Misconceptions and associated factors of COVID-19 infection among internally displaced persons in Sudan

Coronavirus disease 2019 (COVID-19) is a global public health threat that has spread rapidly and caused morbidity and mortality worldwide. Reducing the myths about infectious diseases is vital for controlling transmission. This study explored the level of misconceptions and associated factors of COVID-19 among internally displaced persons in Sudan. This study is a cross-sectional, descriptive design and community-based study. We collected the data using a self-administered questionnaire via the convenience sampling technique among internally displaced persons in the camps of Zalingei town in the central Darfur region of Sudan. The total mean score of the respondents' misconception was 3.1725 (SD=0.59) with 63.2%, indicating moderate misunderstanding of COVID-19. Multiple linear regression revealed the independent variables together had a significant impact on a misconception, F(14,116)=2.429, p<0.005. The regression model explains 22.7% of the variance in misunderstanding. Analysis of the influence of single factors on the dependent variable showed that people aged 31­40 years had significantly higher levels of misconception, 0.381 (t=2.116, p<0.037), than those aged over 60 years, and university graduates had considerably lower levels of misunderstanding, −0.061 (t=−2.091, p<0.03) than non-graduates. This study found a moderate level of misconception of COVID-19. Non-graduates had higher levels of misunderstanding than graduates. The results suggest that an education campaign should focus on people with low levels of education to correct their misconceptions regarding the prevention of COVID-19 infection

Challenges of women refugees in utilising reproductive health services in public health institutions in Durban, KwaZulu-Natal, South Africa

Background: Reproductive health services are essential for everyone worldwide. In South Africa, the available literature does not address reproductive health as a full package for women refugees and their experiences. This study addressed women refugees in relation to reproductive healthcare services they receive from public healthcare facilities. Aim: The aim of the study was to document the day-to-day experiences of women refugees and uncover their challenges regarding utilisation of reproductive health services in public institutions of Durban, KwaZulu-Natal. Setting: The study was conducted in eThekwini district, Durban, KwaZulu-Natal, and did not consider participants who are located beyond the above-mentioned city's borders. Methods: A qualitative, descriptive design was used. A semi-structured interview guide was used to collect data through face-to-face in-depth interviews with eight women refugees. Thematic content analysis guided the study. Results: Two major themes emerged: negative experiences or challenges, and positive experiences. The most dominant negative experiences included medical xenophobia and discrimination, language barrier, unprofessionalism, failure to obtain consent and lack of confidentiality, ill-treatment, financial challenges, internalised fear, religious and cultural hegemony, and the shortage of health personnel and overcrowding of public hospitals. The positive experiences included positive treatment and care and social support. Conclusion: The findings revealed that women refugees in Durban, KwaZulu-Natal, face many challenges such as medical xenophobia and discrimination in their attempt to seek reproductive health services in public healthcare facilities, making them even more vulnerable. Assisting women refugees with their reproductive health needs will remediate the challenges they face

Using livelihoods to support primary health care for South Sudanese refugees in Kiryandongo, Uganda

Introduction: Conflict in South Sudan has displaced 2.3 million people, of whom 789,098 (35%) have taken refuge in Uganda ­ a country that allows refugees to work, own property, start their own businesses and access public health services. In this context, refugees have identified livelihoods and primary health care as key priorities for their wellbeing. Objective: Building on previous research in South Sudan and Uganda, the objective of our current work is exploring how income-generating livelihood activities and other interventions can be used to support primary health care for South Sudanese refugees in Kiryandongo District, Uganda. Methods: We drew on existing secondary data and five scoping visits to the refugee settlements in Kiryandongo and northern Uganda to formulate our approach. Results: In Kiryandongo District, primary health care and livelihoods can best be supported by an integrated combination of 1) providing standardised training to local Village Health Teams (VHTs); 2) helping organise VHTs into village savings and loan association groups; and 3) supporting VHTs with training to establish sustainable income-generating activities. Conclusions: Integrated interventions that address income-generating activities for community health workers can meet the basic needs of front-line volunteer primary health care staff and better enable them to improve the health of their communities

Évaluation du stress chez le personnel au service des refugiés et demandeurs d'asile à Dakar

