Suchergebnisse

AbstractThe continuing violence in Iraq has led to further damage to the health sector in a country already affected by sanctions, war and harsh rule. As a consequence some doctors have been killed and others have migrated, both within Iraq and from Iraq to neighbouring countries. In this article we report patterns of migration of Iraqi physicians, identify perceived future plans, and assess factors behind physicians' decisions. Respondent driven sampling in 2007 was used to interview 401 Iraqi medical doctors who migrated to Jordan after the 2003 invasion of Iraq The main outcome measure for this study was the future plans of physicians, which included permanently residing outside Iraq or returning to Iraq. Physicians who planned to return to Iraq differed from those who planned to reside permanently outside Iraq in the following factors: age categories (relative odds comparing age 50 plus to those under 30 = 0.46, 95% CI: 0.21–0.97), years spent outside of Iraq (RO = 2.03, 95% CI = 1.28–3.21), no difficulties in Jordan (RO = 0.53, 95% CI = 0.31–0.93), and household members residing in Iraq (RO = 1.17, 95% CI = 1.05 – 1.31). Many doctors who fled Iraq after the 2003 invasion do not plan to return, which must be considered in future training strategies for the Iraqi health sector.

Liberia's civil war lasted more than fourteen years, ending in August 2003. During the conflict, nationally reported crude death rates increased from pre-conflict levels of the 1980s. However, fighting and insecurity precluded population-based assessments, and minimal information on conflict-related mortality is available. The present study estimated mortality among internally displaced persons (IDPs) in the greater Monrovia area and was based on a sample of 378 households with 2,134 individuals over a recall period from the July 2000 invasion by rebel forces to September 2004. A crude mortality rate of 22/1,000/year (95 CI: 19–25) or 0.6/10,000/day (95 CI: 0.5–0.7) was found among Monrovia IDPs and excess mortality was estimated at 6/1,000/year (95% CI: 3–9). The most deaths occurred in 2003, with the death rate peaking during a cholera outbreak. Of 242 reported deaths, 60% (95 CI: 54–66) were attributed to illness and 33% (95 CI: 27–39) to violence.

Purpose
– The purpose of this paper is to characterize and investigate relationships between disaster preparedness, impacts, and humanitarian response among Eastern Uganda populations affected by the 2010 landslides and floods.


Design/methodology/approach
– A stratified cluster survey of the disaster-affected populations was conducted five months after the onset of the disasters. Probability proportional to size sampling was used to sample 800 households, including 400 affected by floods in Butaleja District and 400 affected by landslides in Bududa District.


Findings
– Mortality was significantly higher in the landslide-affected populations as compared to flood-affected populations (deaths reported: 4.5 vs 1.6 percent, p<0.01) whereas injuries were more common in the flood-affected areas (injuries reported: 3.1 vs 1.1 percent, p<0.01). Livelihoods impacts were widespread and reported in more than 95 percent of households. Respondents indicated that the community and government were unprepared to respond in both flood (90.5 and 77.8 percent, respectively) and landslide (95.3 and 74.9 percent) affected areas.


Practical implications
– The majority of households felt that both their communities and the government were unprepared to respond to disasters. Given the likelihood for recurrence of natural disasters in these communities, expansion of both community-based disaster preparedness (CBDP) programs and their evidence base should be prioritized.


Originality/value
– There is a paucity of evidence on community perceptions of disaster preparedness and on CBDP programs. The paper highlights these issues in the context of two disasters in Uganda and calls for expansion of the evidence based to inform risk reduction strategies in low-income settings.

According to current estimates, Syria hosts the largest number of Iraqi refugees in the region. This study aimed to provide information on the household economy and livelihoods among Iraqi refugees residing in urban areas of Syria. A nationally representative 80 * 10 cluster survey of Iraqi refugee households (total n = 800) was conducted in March 2009. Overall, 69 per cent of households reported having financial difficulties; 14 per cent fell below the poverty line of US$1/person/day and 41 per cent were living on less than US$2/person/day. High levels of dependency on remittances, pensions, and UN support were observed. Nearly 40 per cent of households reported an employed member, of whom 58 per cent reported workplace difficulties. Uncertain legal status and inability to work in the formal sector are principal concerns among the Iraqi population in Syria. Humanitarian assistance planners should consider livelihoods and cash transfer programmes that promote income generation and reduce dependency on savings and other outside sources. Adapted from the source document.

Abstract

Background
Almost two-thirds of refugees, internally displaced persons, returnees and other persons affected by humanitarian emergencies live in malaria endemic regions. Malaria remains a significant threat to the health of these populations.


Methods
Data on malaria incidence and mortality were analyzed from January 2006 to December 2009 from the United Nations High Commissioner for Refugees Health Information System database collected at sites in Burundi, Chad, Cameroon, Ethiopia, Kenya, Sudan, Tanzania, Thailand, and Uganda. Data from three countries during 2006 and 2007, and all nine countries from 2008 to 2009, were used to describe trends in malaria incidence and mortality. Monthly counts of malaria morbidity and mortality were aggregated into an annual country rate averaged over the study period.


Results
An average of 1.18 million refugees resided in 60 refugee sites within nine countries with at least 50 cases of malaria per 1000 refugees during the study period 2008-2009. The highest incidence of malaria was in refugee sites in Tanzania, where the annual incidence of malaria was 399 confirmed cases per 1,000 refugees and 728 confirmed cases per 1,000 refugee children younger than five years. Malaria incidence in children younger than five years of age, based on the sum of confirmed and suspected cases, declined substantially at sites in two countries between 2006 and 2009, but a slight increase was reported at sites within four of seven countries between 2008 and 2009. Annual malaria mortality rates were highest in sites in Sudan (0.9 deaths per 1,000 refugees), Uganda and Tanzania (0.7 deaths per 1000 refugees each). Malaria was the cause of 16% of deaths in refugee children younger than five years of age in all study sites.


Conclusions
These findings represent one of the most extensive reports on malaria among refugees in post-emergency sites. Despite declines in malaria incidence among refugees in several countries, malaria remains a significant cause of mortality among children younger than five years of age. Further progress in malaria control, both within and outside of post-emergency sites, is necessary to further reduce malaria incidence and mortality among refugees and achieve global goals in malaria control and elimination.