Cerebral and Plasmodium ovale Malaria in Rhode Island.

We report two cases of malaria diagnosed in Rhode Island. First, a 21-year-old female who presented with 5 days of fevers, chills, headache, and myalgias after returning from a trip to Liberia, found to have uncomplicated malaria due to P. ovale which was treated successfully with atovaquone/proguanil and primaquine. Second, a chronically ill 55-year-old male presented with 3 days of headache followed by altered mental status, fever, and new-onset seizures after a recent visit to Sierra Leone, found to have P. falciparum malaria requiring ICU admission and IV artesunate treatment. The diagnosis and management of malaria in the United States (US), as well as its rare association with subdural hemorrhage are subsequently reviewed.

Future orientation of youth with a history of war trauma: a qualitative study in the African context.

Adolescence is an important developmental period for social relationships, identity formation and future planning. Traumatic experiences, such as war and persecution, may interfere with optimal development, including the future orientation of adolescents. The present study examines how young adult war survivors construct, make sense of, and narrate their future goals, plans, and expectations. The participants were 13 Liberian 25-35-year old male and female refugees living in Ghana. This qualitative study is based on semi-structured interviews with prompting questions. By applying a phenomenological approach the interview transcripts were categorized into themes and subthemes about future orientations. Results revealed three main themes, two of them desired a positive future orientation, indicating optimism and determination to improve one's own life and to contribute to a flourishing nation and to peacebuilding. The third theme illustrated a failure to reconstruct war-shattered lives and involved pessimistic views of the future. The results are discussed in relation to peacebuilding and the developmental challenges of young adults as war survivors.

Factors Influencing Dietary Practices Among Ghanaian Residents and Liberians Living in a Protracted Refugee Situation in Ghana.

OBJECTIVE: Examine dietary practices among Liberian refugees living in a protracted refugee situation and Ghanaians living among them. DESIGN: Qualitative data were collected via audio-taped in-depth interviews as part of a larger mixed-methods cross-sectional study. SETTING: Buduburam Refugee Settlement and neighboring villages, Ghana. PARTICIPANTS: Twenty-seven Liberian and Ghanaian women aged ≥16 years, who lived with ≥1 other female generation. PHENOMENON OF INTEREST: Similarities and differences in factors influencing dietary practices among Liberian refugees living in Buduburam Refugee Settlement and Ghanaians living in and around this settlement. ANALYSIS: Domains, themes, and subthemes were confirmed through a highly iterative coding and consensus process. ATLAS.ti (version 7.5.10) was used to finalize coding and extract quotations. RESULTS: Seven domains emerged forming direct and indirect pathways influencing dietary patterns among Liberian refugees and Ghanaians: social support, food availability, nutrition knowledge, cultural food beliefs, food access, food preparation, and national identity. CONCLUSIONS AND IMPLICATIONS: Findings provide important insights into crucial factors driving dietary practices among refugees and local communities in and around a former protracted refugee settlement. Results strongly suggest that nutrition education, food availability, and access issues should be addressed with culturally sensitive programs targeting both the refugee and host communities.

Narratives of Agency and Capability from Two Adolescent Girls in Post-conflict Liberia.

Between 1989 and 2003, Liberia experienced a brutal civil war characterized by ethnic killings, sexual violence and the use of child soldiers. Five years after the war ended, half the population of Liberia was under 18 years old. Understanding the needs of these youth is thus essential to the recovery of the nation. This study focuses on the narratives of two female adolescents, selected from 75 in-depth individual interviews with post-conflict Liberian youth conducted in 2012. A narrative analysis approach was employed to examine each interview for multiple layers of meaning. The aim of the study was to elucidate factors that may enable post-conflict youth to reclaim a sense of agency and return to normal developmental tasks. The study explores the ways in which these youth navigate complicated power dynamics in the post-conflict setting and how gender impacts their experiences of their own agency and capability. The dynamics between the participants and the interviewer are explored to further illustrate how power dynamics manifest. These narratives support the involvement of youth in projects that help others as an avenue for promoting agency and resilience for themselves.

"My Heart Die in Me": Idioms of Distress and the Development of a Screening Tool for Mental Suffering in Southeast Liberia.

