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Linking research to action to address unintended pregnancy in refugee settings in Uganda
Get PDFThe evidence available to support and shape improved family planning (FP) programming in refugee settings is sparse, and little is known about how to effectively deliver such programming to the most vulnerable, including women and girls. Baobab is responding to these questions through two complementary formative studies on unintended pregnancy and abortion incidence in refugee settings in Uganda. The findings pointed to a critical mass of non-users who intend to use an FP method in the future, and of non-users who have no such intention, but are still supportive of FP use. To expand access to FP services using existing, low-cost approaches and appropriate communication mechanisms and scale-up platforms, we propose to harness existing food distribution and refugee verification platforms as a strategic avenue for reaching women with FP information and counseling, coupled with strengthened referral procedures between these platforms and health facilities for actual FP provision and uptake
Estimates of hospitalisations and deaths in patients with COVID-19 associated with undiagnosed diabetes during the first phase of the pandemic in eight low-income and middle-income countries: A modelling study
No full textBackground: Patients with COVID-19 that had diagnosed chronic diseases—including diabetes—may experience higher rates of hospitalisation and mortality relative to the general population. However, the burden of undiagnosed co-morbidities during the pandemic has not been adequately studied. Methods: We developed a model to estimate the hospitalisation and mortality burden of patients with COVID-19 that had undiagnosed type 1 and type 2 diabetes (UD). The retrospective analytical modelling framework was informed by country-level demographic, epidemiological and COVID-19 data and parameters. Eight low-and middle-income countries (LMICs) were studied: Brazil, China, India, Indonesia, Mexico, Nigeria, Pakistan, and South Africa. The modelling period consisted of the first phase of the pandemic—starting from the date when a country identified its first COVID case to the date when the country reached 1% coverage with one dose of a COVID-19 vaccine. The end date ranged from Jan 20, 2021 for China to June 2, 2021 for Nigeria. Additionally, we estimated the change in burden under a scenario in which all individuals with UD had been diagnosed prior to the pandemic. Findings: Based on our modelling estimates, across the eight countries, 6.7 (95% uncertainty interval: 3.4–11.3) million COVID-19 hospitalised patients had UD of which 1.9 (0.9–3.4) million died. These represented 21.1% (13.4%–30.1%) of all COVID-19 hospitalisations and 30.5% (14.3%–55.5%) of all COVID-19 deaths in these countries. Based on modelling estimates, if these populations had been diagnosed for diabetes prior to the COVID-19 pandemic, 1.7% (−3.0% to 5.9%) of COVID-19 hospitalisations and 5.0% (−0.9% to 14.1%) of COVID-19 deaths could have been prevented, and 1.8 (−0.3 to 5.0) million quality-adjusted life years gained. Interpretation: Our findings suggest that undiagnosed diabetes contributed substantially to COVID-19 hospitalisations and deaths in many LMICs
Experiences of integrating a psychological intervention into a youth-led empowerment program targeting out-of-school adolescents, in urban informal settlements in Kenya: A qualitative study
No full textIntroduction: Depression, anxiety and behavioural disorders are the leading causes of illness and disability in adolescents. This study aims to evaluate the feasibility of integrating mental health services into a youth-led community-based intervention targeting out-of-school adolescents, residing in Kariobangi and Rhonda informal settlements in Kenya. Method: Youth mentors were trained on the Bridging the Gaps (BTG) curriculum that integrated a modified version of the World Health Organization’s (WHO) Problem Management Plus (PM+) psychological intervention into a sexual health, life-skills and financial education curriculum. Community lay mentors facilitated 72 weekly group sessions for 469 adolescent boys and girls, augmented with five enhanced one-on-one treatment sessions for those displaying signs of psychological distress. Adolescents displaying severe signs of psychological distress were referred directly to a primary health facility or connected to specialist services. A qualitative survey took place between February and March 2022, around four months before the end of the program. In-depth interviews were carried out with 44 adolescents, 7 partners, 19 parents and 11 stakeholders. Four focus group discussions were carried out with 17 mentors. Respondents were purposively selected to be interviewed based on their level of exposure to the intervention and ability to provide in-depth experiences. Themes focused on the program’s perceived effectiveness, ability to develop the capacity of lay mentors to address mental health issues, and increased access to mental health services. Results: Adolescents reported that the intervention was able to improve their confidence in speaking up about their problems, equip them with essential first-aid skills to manage and treat anxiety or mild depression, provide them access to free one-on-one psychological help sessions, and increase their social network. Mentors were able to adhere to the core principles of psychological intervention delivery, providing preventative and treatment-focused psychosocial services. Furthermore, parents reported experiencing improved adolescent receptivity to parental suggestions or advice leading to improved parent-adolescent relationships. Mentors referred adolescents for a variety of reasons including severe mental illness, rape, and alcohol and substance use however, the high cost of transport was the main barrier limiting adolescents from following through with their referrals. Conclusion: The findings demonstrate that integration of mental health services into community-based interventions is feasible and has benefits for adolescents, parents, and mentors