Introduction. Dans les pays émergents, les conséquences du stress demeurent sous-évaluées. Le stress cumulatif est associé au travail humanitaire. Une lourde charge de travail est souvent associée à un manque de reconnaissance du travail accompli et à des difficultés de communication. S'ajoutent la nécessité de faire face à des situations devant lesquelles on se sent désarmé (souffrance des bénéficiaires, guerre) ou au contraire des situations d'attente avec impossibilité d'agir pour des raisons de sécurité. L'objectif de notre travail était d'évaluer la prévalence du stress chez le personnel de l'UNHCR et de l'OFADEC à Dakar au Sénégal et de déterminer les facteurs caractéristiques du stress. Patients et méthodes. Nous avons mené une étude transversale descriptive et analytique du 30 mai au 30 décembre 2012. Soixante individus ont été sélectionnés grâce à un échantillonnage aléatoire. A l'aide d'un questionnaire auto-administré, nous avons enregistré les caractéristiques sociodémographiques, l'hygiène de vie, les conditions de travail, le plan de carrière et les propositions d'amélioration, l'appréciation du stress et les problèmes relationnels. La saisie et exploitation des données ont été effectuées par les logiciels Epi-Info 3.5.4 et Microsoft Excel 2010. Résultats. Cinquante-deux salariés ont participé à l'étude, 30 exerçant à l'OFADEC et 22 à l'UNHCR avec une prédominance masculine (sexe ratio = 1,73). Il s'agissait d'une population jeune, entre 20 et 39 ans dans 53,84 % des cas, tabagique dans 11,53 % des cas et présentant des troubles du sommeil dans 15,38 % des cas. 78.8% des enquêtés avaient un contrat à durée déterminé. La prévalence du stress était de 40,38 % (n = 21) avec une prédominance masculine (sexe ratio = 2). La quasi-totalité des stressés (92,9 %) travaillait en équipe et 66,7 % avaient travaillé sans arrêt durant les 12 derniers mois. 25 agents (42,9 %) se sentaient épuisés, 12 (23,8 %) inquiets ; 10 (19 %) avaient un mal être et 7(14,3 %) avaient plusieurs sentiments à la fois. 37 (71,4 %) stressés adoptaient une attitude agressive face au stress et 29(56,7 %) des agents déclaraient être victimes d'agression verbale. Conclusion. Une bonne gestion du stress au travail passe par la mise en place de modes d'organisation favorables à la santé physique et mentale des travailleurs

Sexual trauma and post-traumatic stress among African female refugees and migrants in South Africa

Background: While there is considerable research in developed countries on the nature and extent of post-traumatic stress among refugees and migrants, few report on female Africans migrating within Africa. Aim: The aim of this study was to investigate the association between exposure to traumatic life events and post-traumatic stress disorder risk in refugees and migrants in Durban, South Africa, with specific focus on sexual trauma events among women. Methods: Interviews were conducted on 157 consenting non-South African adults using a sociodemographic questionnaire, Life Events Checklist (documenting traumatic events experienced) and the Harvard Trauma Questionnaire (measuring post-traumatic symptomatology). Associations between total number of traumatic events and post-traumatic stress were explored using adjusted regression models. Results: The results of one model indicated that greater numbers of traumatic life events experienced by women were associated with raised odds of post-traumatic stress disorder risk (ß = 1.48; p < 0.001). Another model indicated that exposure to sexual trauma events were associated with greater odds of post-traumatic stress disorder risk (ß = 4.09; p = 0.02).Conclusion: Our findings highlight the critical importance of mental health service for females with history of sexual traumatic events for this vulnerable population

