A participatory approach to assessing refugee perceptions of health services.

OBJECTIVE: The necessity and value of beneficiary input is widely recognized by the humanitarian community. Nevertheless, limited beneficiary involvement occurs due to various barriers. This study explores the effectiveness of an innovative, participatory approach to assessing beneficiary perceptions in resource-limited settings. METHODS: A unique hybrid of qualitative and quantitative methodologies assessed perceptions of health programs within five refugee camps in Kenya and Tanzania. A database of perceptions and opinions was established through key-informant interviews, focus group discussions and free-response questionnaires among refugees, community leaders and healthcare providers. Each participant subsequently force-ranked the collected views into quasi-normal distribution according to level of agreement. Responses were analyzed using by-person factor analysis software. FINDINGS: Eighty-one individuals (96%) successfully completed the participatory exercise. The methodologies identified detailed levels of consensus, rank-ordered priorities and unique sub-population opinions. CONCLUSION: The authors illustrate benefits and feasibility of qualitative quantitative participatory methodology in assessing beneficiary perceptions of refugee services.

The risks and impacts of portering on the well-being of children in Nepal.

A variety of underlying conditions increase the likelihood of children entering the labor force. Nearly half of Nepal's population between 5 and 14 years of age is economically active, many in conditions classified by the International Labor Organization as 'the worst forms of child labor'. In order to assess the relationship between portering and well-being outcomes, including diet, nutrition status, injury and social and behavioral risks, a cross-sectional study was conducted among long distance child porters in Eastern Nepal. Porters were consistently less well off than their non-portering peers according to a variety of indicators. Porters were 2.2 (95% CI: 1.4-3.4) times as likely not to have attended school in the past month and frequency of attendance was significantly lower among porters. Porters had worse diets and significantly lower Body mass indexes than controls; prevalence of anemia was 30% and the risk of anemia was 1.9 (95% CI: 1.1-3.1) times greater for porters as compared with controls. Injury rates within the past year were similar between the two groups, with 88% of participants reporting being injured. Prevalence of alcohol use among porters was 38% and porters were 2.9 (95 CI: 1.7-4.9) times more likely to consume alcohol than controls. Risk of sexual assault was 10.1 (95 CI: 2.3-43.9) times greater among porters as compared with their non-portering peers, and 91% indicated they felt portering negatively impacted their general well-being. Findings indicate that despite the Nepalese government's legislative efforts to regulate to the portering industry, portering children experience a substantially increased risk of negative physical, emotional and educational outcomes due to their involvement in exploitive and dangerous work. The long-term ramifications of portering are harmful to the well-being of children, and in the long run, lack of education may reduce employment options and the chance to escape from a life of continued poverty.