The integration of culturally salient idioms of distress into mental healthcare delivery is essential for effective screening, diagnosis, and treatment. This study systematically explored idioms, explanatory models, and conceptualizations in Maryland County, Liberia to develop a culturally-resonant screening tool for mental distress. We employed a sequential mixed-methods process of: (1) free-lists and semi-structured interviews (n = 20); patient chart reviews (n = 315); (2) pile-sort exercises, (n = 31); and (3) confirmatory focus group discussions (FGDs); (n = 3) from June to December 2017. Free-lists identified 64 idioms of distress, 36 of which were eliminated because they were poorly understood, stigmatizing, irrelevant, or redundant. The remaining 28 terms were used in pile-sort exercises to visualize the interrelatedness of idioms. Confirmatory FDGs occurred before and after the pile-sort exercise to explain findings. Four categories of idioms resulted, the most substantial of which included terms related to the heart and to the brain/mind. The final screening tool took into account 11 idioms and 6 physical symptoms extracted from patient chart reviews. This study provides the framework for culturally resonant mental healthcare by cataloguing language around mental distress and designing an emic screening tool for validation in a clinical setting.

Health-Needs Assessment for West African Immigrants in Greater Providence, RI.

African immigrants in the United States may experience barriers to health-care access and effectiveness. This mixed-methods study used paper-based surveys of people (N=101) in the target population from Nigeria, Ghana, and Liberia, recruited through convenience and snowball sampling. Semi-structured interviews were conducted with 3 clergy members who pastor churches with large Nigerian, Ghanaian, and Liberian populations, respectively; and five physicians and a clinical pharmacist who serve African immigrants. RESULTS: Length of stay in the United States was associated with the health status of refugee children. Undocumented immigration status was associated with lack of health insurance. Cardiovascular diseases, uterine fibroids and stress-related disorders were the most prevalent reported conditions. Regardless of English fluency, many immigrants are unfamiliar with medical terminology. CONCLUSION: African immigrants in the state of Rhode Island need more health education and resources to navigate the US health-care system. [Full article available at http://rimed.org/rimedicaljournal-2017-01.asp].

Dietary patterns in Liberian refugees in Buduburam, Ghana.

Previous research suggests that acculturation (i.e., exposure and assimilation to local culture) is associated with changes in dietary patterns among immigrants. This study investigates this association in a refugee population using time in refugee settlement as a proxy for acculturation. A cross-sectional survey was conducted among a systematic sample to (a) identify dietary patterns in Liberian refugees and Ghanaians living in or near a refugee settlement, (b) compare adherence to these dietary patterns between groups, and (c) investigate the association between acculturation and dietary patterns in Liberian refugees. Participants were Liberian and Ghanaian women with young children living in the Buduburam refugee settlement or Awutu in Ghana (n = 480; 50% Liberian; mean age 28, SD 6.3, range 16-48 years). Time in settlement was assessed by self-report; food consumption was assessed by food frequency questionnaire. Principal component analysis was used to identify dietary patterns; a generalized linear model was used to test the association of interest. Three distinct dietary patterns emerged: Healthy, Sweets, and Fats. Ghanaians were more adherent to the Healthy pattern than Liberians (p < 0.05). Liberians were more adherent to the Sweets and Fats patterns than Ghanaians (p < 0.05). There were no significant differences in dietary pattern adherence among the Liberians based on time in settlement. Ghanaians living in Awutu were more adherent to the Healthy pattern than Ghanaians who lived in settlement (p < 0.05). Differences in dietary patterns were observed between Liberian refugees and Ghanaians. These differences were not associated with acculturation and may be related to the food environment in the settlement.

Food insecurity and budgeting among Liberians in the US: how are they related to socio-demographic and pre-resettlement characteristics.

Objectives of this study: (1) Examine food insecurity (FI) prevalence and its relationship with sociodemographic and pre-resettlement characteristics; (2) Investigate differences in amount of money spent on food/month by food security status and socio-demographic characteristics. A pilot study with semi-structured in-home interviews was conducted with Liberian caregivers (n = 33). FI was indicated in 61% of households. FI was higher among women >40, had ≤ high school education and those making ≤$1,000/month. Women arriving in US >15 years of age were more likely to be food insecure. Participants spent an average $109/month on groceries/member. Food insecure women, and those without a car spent more money on food (P < .10). Liberian women in this sample experience high levels of FI upon resettlement. Besides poor economic conditions, pre-resettlement characteristics were associated with food security status. These findings call for future research to understand how preresettlement conditions affect food choices, budgeting and thereby food security status.