HIV/AIDS among pastoralists and refugees in Kenya: a neglected Problem

The eight member states (Djibouti; Eritrea; Ethiopia; Kenya; Somalia; South Sudan; Sudan and Uganda) of the Intergovernmental Authority for Development (IGAD) have the largest proportions of cross-border mobile pastoralists and refugees in Africa. Although all IGAD countries have had national HIV/AIDS prevention; care and treatment programmes since the late 1980s; the IGAD Regional HIV et AIDS Partnership Program was (IRAPP) established in 2007 to mitigate the challenges of HIV among neglected pastoral and refugee communities. This article assesses vulnerability of pastoralists and refugee communities to HIV and interventions targeting these groups in the IGAD countries. Outcomes from this study may serve as a baseline for further research and to improve interventions. Published articles were accessed through web searches using PubMed and Google Scholar engines and unpublished documents were collected manually. The search terms were HIV risk behaviour; vulnerability; HIV prevalence and interventions; under the headings pastoralists; refugees; IGAD and north-east Africa for the period 2001-2014. Of the 214 documents reviewed; 78 met the inclusion criteria and were included. Most HIV/AIDS related studies focusing of pastoral communities in IGAD countries were found to be limited in scope and coverage but reveal precarious situations. Sero-prevalence among various pastoral populations ranged from 1% to 21% in Ethiopia; Kenya; Somalia and Uganda and from 1% to 5% among refugees in Sudan; Kenya and Uganda. Socioeconomic; cultural; logistic; infrastructure and programmatic factors were found to contribute to continuing vulnerability to HIV. Interventions need to be further contextualised to the needs of those impoverished populations and integrated into national HIV/AIDS programmes. HIV/AIDS remains a major public health concern among the pastoral and refugee communities of IGAD countries. This calls for IGAD to collaborate with national and international partners in designing and implementing more effective prevention and control programmes. Furthermore; interventions must extend beyond the health sector and improve the livelihood of these populations

Epidemic Cholera in Kakuma Refugee Camp; Kenya; 2009: the Importance of Sanitation and Soap

Introduction: Cholera remains a major public health problem that causes substantial morbidity and mortality in displaced populations due to inadequate or unprotected water supplies; poor sanitation and hygiene; overcrowding; and limited resources. A cholera outbreak with 224 cases and four deaths occurred in Kakuma Refugee Camp in Kenya from September to December 2009. Methodology: We conducted a case-control study to characterize the epidemiology of the outbreak. Cases were identified by reviewing the hospital registry for patients meeting the World Health Organization (WHO) case definition for cholera. For each case a matched control was selected. A questionnaire focusing on potential risk factors was administered to cases and controls.Results: From 18 September to 15 December 2009; a total of 224 cases were identified and were hospitalised at Kakuma IRC hospital. Three refugees and one Kenyan national died of cholera. V. cholerae O1; serotype Inaba was isolated in 44 (42) out of 104 stool specimens collected. A total of 93 cases and 93 matched controls were enrolled in the study. In a multivariate model; washing hands with soap was protective against cholera (adjusted odds ratio [AOR] =0.25[0.09-0.71]; p 0.01); while presence of dirty water storage containers was a risk factor (AORConclusion: Provision of soap; along with education on hand hygiene and cleaning water storage containers; may be an affordable intervention to prevent cholera

Contraceptive use: knowledge, perceptions and attitudes of refugee youths in Oru refugee camp, Nigeria

Refugee youths are vulnerable persons who have a need for contraception, yet face challenges that limit its use. Data on perceptions, knowledge, access and attitudes toward contraceptive use were collected from 208 refugee youths living in Oru refugee camp, Nigeria. Findings revealed that respondents experience difficulty gaining access to family planning services, which are not available in the camp. Most respondents had little correct information about contraceptives; 42.9% had misperceptions about its safety, believing that contraceptives are dangerous and that chemicals in contraceptives can damage their reproductive system. Such beliefs have resulted in the low use of contraceptives (31.6% use last sex) and many unintended pregnancies, which have caused some refugee girls to drop out of school. Findings may aid in the development of targeted interventions to educate refugee youths in order to dispel misperceptions about the safety of contraceptives and ensure adequate access to family planning services (Afr J Reprod Health 2010; 14[4]: 17-26)

Mortality and health among internally displaced persons in western Kenya following post-election Violence; 2008: novel use of demographic surveillance

