COVID-19 in humanitarian settings: documenting and sharing context-specific programmatic experiences

Singh, Neha; Abrahim, Orit; Altare, Chiara; Blanchet, Karl; Favas, Caroline; Odlum, Alex; Spiegel, Paul

doi:10.1186/s13031-020-00321-w

Cited by 22 publications

(27 citation statements)

References 7 publications

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“…COVID-19 also contributed to fear and wishes to return to home countries. Together, these findings suggest the importance of further exploring food insecurity and SGBV that may have worsened since COVID-19 across global contexts [3,4,35,36], specifically among refugee adolescents and youth in humanitarian settings to understand their lived experiences. Our findings also suggest the importance of psychosocial support for young refugees who may be experiencing fear, panic and social isolation during COVID-19 that may exacerbate pre-existing psychological distress [33,34].…”

Section: Discussionmentioning

confidence: 99%

“…This is particularly salient to explore with refugees who may experience a high prevalence of psychological distress [34]. There are rising concerns of increased SGBV during COVID-19, including in humanitarian contexts [35,36]. Little is known of COVID-19-related stressors among refugee and displaced adolescents and youth, and how these may amplify pre-existing stressors.…”

Section: Introductionmentioning

confidence: 99%

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Exploring resource scarcity and contextual influences on wellbeing among young refugees in Bidi Bidi refugee settlement, Uganda: findings from a qualitative study

et al. 2021

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Background Contextual factors including poverty and inequitable gender norms harm refugee adolescent and youths’ wellbeing. Our study focused on Bidi Bidi refugee settlement that hosts more than 230,000 of Uganda’s 1.4 million refugees. We explored contextual factors associated with wellbeing among refugee adolescents and youth aged 16–24 in Bidi Bidi refugee settlement. Methods We conducted 6 focus groups (n = 3: women, n = 3: men) and 10 individual interviews with young refugees aged 16–24 living in Bidi Bidi. We used physical distancing practices in a private outdoor space. Focus groups and individual interviews explored socio-environmental factors associated with refugee youth wellbeing. Focus groups were digitally recorded, transcribed verbatim, and coded by two investigators using thematic analysis. Analysis was informed by a social contextual theoretical approach that considers the interplay between material (resource access), symbolic (cultural norms and values), and relational (social relationships) contextual factors that can enable or constrain health promotion. Results Participants included 58 youth (29 men; 29 women), mean age was 20.9 (range 16–24). Most participants (82.8%, n = 48) were from South Sudan and the remaining from the Democratic Republic of Congo (17.2% [n = 10]). Participant narratives revealed the complex interrelationships between material, symbolic and relational contexts that shaped wellbeing. Resource constraints of poverty, food insecurity, and unemployment (material contexts) produced stress and increased sexual and gender-based violence (SGBV) targeting adolescent girls and women. These economic insecurities exacerbated inequitable gender norms (symbolic contexts) to increase early marriage and transactional sex (relational context) among adolescent girls and young women. Gendered tasks such as collecting water and firewood also increased SGBV exposure among girls and young women, and this was exacerbated by deforestation. Participants reported negative community impacts (relational context) of COVID-19 that were associated with fear and panic, alongside increased social isolation due to business, school and church closures. Conclusions Resource scarcity produced pervasive stressors among refugee adolescents and youth. Findings signal the importance of gender transformative approaches to SGBV prevention that integrate attention to resource scarcity. These may be particularly relevant in the COVID-19 pandemic. Findings signal the importance of developing health enabling social contexts with and for refugee adolescents and youth.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Exploring resource scarcity and contextual influences on wellbeing among young refugees in Bidi Bidi refugee settlement, Uganda: findings from a qualitative study

et al. 2021

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“…To our knowledge, the documentation of this programmatic adaptation is a novel contribution to the literature. A recent article by Singh et al (2020) reviewed programmatic adaptations and context specific interventions that are implemented by humanitarian organizations in response to the COVID-19 pandemic [40]. The review categorized these adaptations based on an operational framework that allows locating information by specific humanitarian activity, with one of these activities focusing on nutrition.…”

Section: Discussionmentioning

confidence: 99%

“…The review categorized these adaptations based on an operational framework that allows locating information by specific humanitarian activity, with one of these activities focusing on nutrition. The review indicated that few countries including Pakistan, South Sudan, Bangladesh have implemented nutrition program adaptations, but without providing any description of these adaptations [40]. A study by Francis and Pegg (2020) [41] in the humanitarian setting of the Niger Delta described an adaptation of the school nutrition program, and its transformation into socially distanced feeding programs, after the forced schools' closure amidst the pandemic.…”

Section: Discussionmentioning

confidence: 99%

“…The process of adaptation conducted in Yemen has provided frontline HWs with context-specific technical guidance during the challenging COVID-19 pandemic. Supporting HWs with context-tailored technical guidance is crucial, particularly when most available guidance at the global level is primarily normative, and not developed for a humanitarian context or too broad to be adopted in different types of humanitarian settings [40]. Through the documentation of the nutrition programmatic adaptation in Yemen, this paper has revealed the quick reactivity and creativity of frontline humanitarian actors on the ground who are working with vulnerable populations in extremely challenging environments.…”