Imported Armillifer pentastomiasis: report of a symptomatic infection in The Netherlands and mini-review.

We report a case of symptomatic visceral Armillifer pentastomiasis in a 23-year-old female Liberian immigrant to The Netherlands. The patient was referred to the gynecologist because of lower abdominal pain. During laparotomy, multiple adhesions were seen in the lower pelvis and a hydrosalpinx with an encapsulated Armillifer nymph, most likely Armillifer armillatus, was found. Key features of the parasite's cuticle which facilitate the diagnosis of pentastomiasis, are presented. Symptomatic pentastomiasis is uncommon, and most cases are diagnosed incidentally during surgery for other reasons, or at autopsy. With regard to increasing international migration, other imported pentastomiasis cases to Europe and North America are reviewed, and more cases are likely to be seen in the future.

Hepatitis a screening for internationally adopted children from hepatitis A endemic countries.

Screening for hepatitis A virus (HAV) infection is not currently routinely recommended in internationally adopted children. International adoptees seen at the University of Minnesota International Adoption Clinic from 2006 to 2010 were assessed for acute HAV infection (positive HAV immunoglobulin M). Thirty of the 656 children screened (4.6%) were acutely HAV infected. HAV-infected children emigrated from Ethiopia (16), Guatemala (4), China (2), Colombia (2), Haiti (2), Philippines (2), Liberia (1), and Nepal (1). Infection was most frequent among children younger than 2 years (6.7%). No symptoms distinguished children with acute HAV infection from uninfected children. HAV infection caused significant social disruption, including separation of children from their ill adoptive parents during the initial weeks postarrival, a period important for postadoption adjustment and attachment. All international adoptees arriving from countries with high or intermediate HAV endemicity should be screened for HAV infection on arrival to the United States.

Tuberculous meningitis in child born in the US to immigrants from a tuberculosis-endemic country.

This is a case of a child born in the US to immigrant parents from a tuberculosis (TB)-endemic area of Liberia who was diagnosed with TB meningitis after a greater than 1-month history of unremitting fever. This report aims to highlight the importance of early identification of TB in the pediatric population with risk factors for TB and considering TB as a diagnosis among US born children to immigrants from TB-endemic countries.

Spinal cord schistosomiasis: unexpected postmortem finding.

OBJECTIVES: To report a case of a US resident, originally from Liberia, with chronic hepatitis C infection who developed acute neurologic symptoms of the lower limbs. METHODS: Our case is compared to previously reported similar cases, with emphasis on clinical symptoms, investigations, diagnosis, and prognosis. RESULTS: The patient was transferred to the University of Iowa Hospital and Clinics for further management of severe retroperitoneal bleeding and died 2 days after admission. The diagnosis of schistosomiasis was established on examination of the spinal cord at autopsy, where multiple Schistosoma mansoni eggs were seen in the vasculature of the spinal cord. CONCLUSIONS: The diagnosis of schistosomiasis may go undiagnosed in countries where the disease is not endemic but should be considered when investigating spinal cord disease in patients native to an endemic area or international travelers.

" . . . There is no war here; it is only the relationship that makes us scared": factors having an impact on domestic violence in Liberian refugee communities in South Australia.

This article explores the factors that have an impact on domestic violence in African refugee communities, with specific reference to the Liberian community in South Australia. Seventeen focus group discussions were undertaken with women participants of the Liberian Women's Gathering. The nested ecological model (Dutton, 2001; Heise, 1998) is used to conceptualize the factors having an impact on domestic violence. The findings suggest that disruption to traditional gender roles has an impact on domestic violence at the cultural, socioeconomic, familial, and individual levels and that women's experience of domestic violence must be understood in relation to the acute and prolonged stressors of war, loss, and displacement.

Progressive disseminated histoplasmosis among human immunodeficiency virus-infected patients from West-Africa: report of four imported cases in Italy.

We report four imported cases of progressive disseminated histoplasmosis (PDH) due to Histoplasma capsulatum variety capsulatum in Human Immunodeficiency Virus-infected patients from West Africa. This report highlights the need to consider diagnosis of PDH among patients with acquired immunodeficiency syndrome who originate from West Africa and present with a prolonged febrile illness and very low CD4 count.