Objective To evaluate mortality and morbidity among internally displaced persons (IDPs) who relocated in a demographic surveillance system (DSS) area in western Kenya following post-election violence. Methods In 2007; 204 000 individuals lived in the DSS area; where field workers visit households every 4 months to record migrations; births and deaths. We collected data on admissions among children 5 years of age in the district hospital and developed special questionnaires to record information on IDPs. Mortality; migration and hospitalization rates among IDPs and regular DSS residents were compared; and verbal autopsies were performed for deaths. Findings Between December 2007 and May 2008; 16 428 IDPs migrated into the DSS; and over half of them stayed 6 months or longer. In 2008; IDPs aged 15.49 years died at higher rates than regular residents of the DSS (relative risk; RR: 1.34; 95confidence interval; CI: 1.004.1.80). A greater percentage of deaths from human immunodeficiency virus (HIV) infection occurred among IDPs aged . 5 years (53) than among regular DSS residents (25.29) (P 0.001). Internally displaced children 5 years of age did not die at higher rates than resident children but were hospitalized at higher rates (RR: 2.95; 95CI: 2.44.3.58). Conclusion HIV-infected internally displaced adults in conflict-ridden parts of Africa are at increased risk of HIV-related death. Relief efforts should extend to IDPs who have relocated outside IDP camps; particularly if afflicted with HIV infection or other chronic conditions

Determinants of HIV/AIDS in Armed Conflict Populations

"More than 40 million people worldwide have been infected with human immunodeficiency virus (HIV) since it was first reported in 1981. Over 25 million of these have lost their lives to the disease. Most of the studies related to HIV/AIDS have been conducted in stable populations across the globe. Few of these studies have been devoted to displaced populations; particularly those in areas of conflict. Displaced populations that are forced to leave their homes in most cases find themselves in unfamiliar territories; often poor and hungry. Many of them become refugees and internally displaced people (IDPs). The objective of this review was to address a number of different social determinants of HIV/AIDS in displaced populations in areas of conflict. A comprehensive review of peer reviewed literature published in eng between 1990 and 2010 obtained through an open search of PUBMED database using key words such as ""HIV and war""; ""HIV/AIDS and conflict""; ""AIDS and security"" was conducted. Twelve different studies that looked at the implications of HIV/AIDS in conflict or displaced populations were retrieved. The review revealed that there were various factors influencing conflict and HIV/AIDS such as forced population displacement; breakdown of traditional sexual norms; lack of health infrastructure; and poverty and powerlessness of women and children. Social determinants of increased HIV/AIDS prevalence in displaced populations are scarcity of food; poverty; insecurity of displaced populations and gender power differentials."

Immigrants' and Refugees' Unmet Reproductive Health Demands in Botswana: Perceptions of Public Health Providers

Background: The health care of Botswana (citizens of Botswana) as indicated in the country's VISION 2016 is uppermost in the priorities of Government of Botswana; yet Botswana's National Health Policy; the Immigration Policy; and the National Sexual and Reproductive Health Programme Framework all are silent on the obligations of the government for providing health services for the immigrant and refugees population. In view of the high prevalence of HIV/AIDS in Botswana; South Africa and other sub-Saharan countries; it is critical that reproductive health services be as affordable and accessible for this population as they are for others in Botswana. This study; therefore; has measured the views of the primary health care providers in Botswana on the perceived reproductive health needs of immigrants and refugees; the availability and accessibility of reproductive health care services to the immigrant and refugee population in the country. This information will be necessary for policy makers; Government of Botswana and the private sector to shape interventions measures to assist immigrants and refugees seek and access their desired reproductive health services. Methods: The study targeted all the 4; 667 medical doctors and nurses who were serving in various hospitals and clinics in 23 health districts of Botswana at the time of this study. Using NCS Pearson statistical software; the sample size for the study was determined to be 851. This estimated sample size was allocated to the 23 health districts (strata) using probability proportional to size (PPS). Having obtained the sample size for each district; the health providers to be interviewed from each health district were selected randomly and in proportion to the number of doctors and nurses in each district. Questionnaires were administered to these health providers by research assistants; who explained the purpose of the study and obtained informed consent. The questionnaires were coded to ensure anonymity of the respondents. The questionnaire contained questions about the health care providers' demographic characteristics; their opinions on the reproductive health needs of immigrants and refugees; and their views on factors that influence accessibility of these services to immigrants and refugees. The fieldwork ended collecting data from 678 doctors and nurses (about 80of the targeted sample). Results: Majority of the health providers indicated that the most important reproductive health needs of the immigrants and refugees; namely; pregnancy related (Prenatal; Obstetrics; Postnatal conditions); STI treatment; HIV/AIDS treatment and counseling; and family planning were not different from those of the locals. However; some major differences noted between the local population and the foreigners were (i) that ARV treatments and PMTCT were never accessible to the non-citizens; (ii) that while treatments and other health services were free to Batswana (citizens of Botswana); a fee was charged to non-citizens. Although 86of the 21 studied reproductive health services were available in the health care system more than 50of the time; only 62of them could be accessible to the immigrants and refugees 50of the times. The major reasons for inability to access these services were: (i) The immigrants and refugees have to pay higher fees to access the reproductive health services (ii) Once an immigrant or refugee is identified as HIV positive; there are no further follow-ups on the patient such as detecting the immune status using CD4 count or testing the viral load (iii) The immigrants and refugees do not have referral rights to referral clinics/ hospitals for follow- ups in case of certain health conditions (iv) The immigrants and refugees are required to enlist in the Medical Aids scheme which can help offset part of the costs for the desired services. Conclusions: The study recommended an improved availability of reproductive health services to the immigrants and refugees and the expunging of laws and practices which made it difficult for immigrants and refugees to access the available reproductive health services