Population change in wildfire-affected areas in the United States: Evidence from U.S. Postal Service residential address data
No full textWe examine the utility of data on active and vacant residential addresses to inform local and timely monitoring and assessments of how areas impacted by wildfires and extreme weather events more broadly lose (or not) and subsequently recover (or not) their populations. Provided by the U.S. Postal Service to the U.S. Department of Housing and Urban Development and other users, these data are an underutilized and potentially valuable tool to study population change in disaster-affected areas for at least three reasons. First, as they are aggregated to the ZIP + 4 level, they permit highly local portraits of residential and, indirectly, of population change. Second, they are tabulated on a quarterly basis starting in 2010 through the most recent quarter, thereby allowing for timely assessments than other data sources. Third, one mechanism of population change—namely, underlying changes in residential occupancies and vacancies—is explicit in the data. Our findings show that these data are sufficient for detecting signals of residential and, indirectly, of population change during and after particularly damaging wildfires; however, there is also noticeable variation across cases that requires further investigations into, for example, the guidance the U.S. Postal Services provides its postal offices and carriers to classify addresses as vacant
Effect of rotavirus vaccination on the burden of rotavirus disease and associated antibiotic use in India: A dynamic agent-based simulation analysis
No full textBackground: Rotavirus is a leading cause of diarrhea in infants and young children in many low- and middle-income countries. India launched a childhood immunization program for rotavirus in 2016, starting with four states and expanding it to cover all states by 2019. The objective of this study was to estimate the effects of the rotavirus vaccination program in India on disease burden and antibiotic misuse. Methods: We built a dynamic agent-based model of rotavirus progression in children under five within each district in India. Simulations were run for various scenarios of vaccination coverage in the context of India\u27s Universal Immunization Programme. Population data were obtained from the National Family Household Surveys and used to calibrate the models. Disease parameters were obtained from published studies. We estimated past and projected future reduction of disease burden and antibiotic misuse due to full vaccination nationwide, by state, and by wealth quintile. Results: We estimate that rotavirus vaccination in India has reduced the prevalence of rotavirus cases by 33.7% (prediction interval: 30.7–36.0%), total antibiotic misuse due to rotavirus by 21.8% (18.6–25.1%), and total deaths due to rotavirus by 38.3% (31.3–44.4%) for children under five. We estimate total antibiotic misuse due to rotavirus infection to be 7.6% (7.5–7.9%) of total antibiotic consumption in this demographic versus 9.6% (9.4–9.9%) in the absence of vaccination. We project rotaviral prevalence to drop to below one case for every 100,000 individuals in those below five if vaccination coverage is increased by 50.3% (45.2–58.5%) to 68.1% (63.1–76.4) nationwide. Conclusion: Universal coverage of childhood rotavirus vaccination can substantially reduce inappropriate antibiotic use in India
Girls First Fund: External evaluation
Get PDFThe Population Council is leading an evaluation of programs funded by the Girls First Fund (GFF) in the Dominican Republic (DR), India, and Niger. These three countries were chosen to maximize geographic, social, cultural, and economic diversity across contexts, but common to all three is the continued persistence of child marriage and the presence of collective efforts to eliminate it. The broader goal of this evaluation is: 1) to demonstrate proof of concept for the impact of GFF-supported programs; 2) to examine key outcomes of interest to the GFF and the community-based organizations (CBOs) that it funds, including education, child marriage, and pregnancy; and 3) to assess the impact of the CBO programs on intermediary outcomes including girls’ agency, self-efficacy, educational aspirations, and gender-equitable attitudes. This report summarizes results from baseline surveys and qualitative activities in all three countries
The CHH–Lancet Commission on Health, Conflict, and Forced Displacement: Reimagining the humanitarian system
No full textInternational humanitarian law is routinely being broken with impunity in conflicts globally. Populism tinged with anti-refugee discourse has led to a weakening of asylum and refugee law in many countries. While special protection of hospitals and ambulances was previously largely respected by warring parties under the Geneva Conventions, attacks on health care have become the norm. With conflict-related deaths at a 26-year record high and more than 110 million people forcibly displaced worldwide at the end of June, 2023, the humanitarian system is overwhelmed, despite increases in humanitarian support from public and private donors. As one of us (PBS) wrote in The Lancet in 2017: “An unprecedented number of humanitarian emergencies of large magnitude and duration is causing the largest number of people in a generation to be forcibly displaced. Yet the existing humanitarian system was created for a different time and is no longer fit for purpose.” Since then, the situation has become worse. The creeping normalisation of violations of international humanitarian law and refugee law and insufficient accountability of humanitarian organisations to affected persons must be rejected. The humanitarian system needs to be reimagined with the priorities of the affected communities at its centre
