hold humanitarian health systems to account for the sexual and reproductive health and rights of refugee and host community women and girls in northern Uganda. Over a fifteen-month period we conducted a multi-methods exploratory study with refugee and host community rights-holders and duty-bearers using longitudinal in-depth interviews, focus groups, and secondary data document review. Deductive and inductive coding techniques were used to analyze data iteratively for content and themes. 107 sexual and reproductive health and rights related complaints and feedback were collected through the community complaints mechanism. Complaints concerned experiences of disrespect and abuse by health care workers; lack of adolescent access to sexual and reproductive health services and information; sexual and gender-based violence; and lack of access to acceptable and quality health goods and services. Participants reported an increased understanding and claiming of human rights through the intervention, acceptability of rights-based accountability strategies among humanitarian health system actors, and improved access to remedies when sexual and reproductive health rights are not respected. Findings demonstrate integrating rights-based social accountability mechanisms at the level of humanitarian response as a promising approach for strengthening and holding humanitarian health systems accountable for the sexual and reproductive health and rights of women and girls affected by humanitarian situations.
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Affiliation(s)
- Grady Arnott
- Center for Reproductive Rights, Global Legal Program, New York, New York, United States of America
| | - Charles Otema
- CARE International in Uganda, Health Equity and Rights Team, Bugolobi, Kampala, Uganda
| | - Godfrey Obalim
- CARE International in Uganda, Health Equity and Rights Team, Bugolobi, Kampala, Uganda
| | - Beatrice Odallo
- Center for Reproductive Rights, Global Legal Program, Nairobi, Kenya
| | - Teddy Nakubulwa
- CARE International in Uganda, Gender Justice Program, Bugolobi, Kampala, Uganda
| | - Sam B T Okello
- CARE International in Uganda, Gender Justice Program, Bugolobi, Kampala, Uganda
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van den Broek N. Keep it simple - Effective training in obstetrics for low- and middle-income countries. Best Pract Res Clin Obstet Gynaecol 2021; 80:25-38. [PMID: 34872860 DOI: 10.1016/j.bpobgyn.2021.10.007] [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: 07/27/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 11/30/2022]
Abstract
In low-and middle-income countries, the burden of disease related to pregnancy and childbirth remains high. The health of the mother is intricately linked to that of the baby. Neonatal mortality is most likely to occur in the first week of life accounting for almost half of all deaths among children under 5-year old. Many babies are stillborn each year. It is important that healthcare is accessible, available, and of good quality. This requires a functioning health system with motivated, competent healthcare providers who were able to provide the continuum of care for mothers and babies. Pre- and in-service training is effective if it uses adult learning approaches, includes all members of the maternity team, and is focused on the core content of the care packages that are agreed for each setting. Most programmes that seek to build the capacity of the health system include training as one of the interventions to be implemented.
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Affiliation(s)
- Nynke van den Broek
- Maternal and Newborn Health, Independent Consultant Global Health, 5 Newcroft Road, Liverpool, L25 6EP, United Kingdom.
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15
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Khan MF, Jeannetot D, Olleri KS, Bakker M, Musani AS, Abdel Moneim ARI, Hatahit W, Zwanikken P. An assessment of the quality of care provided at primary health care centres in camps for internally displaced persons in Iraq in 2018. Confl Health 2021; 15:67. [PMID: 34496920 PMCID: PMC8425107 DOI: 10.1186/s13031-021-00402-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 08/23/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The humanitarian crisis in Iraq remains one of the largest and most unstable in the world. In 2014, over 2.5 million civilians were displaced in Iraq; between 2015 and 2017 more than 3 million people continued to be displaced. While health-related research concerning internally displaced persons (IDPs) population has been conducted in many settings, very few have looked at the quality of care delivered in primary health care centres (PHCC) inside camps. The objective of this operational research is to assess the quality of health care services at PHCC in operational IDP camps supported by local and international NGOs (humanitarian partners) as well as the Directorate of Health (DoH) in Iraq at baseline and after 6 months. METHOD A framework based on five components was used to assess quality of care by assigning a quality-of-care index score. Using a longitudinal design; data were collected through observations of facilities and of patient consultations, as well as health worker and patient exit interviews, in static PHCC in operational IDP camps of Iraq during two different phases: in June (n = 55), and December 2018 (n = 47). These facilities supported more than 500,000 IDPs. Descriptive and statistical analyses were conducted, and the results compared. RESULT For all camps (n = 47), the average overall quality of care index score increased between the two phases. No specific type of organisation consistently provided a better quality of care. The camp size was unrelated to the quality of care provided at the respective facility. The domain indicators "Client Care" and "Environment and Safety" mostly related to the variation in the general assessment of quality. Patient satisfaction was unrelated to any other domain score. Compared at 0 and after 6-months, the quality of care index score between the type of organisation and governorate showed that feedback positively impacted service delivery after the first assessment. Positive differences in scores also appeared, with notable improvements in Client care and Technical competence. CONCLUSION Humanitarian partners and the DoH are able to provide quality care, independent of camp size or the number of camps managed, and their cooperation can lead to quick improvements. This research also shows that quality of care assessment in emergency settings can be carried out in formal IDP camps using non-emergency standards.
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Affiliation(s)
| | | | | | - Mirjam Bakker
- KIT Royal Tropical Institute, Amsterdam, The Netherlands
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Currie S, Natiq L, Anwari Z, Tappis H. Assessing respectful maternity care in a fragile, conflict-affected context: Observations from a 2016 national assessment in Afghanistan. Health Care Women Int 2021; 45:169-189. [PMID: 34126037 DOI: 10.1080/07399332.2021.1932890] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 05/17/2021] [Indexed: 12/17/2022]
Abstract
Evidence on experiences and perceptions of care in pregnancy and childbirth in conflict-affected settings is limited. We interviewed 561 maternity care providers and observed 413 antenatal care consultations, 671 births, and 393 postnatal care consultations at public health facilities across Afghanistan. We found that healthcare providers work under stressed conditions with insufficient support, and most women receive mixed quality care. Understanding socio-cultural and contextual factors underpinning acceptance of mistreatment in childbirth, related to conflict, insecurity, gender and power dynamics, is critical for improving the quality of maternity care in Afghanistan and similar fragile and conflict affected settings.
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Affiliation(s)
- Sheena Currie
- Jhpiego, Technical Leadership Office, Baltimore, Maryland, USA
| | - Laila Natiq
- Jhpiego, Technical Leadership Office, Baltimore, Maryland, USA
- Independent Researcher, Alexandria, Virginia, USA
| | | | - Hannah Tappis
- Jhpiego, Technical Leadership Office, Baltimore, Maryland, USA
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