UNASSIGNED: Decades of conflict and cycles of disasters in Afghanistan have caused enormous impacts on health, the economy, and even national security.
UNASSIGNED: We aimed to assess the levels of depression, anxiety, and stress symptoms and their determinants among Afghan healthcare workers.
UNASSIGNED: A cross-sectional study of 830 Afghan healthcare workers working in public and private hospitals was conducted between May and July 2021. We employed a non-probability sampling method to select our subjects. The questionnaire was composed of sections on sociodemographic information, working conditions, and Depression, Anxiety, and Stress Scale-21 (DASS-21). Multivariable linear regression models were fitted using SPSS 21 to identify determinants of mental health symptoms among Afghan healthcare workers at a 5% significance level.
UNASSIGNED: Of all participants, 52.3% (435) had symptoms of depression, 48.8% (405) anxiety, and 46.9% (389) stress. The likelihood of mental health symptoms was higher among those who worked in an urban setting (P = 0.001), were physically inactive (P = <0.001), had a decrease in income or an unpaid salary in the past six months (P = <0.001), thinking of leaving Afghanistan (P = <0.001), had medical comorbidity (P = <0.001), and being single (P = 0.048)].
UNASSIGNED: This study highlights the important findings about the psychological health of healthcare workers in Afghanistan. These findings suggest rapid, actionable, and locally relevant interventions to assure potential improvements in working and living conditions for the health staff.

The COVID-19 pandemic has further aggravated the burden of mental health and presents an opportunity for public health research to focus on evidence-based interventions appropriate for populations residing in resource-constrained, post-conflict settings. Post-conflict settings have a higher service gap in mental health and fewer protective factors, such as economic and domestic security. Post-conflict settings are defined as locations where open warfare has ended but resulting challenges have remained for years. A strong emphasis on the engagement of diverse stakeholders is needed to arrive at sustainable and scalable solutions to mental health service delivery. This review discusses mental health service delivery gaps in post-conflict settings, highlights the urgency of the matter in the context of the COVID-19 pandemic, and provides recommendations for service gaps from evidence-based case study exemplars with an implementation science lens using the Consolidated Framework for Implementation Research (CFIR) as guide to improving adaptation and uptake.

Emergency care systems (ECS) organize and provide access to life-saving care both during transport and at health facilities. Not enough is known about ECS in uncertain contexts such as post-conflict settings. This review aims to systematically identify and summarize the published evidence on the delivery of emergency care in post-conflict settings and to guide health sector planning.
We searched five databases (PubMed MEDLINE, Web of Science, Embase, Scopus, and Cochrane) in September 2021 to identify relevant articles on ECS in post-conflict settings. Included studies (1) described a context that is post-conflict, conflict-affected, or was impacted by war or crisis; (2) examined the delivery of an emergency care system function; (3) were available in English, Spanish, or French; and (4) were published between 1 and 2000 and 9 September 2021. Data were extracted and mapped using the essential system functions identified in the World Health Organization (WHO) ECS Framework to capture findings on essential emergency care functions at the scene of injury or illness, during transport, and through to the emergency unit and early inpatient care.
We identified studies that describe the unique burden of disease and challenges in delivering to the populations in these states, pointing to particular gaps in prehospital care delivery (both during scene response and during transport). Common barriers include poor infrastructure, lingering social distrust, scarce formal emergency care training, and lack of resources and supplies.
To our knowledge, this is the first study to systematically identify the evidence on ECS in fragile and conflict-affected settings. Aligning ECS with existing global health priorities would ensure access to these critical life-saving interventions, yet there is concern over the lack of investments in frontline emergency care. An understanding of the state of ECS in post-conflict settings is emerging, although current evidence related to best practices and interventions is extremely limited. Careful attention should be paid to addressing the common barriers and context-relevant priorities in ECS, such as strengthening prehospital care delivery, triage, and referral systems and training the health workforce in emergency care principles.