Section: Discussionmentioning

confidence: 99%

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Maintaining Essential Nutrition Services to Underfive Children in Yemen: A Programmatic Adaptation Amidst the COVID-19 Pandemic

et al. 2021

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The World Health Organization (WHO) acknowledged that, as health services divert their attention to the COVID-19 pandemic, the delivery of essential nutrition services may be compromised. This impact may be more pronounced in the context of humanitarian crises, such as the one currently unfolding in Yemen. In line with Pillar 9 of the WHO’s COVID-19 Strategic Preparedness and Response Plan, this paper reports on the nutrition program adaptations in Yemen to maintain the delivery of essential nutrition services to under-five children. The process of adaptation focused on the services provided within the nutrition surveillance system (NSS), therapeutic feeding centers (TFC), and isolation units (IU). It was conducted in five steps: (1) situation analysis; (2) development of guidance documents; (3) consultation process; (4) capacity-building programs; and (5) incorporation of programmatic adaptation within nutrition services. As of September 2020, NSS, TFC, and IUs services have shifted their standard operating procedures in line with the context-specific adaptations. The process described in this paper may serve as a case-study for other countries that intend to undertake similar adaptations in their nutrition program to contribute to the implementation of the WHO response plan and maintain the delivery of essential nutrition services to children.

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Findings from the Tushirikiane mobile health (mHealth) HIV self‐testing pragmatic trial with refugee adolescents and youth living in informal settlements in Kampala, Uganda

Logie,

Okumu,

Berry

et al. 2023

J Int AIDS Soc.

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IntroductionUrban refugee youth remain underserved by current HIV prevention strategies, including HIV self‐testing (HIVST). Examining HIVST feasibility with refugees can inform tailored HIV testing strategies. We examined if HIVST and mobile health (mHealth) delivery approaches could increase HIV testing uptake and HIV status knowledge among refugee youth in Kampala, Uganda.MethodsWe conducted a three‐arm pragmatic controlled trial across five informal settlements grouped into three sites in Kampala from 2020 to 2021 with peer‐recruited refugee youth aged 16–24 years. The intervention was HIVST and HIVST + mHealth (HIVST with bidirectional SMS), compared with standard of care (SOC). Primary outcomes were self‐reported HIV testing uptake and correct status knowledge verified by point‐of‐care testing. Some secondary outcomes included: depression, HIV‐related stigma, and adolescent sexual and reproductive health (SRH) stigma at three time points (baseline [T0], 8 months [T1] and 12 months [T2]). We used generalized estimating equation regression models to estimate crude and adjusted odds ratios comparing arms over time, adjusting for age, gender and baseline imbalances. We assessed study pragmatism across PRECIS‐2 dimensions.ResultsWe enrolled 450 participants (50.7% cisgender men, 48.7% cisgender women, 0.7% transgender women; mean age: 20.0, standard deviation: 2.4) across three sites. Self‐reported HIV testing uptake increased significantly from T0 to T1 in intervention arms: HIVST arm: (27.6% [n = 43] at T0 vs. 91.2% [n = 135] at T1; HIVST + mHealth: 30.9% [n = 47] at T0 vs. 94.2% [n = 113] at T1]) compared with SOC (35.5% [n = 50] at T0 vs. 24.8% [ = 27] at T1) and remained significantly higher than SOC at T2 (p<0.001). HIV status knowledge in intervention arms (HIVST arm: 100% [n = 121], HIVST + mHealth arm: 97.9% [n = 95]) was significantly higher than SOC (61.5% [n = 59]) at T2. There were modest changes in secondary outcomes in intervention arms, including decreased depression alongside increased HIV‐related stigma and adolescent SRH stigma. The trial employed both pragmatic (eligibility criteria, setting, organization, outcome, analysis) and explanatory approaches (recruitment path, flexibility of delivery flexibility, adherence flexibility, follow‐up).ConclusionsOffering HIVST is a promising approach to increase HIV testing uptake among urban refugee youth in Kampala. We share lessons learned to inform future youth‐focused HIVST trials in urban humanitarian settings.

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COVID-19 in humanitarian settings: documenting and sharing context-specific programmatic experiences

Cited by 22 publications

References 7 publications

Exploring resource scarcity and contextual influences on wellbeing among young refugees in Bidi Bidi refugee settlement, Uganda: findings from a qualitative study

Exploring resource scarcity and contextual influences on wellbeing among young refugees in Bidi Bidi refugee settlement, Uganda: findings from a qualitative study

Maintaining Essential Nutrition Services to Underfive Children in Yemen: A Programmatic Adaptation Amidst the COVID-19 Pandemic

Findings from the Tushirikiane mobile health (mHealth) HIV self‐testing pragmatic trial with refugee adolescents and youth living in informal settlements in Kampala, Uganda

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