Assessing Interventions Available to Internally Displaced Persons in Abia State; Nigeria

Internally displaced persons are faced with several problems; such as sexual violence; and deserve appropriate intervention; especially in view of the increasing prevalence of HIV/AIDS and other infections in Nigeria. This study attempts to assess interventions offered by governmental authorities and organizations to internally displaced persons and to identify gaps in services as well as to identify what needs to be strengthened. Method: The author reviewed relevant published and unpublished documents and collected data by interviews with semi-structured questions. Twenty-five organizations and government and police departments and 55 internally displaced persons were interviewed.Results: None of the organizations; including governmental institutions; provided social services or assistance in prevention of HIV/AIDS to internally displaced persons. The main services provided by 17 (68) organizations to 43 (78.2) of internally displaced persons were provision of food; clothing and money; but these were provided on an ad hoc basis. Only 3 organizations (12) included spiritual counseling and resolution of communal conflicts in their services. Conclusion: The fact that most organizations; including the government; do not have services for internally displaced persons indicates lack of support for internally displaced persons. The government should be urged to include these people in most prevention services; including HIV/AIDS prevention and treatment. This should help reduce the national prevalence of HIV/AIDS

Factors Associated with Malnutrition among Children in Internally Displaced Person's Camps; Northern Uganda

Introduction Since mid 1990s; Uganda has had an estimated 1.6 million internally displaced persons (IDPs) in the northern and eastern districts. A major cause of morbidity and mortality amongst children in displaced settings is protein energy malnutrition. Objective To estimate the prevalence of and describe the risk factors for protein energy malnutrition among under five years old children living in internally displaced persons camps in Omoro county Gulu district. Methods This was a cross sectional study undertaken among internally displaced people's in Omoro county; Gulu district during 13 - 23rd September 2006. Anthropometric measurements of 672 children aged 3 59 months were undertaken and all their caretakers interviewed. The anthropometric measurements were analyzed using z- scores of height-for-age (H/A) and weight-for-height (W/H) indices. Qualitative data were collected through 6 focus group discussions; key informant interviews and observation. Data were captured using Epi Data version 3.0 and analyzed using EPI-INFO version 3.3.2 and SPSS version 12.0 computer packages respectively. Results The prevalence of global stunting was found to be 52.4and of global acute malnutrition 6.0. Male children are at risk of being stunted Adjusted OR 1.57 95CI 1.15-2.13; p value=0.004. Children in the age group 3 24 months were at risk of acute malnutrition Adjusted OR 2.78 95CI 1.26-6.15; p value=0.012 while de-worming was protective Adjusted OR 0.44 95CI 0.22-0.88; p value=0.018. The main sources of foodstuff for IDPs include food rations distributed by WFP; cultivation and purchase. Conclusion and Recommendations There is high prevalence of protein energy malnutrition (stunting) among children in the internally displaced people's camps in Gulu district. Male children are at an increased risk of stunting while children aged between 3 24 months are at an increased risk of suffering from acute malnutrition. Stakeholders including local government and relief organizations should intensify efforts to improve the nutritional status of IDPs especially children in the camp settings. The quantity of and access to household food supplies; health education on infant and child feeding and integrated management of childhood illnesses (IMCI) activities in the camps should be strengthened

Morbidity and Mortality amongst Southern Sudanese in Koboko Refugee Camps; Arua district; Uganda

