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Rare and highly destructive wildfires drive human migration in the U.S.
No full textThe scale of wildfire impacts to the built environment is growing and will likely continue under rising average global temperatures. We investigate whether and at what destruction threshold wildfires have influenced human mobility patterns by examining the migration effects of the most destructive wildfires in the contiguous U.S. between 1999 and 2020. We find that only the most extreme wildfires (258+ structures destroyed) influenced migration patterns. In contrast, the majority of wildfires examined were less destructive and did not cause significant changes to out- or in-migration. These findings suggest that, for the past two decades, the influence of wildfire on population mobility was rare and operated primarily through destruction of the built environment
The global macroeconomic burden of Alzheimer\u27s disease and other dementias: Estimates and projections for 152 countries or territories
No full textBackground: Alzheimer\u27s disease and other dementias (ADODs) severely threaten the wellbeing of older people, their families, and communities, especially with projected exponential growth. Understanding the macroeconomic implications of ADODs for policy making is essential but under-researched. Methods: We used a health-augmented macroeconomic model to calculate the macroeconomic burden of ADODs for 152 countries or territories, accounting for: the effect on labour supply of reduced working hours of informal caregivers; the effect on labour supply of ADODs-related mortality and morbidity; age–sex-specific differences in education, work experience, labour market participations, and informal caregivers; and treatment and formal care costs diverting from savings and investments. Findings: ADODs will cost the world economy 14 513 billion international dollars (INT2961 billion [2507–3564]), the USA (INT1758 billion [1471–2150]) face the largest absolute economic burdens. The economic burden of informal care ranges from 60·97% in high-income countries to 85·45% in lower-middle-income countries, and treatment and formal care costs range from 10·50% in lower-middle-income countries to 30·80% in high-income countries. Interpretation: The macroeconomic burden of ADODs is substantial and unequally distributed across countries and regions. Global efforts to reduce the burden, especially with regard to informal care, are urgently needed
Reducing stigma and promoting HIV wellness/mental health of sexual and gender minorities: RCT results from a group-based programme in Nigeria
No full textIntroduction: High levels of HIV stigma as well as stigma directed towards sexual and/or gender minorities (SGMs) are well documented in the African setting. These intersecting stigmas impede psychosocial wellbeing and HIV prevention and care. Yet, there are few if any evidence-based interventions that focus on reducing internalized stigma and promoting mental health and HIV wellness for SGMs in Africa. We developed and evaluated a group-based intervention drawing on cognitive behavioural therapy (CBT) strategies for men who have sex with men (MSM) and transgender women (TGW) at risk for or living with HIV in Lagos, Nigeria. Methods: The intervention comprised four weekly in-person group sessions facilitated by community health workers. We conducted a delayed intervention group randomized controlled trial (April−September 2022), with pre-post surveys plus 3-month follow-up (immediate group only), as well as qualitative research with participants and programme staff. Outcomes included internalized stigma related to SGM and HIV status, depression, resiliency/coping and pre-exposure prophylaxis (PrEP)/HIV treatment use. Results: Mean age of the 240 participants was 26 years (range 18−42). Seventy-seven percent self-identified as MSM and 23% TGW; 27% were people with HIV. Most (88%) participants attended all four sessions, and 98% expressed high intervention satisfaction. There was significant pre-post improvement in each psychosocial outcome, in both the immediate and delayed arms. There were further positive changes for the immediate intervention group by 3-month follow-up (e.g. in intersectional internalized stigma, depression). While baseline levels of ever-PrEP use were the same, 75% of immediate-group participants reported currently using PrEP at 3 months post-intervention versus 53% of delayed-group participants right after the intervention (pConclusions: This study demonstrated the feasibility and acceptability of a group-based CBT model for MSM and TGW in Nigeria. There were also some indications of positive shifts related to stigma, mental health and PrEP, despite issues with maintaining the randomized design in this challenging environment
Highlights from the first-ever violence against children and youth survey conducted exclusively in a humanitarian setting