Research assessing familial violence against adolescents, using caregiver-adolescent dyads, is limited in post-conflict settings. This study aimed to determine the prevalence and factors associated with adolescent-reported familial abuse in post-conflict northern Uganda. It also assessed the relationship between abuse subtypes and (a) beliefs supporting aggression and (b) adolescent well-being and life satisfaction. A randomly selected community-based sample of 10- to 17-year-old adolescents (54% girls) and their caregivers (N = 427 dyads) in two northern Uganda districts was used. Abuse outcomes were adolescent reported. All measures used standardized tools that have been adapted for research in resource-limited settings. Analyses used multivariable linear regressions in Stata 14/IC. Overall, physical, emotional, and sexual abuse rates were 70% (confidence interval [CI] = [65.7, 74.4]), 72% (CI = [67.4, 76.0]), and 18.0% (CI = [14.0, 21.2]), respectively. Polyvictimization was 61% (CI = [55.4, 64.7]). There were no gender differences regarding adolescent reports of physical and emotional abuse, but adolescent girls were more likely to report sexual abuse and polyvictimization than adolescent boys. All forms of adolescent-reported abuse (except sexual abuse) were associated with caregiver reports of harsh disciplinary practices. In addition, emotional abuse was associated with physical and sexual abuse. Physical abuse was associated with being an orphan and emotional abuse. Sexual abuse was associated with being a girl, older adolescent age, living in a larger household, and emotional abuse. Polyvictimization was positively associated with being an orphan, younger caregiver age, caregiver-reported poor monitoring and supervision, and higher household socioeconomic status, but negatively associated with lower parental role satisfaction. Physical and emotional (but not sexual) abuse and polyvictimization were associated with beliefs supporting aggression among adolescents. All abuse subtypes were associated with lower levels of perceived well-being and life satisfaction among adolescents in this study. Child abuse prevention programs have the potential to improve adolescent-caregiver interaction and interrupt the violence transmission cycle in this setting.

No abstract available.

BACKGROUND: Access to adequate antenatal care (ANC) is critical in ensuring a good maternal health and in preventing maternal and neonatal morbidity and mortality. South Sudan has one of the world\'s poorest health indicators due to a fragile health system and a combination of socio-cultural, economic, and political factors. This study was conducted to identify barriers to utilisation of ANC services in Rumbek North County.
METHODS: Using a qualitative design, data were collected through 14 focus group discussions with 169 women and 45 men and 12 key informant interviews with community leaders, staff working in health facilities, and the staff of the County Health Department. Data were analysed using inductive content analysis.
RESULTS: The perceived barriers to ANC utilisation were categorised as follows: 1) Issues related to access to health facilities and lack of resources. These included long distance to health facilities, lack of means of transportation to the health facilities, floods and poor roads, and demand for payment for health care at some health facilities; 2) The influence of the socio-cultural context and conflict including heavy burden of domestic chores, the negative influence of husbands who were reluctant to allow their wives to attend ANC, and insecurity; 3) Perceptions about pregnancy including misperceptions about the benefits of ANC and low perceived risk of pregnancy-related complications; and 4) Perceptions about the quality of care and the efficacy of medical treatment.
CONCLUSIONS: This study identified a myriad of factors deeply entrenched in the society, which prevent women from utilising ANC services. It also elicits broad aspects of interconnectedness among the barriers. To ensure effectiveness, strategies to improve utilisation of ANC in the study area and in similar contexts need to take into account the barriers identified by this study.

With a total fertility ratio of 6.7 children per woman, a maternal mortality ratio over 1,000 deaths per 100,000 live births, high rates of sexual and gender-based violence, and the lowest contraceptive prevalence rate in the world, women\'s reproductive health indices in Somalia prove alarming. The voices of women living in Somalia have long been neglected and we undertook this qualitative study to explore women\'s reproductive health knowledge and experiences. In 2014, we conducted four focus group discussions with 21 married and unmarried women of reproductive age living in Mogadishu, Somalia. Discussions took place in Somali and we used a constant comparative approach to analyse the discussions for content and themes. Our findings reveal that misinformation, restrictive policies, mistrust of clinicians, and prohibitively expensive services shape women\'s experiences and health-seeking behaviours. Women identified the need for culturally resonant reproductive health information and services as a significant priority. As Somalia begins to emerge from over two decades of civil war, it is imperative that comprehensive reproductive health issues are included on the national agenda and that women\'s perspectives are incorporated into future policies and interventions.

The extent to which disarmament, demobilisation and reintegration (DDR) programmes initiated by state or multilateral agencies can realise the reintegration of ex-combatants remains debated. While some consider that DDR should have the ambition to result in long-term reintegration, others argue that DDR should focus on short-term goals. This paper explores experiences with the reintegration of ex-combatants in Burundi. It shows the interconnectedness of economic and social reintegration processes, and demonstrates that the reintegration of ex-combatants cannot be seen in isolation from the wider recovery and development context in which DDR is taking place. Moreover, the case demonstrates that reconciliation and social reintegration are deeply interconnected, to the extent that social reintegration may fail if reconciliation is not taken into account. Rather than a debate between long- and short-term goals, the focus should therefore be on increasing the understanding of reintegration processes and finding ways in which programmes can contribute to those.