To determine the causes of morbidity; mortality and assess the nutritional status of children under five years; on Koboko refugee camps; Arua District; Uganda. Design: Review and analysis of refugee treatment records between 1992 and 1994 from maracha and Koboko hospitals and cross sectional nutritional survey of children under five years in camps. Setting: between June 1992 and March 1994; an estimated 70;000 Sudanese refugees were encamped in five transit camps in Koboko county; Arua District. Koboko field hospital was immediately established and Marach hospital designated the referral for refugees. Participants: Hospitalised refugees between 1992 and 1994 in Koboko and Maracha hospitals and children under five years in the camps formed the study popualtions. Interventions: Health facilities and therapeutic nutrition centres were established in the camps. Fortnightly general food distribution and therapeutic feeding programmes were insituted. Severe medical and surgical conditions were referred to marach hospital. Main Outcome measures: Outcome variables considered were morbidity; mortality; case fatality rates; weight/height; weight/age and height/age. Results: Out of 1476 refugees hospitalised in Koboko and Maracha hospitals; 267 died giving a case fatality rate of 18. The leading causes of morbidity were diarrhoea diseases (26.9); ARI (13.6); malaria (10.2); trauma (7.6) and malnutrition (5.0). The main causes of mortality were similar; that is; diarrhoeal diseases (35.9); ARI (23.9);anemia (7.2) and HIV/AIDS (6.8). Conditions associated with high overall case fatality rates were ARI 931.3); HIV/AIDS (30.0) and cardiac failure (29.3) respectively. Nearly half of the children (48.6); H/A - 2SD were stunted; over a third (36.7); W/A - 2SD were underweight and (8.5); W/H - 2SD wasted. Conclusion: Communicable diseases are the predominant causes of morbidity and mortality during the emergency phase of encampment. Timely and effective management of communicable diseases including malnutrition and trauma are crucial to avoid high mortality amongst refugees; coupled with the provision of essential requirements and services such as water; sanitation; food; shelter and immunisation

Assistance aux victimes de violences sexuelles dans les camps de refugies. Lecture ethnologique des recommendations des agences internationales de soutien psycho-social

"Une politique d'assistance definit dorenavant l'approche et les pratiques considerees comme legitimes en matiere de ""sante de la reproduction"" dont ses procedures concernent l'assistance psycho-sociale aux victimes de violences sexuelles. D'apres l'analyse de l'auteur; avant meme sa mise en pratique; elle semble vouloir appliquer des techiques therapeutiques contigentes a un contexte socioculturel souvent etranger a la victime refugiee. De plus; bien que voulant prendre en compte les ""conceptions traditionnelles"" dont les victimes refugiees seraient porteuses; elle nie l'aspect dynamique de la construction individuelle et collective du sens."

Reproductive health care: essential for Africa's refugee and dsiplaced communities

Reproductive health care is desperately needed by increasing numbers of refugees enduring the terrible hardships of forced migration and long term displacement in many countries in Africa. But though crucial; until recently services and information have rarely been made available to these people. In tragic and sometimes violent situations; issues surrounding sexuality and reproductive health care have often remained invisible; or marginalised; in official and unofficial encampments alike

Refugee health: priorities and policies

The timely provision of effective refugee health care requires a multi-sectorial and preventive approach. In the most serious challenges; national and locally available resources will be insufficient and lives will depend on rapid and effective outside support. General agreement among all concerned with refugee health care on the standards and priorities outlined above must be complemented by effective co-ordination of the response; priority setting; procedures and structures appropriate to each specific situation

Health aspects of repatriation of ex-soldiers

The general condition of the soldiers upon arrival at the shelter camps was poor. The post war conditions and physical exhaustion resulting from the movements had created a state of stress in most of the groups. Poor nutritional status was also noticed. Those who were suffering from war wounds were not few in number

Migration and health : refugees and returnees in Ethiopia

Health services to the refugees are based on a four-tier system linked by referral and supervisory arrangement and is consistent with the policy of the Ministry of Health. As with all refugee populations; the health status has to be compared with the levels achieved before immigration and also with those of the neighbouring host population. The health and nutritional status of the refugees under the care and maintenance programme; both in the East and West; is quite stable on the whole and at least comparable to; if not better than; that of the local population