No full textBackground: Violence against children (VAC) has garnered attention as a priority issue, in part, due to the Violence Against Children and Youth Surveys (VACS). Although children are disproportionately represented among forcibly displaced people, VACS are a novelty in humanitarian settings. Objective: This paper presents the approach to the first-ever VACS conducted exclusively in a humanitarian setting (HVACS) in Uganda, in addition to providing an overview of the results of this novel survey, along with their implications. Participants and setting: Participants included 1338 females and 927 males aged 13–24 years living in refugee settlements in Uganda. Methods: This was a cross-sectional representative household survey conducted in all 13 refugee settlements in Uganda between March and April 2022. A three-stage sampling process was used to identify participants. Descriptive analysis was conducted, involving the application of sample weights to obtain estimates that are representative of the study population. Results: VAC in refugee settings is pervasive, with females being more likely than males to experience sexual violence and males being more likely than females to experience physical violence. VAC perpetrators were mostly people who were known to child survivors. Whereas knowledge of where to seek help for violence was relatively high (more so for males compared to females), the levels of disclosure and help-seeking were very low for both groups. Conclusion: Robust surveys that have traditionally excluded humanitarian settings can be conducted in these contexts. Data emanating from such surveys are critical for developing relevant guidance on interventions to appropriately address major public health issues, such as VAC
Disability, childhood experiences of violence and associated health outcomes in refugee settlements in Uganda
No full textBackground: There is limited evidence regarding the associations between disability, childhood experiences of violence, and associated health outcomes in humanitarian settings. Objective: We examined the prevalence of childhood sexual, physical, and emotional violence by disability status, explored associations between childhood violence and type of disability (limitation), perpetrator types, and the negative health outcomes associated with experiencing childhood violence by disability status. Participants and Setting: Participants included 1338 females and 927 males aged 13–24 years living in refugee settings in Uganda. Methods: Data were from a cross-sectional Ugandan Humanitarian Violence against Children and Youth Survey (HVACS) conducted between March and April 2022. Analysis entailed cross-tabulation with a chi-square test and estimation of bivariate and multivariate logistic regression models. Results: For both females and males, the prevalence of sexual violence in childhood was higher among those with disabilities compared to those without disabilities (23.2% vs. 11.5% for females; and 15.7% vs. 7.6% for males). The odds of experiencing sexual violence were higher among females with physical limitations (self-care [AOR:2.1; 95%CI-1.0-4.3] and task performance [AOR:2.5; 95%CI = 1.3–5.2]) and males with both physical [AOR:4.4; 95%CI = 1.4–13.7] and communication [AOR:4.1; 95%CI = 1.3–12.9] limitations compared to those without such limitations. Experiencing violence and having disabilities increased the odds of reporting negative health outcomes including severe mental distress and symptoms or being diagnosed with STI among females by three times. Conclusion: In Uganda\u27s refugee settings, the prevalence of childhood violence is higher among children and youth with disabilities compared to those without disabilities. Females with disabilities and who had experienced childhood violence were considerably more susceptible to negative health outcomes. These findings underscore the need for targeted child protection and response interventions to address the vulnerabilities of children and youth, and particularly for those with disabilities and female children
Guidance document on the use of opinion polls and vignettes to measure public opinion, attitudes and behavioural intentions related to female genital mutilation
Get PDFThis guidance document is part of the FGM Data Hub’s effort to address challenges encountered by programme implementers in measuring change (specifically, unstandardised measurement indicators and complex surveys) and the effect of social desirability in the context of female genital mutilation (FGM). The guidance focuses on how to use a tool developed by the FGM Data Hub to measure social attitudes toward FGM. The process leading to the development of this guidance involved piloting the tool—a simple opinion poll survey using a combination of direct (self-report) and indirect (vignettes about others) questioning methodologies to generate robust data to measure public views on FGM
The globalization of international migration? A conceptual and data-driven synthesis
No full textAlthough the globalization of international migration is commonly accepted as a general tendency in contemporary migration patterns (de Haas, Castles, and Miller 2020, 9), the corresponding body of empirical evidence is mixed and fragmented. Our review of global migration patterns over the past half-century highlights how the theories, expectations, and ultimately findings may vary depending on the specific definitions, vantage points, and measures being used. In this paper, we provide a simpler and integrated account of the globalization of international migration that includes a corresponding empirical template to quantify the relative importance of two processes at work: the intensity and connectivity of international migration. Using recent estimates of country-to-country migration flows every five years from 1990–1995 to 2015–2020, our analysis using demographic decomposition and group-based multitrajectory modeling highlights the dynamic relationship between intensity and connectivity from both the global and country vantage points. Our work in this paper provides a starting point in the form of a much-needed empirical template, one that is also highly flexible and customizable, for future research on the globalization of international migration to coalesce around and use going forward
Classifying climate vulnerability and inequalities in India, Mexico, and Nigeria: A latent class analysis approach
No full textBackground: The climate crisis exacerbates social, economic, and health disparities. This study employs innovative methods to identify distinct groups affected by recent climate events. Methods: A mobile phone-based survey was conducted in April 2022 with individuals residing in multiple climate-affected states across three countries: India (n=1,020), Mexico (n=1,020), and Nigeria (n=1,021). Latent class analysis and classification and regression tree (CART) analysis were used to identify the groups most exposed to climate events, the effects and responses taken, and then to identify the characteristics associated with group membership. Effects included housing damage or lost work, while responses included actions such as borrowing money or dropping out of school. Results: Findings revealed four distinct groups: Group 1 reported low exposure, no effects, or responses (49% of respondents in India, 43% in Mexico, and 27% in Nigeria); Group 2 experienced multiple hazards with moderate effects and some responses; Group 3 was characterized by drought exposure with more effects and responses taken; Group 4 was affected by heavy flooding and rainfall with varied effects. Notably, India had the largest proportion of respondents in Group 3 (17%), in Mexico over a quarte (29%) were in group 4, while over half of Nigerian respondents were in Group 2 (52%). Characteristics associated with membership in each group varied by country. Overall, men from rural areas with lower incomes and reliant on agriculture experienced the highest levels of exposure and vulnerability, while urban women from higher-income households were the least affected. Discussion: This study underscores the importance of considering the intersectionality of risk and vulnerability when formulating policies and programs to address the impacts of climate change. Results emphasize the need for multi-sectoral policies that target the needs of different groups, to reduce inequalities and tailor to the context-specific needs of the most vulnerable people and households
District-level monitoring of universal health coverage, India
No full textObjective: To develop a framework and index for measuring universal health coverage (UHC) at the district level in India and to assess progress towards UHC in the districts. Methods: We adapted the framework of the World Health Organization and World Bank to develop a district-level UHC index (UHCd). We used routinely collected health survey and programme data in India to calculate UHCd for 687 districts from geometric means of 24 tracer indicators in five tracer domains: reproductive, maternal, newborn and child health; infectious diseases; noncommunicable diseases; service capacity and access; and financial risk protection. UHCd is on a scale of 0% to 100%, with higher scores indicating better performance. We also assessed the degree of inequality within districts using a subset of 14 tracer indicators. The disadvantaged subgroups were based on four inequality dimensions: wealth quintile, urban–rural location, religion and social group. Findings: The median UHCd was 43.9% (range: 26.4 to 69.4). Substantial geographical differences existed, with districts in southern states having higher UHCd than elsewhere in India. Service coverage indicator levels were greater than 60%, except for noncommunicable diseases and for service capacity and access. Health insurance coverage was limited, with about 10% of the population facing catastrophic and impoverishing health expenditure. Substantial wealth-based disparities in UHC were seen within districts. Conclusion: Our study shows that UHC can be measured at the local level and can help national and subnational government develop prioritization frameworks by identifying health-care delivery and geographic hotspots where limited progress towards UHC is being made