Background: Currently, there is a significant lack of knowledge concerning urban malaria patterns... more Background: Currently, there is a significant lack of knowledge concerning urban malaria patterns in general and in Abidjan in particular. The prevalence of malaria, its distribution in the city and the fractions of fevers attributable to malaria in the health facilities have not been previously investigated.
Background An estimated 200 million persons in sub-Saharan Africa (SSA) live currently in urban c... more Background An estimated 200 million persons in sub-Saharan Africa (SSA) live currently in urban centres in malaria endemic areas. The epidemiology and control of urban malaria poses a number of specific challenges in comparison to rural areas, most notably the heterogeneous spatial distribution of transmission and the low state of immunity in the population. Interestingly, much less is currently known about malaria in urban settings than in rural areas. As a result there is an essential need for more information on disease burden, distribution and control strategies. In this multi-country study we undertook to study systematically key malariological features in four large SSA cities: Abidjan (Cote d’Ivoire), Ouagadougou (Burkina Faso), Cotonou (Benin) and Dar es Salaam (United Republic of Tanzania). Objectives The general objective of this series of case studies was to further our understanding of malaria transmission and epidemiology in the urban environment in SSA, in view of deve...
Background: Globally, violence disproportionately affects young people, leading to injury, hospit... more Background: Globally, violence disproportionately affects young people, leading to injury, hospitalisation, death, social dysfunction, and poor mental wellbeing. Moreover, it has far-reaching economic consequences for whole nations, due to loss of productivity. Research suggests that attaining a higher level of education promotes factors which insulate youths from poverty and violence. Purpose: In this study we investigated the outcomes, the cost, and the efficiency of a non-formal education program with an additional psychosocial component. The short-term outcome measure was an increase in educational attainment, a crucial step for youth empowerment. The program analysed was the Alternative Learning System (ALS) offered by the Balay Rehabiliation Centre in Bagong Silang, an urban slum in Manila, which targeted out of school youth. Methods: The cost-effectiveness analysis of ALS compared to a ‘do nothing approach’ was performed from the perspective of the service provider. The study...
Currently, there is a significant lack of knowledge concerning urban malaria patterns in general ... more Currently, there is a significant lack of knowledge concerning urban malaria patterns in general and in Abidjan in particular. The prevalence of malaria, its distribution in the city and the fractions of fevers attributable to malaria in the health facilities have not been previously investigated. A health facility-based survey and health care system evaluation was carried out in a peripheral municipality of Abidjan (Yopougon) during the rainy season of 2002, applying a standardized Rapid Urban Malaria Appraisal (RUMA) methodology. According to national statistics, approximately 240,000 malaria cases (both clinical cases and laboratory confirmed cases) were reported by health facilities in the whole of Abidjan in 2001. They accounted for 40% of all consultations. In the health facilities of the Yopougon municipality, the malaria infection rates in fever cases for different age groups were 22.1% (under one year-olds), 42.8% (one to five years-olds), 42.0% (> five to 15 years-olds)...
Aim: To investigate the association between maternal post-traumatic stress disorder (PTSD) during... more Aim: To investigate the association between maternal post-traumatic stress disorder (PTSD) during pregnancy and offspring DNA methylation and cortisol levels. Materials & methods: Blood genome-wide DNA methylation and cortisol was measured in the youngest child of 117 women who experienced sexual violence/torture during the Kosovo war. Results: Seventy-two percent of women had PTSD symptoms during pregnancy. Their children had higher cortisol levels and differential methylation at candidate genes ( NR3C1, HTR3A and BNDF) . No methylation differences reached epigenome-wide corrected significance levels. Conclusion: Identifying the biological processes whereby the negative effects of trauma are passed across generations and defining groups at high risk is a key step to breaking the intergenerational transmission of the effects of mental disorders.
To establish global research priorities for interpersonal violence prevention using a systematic ... more To establish global research priorities for interpersonal violence prevention using a systematic approach. Research priorities were identified in a three-round process involving two surveys. In round 1, 95 global experts in violence prevention proposed research questions to be ranked in round 2. Questions were collated and organized according to the four-step public health approach to violence prevention. In round 2, 280 international experts ranked the importance of research in the four steps, and the various substeps, of the public health approach. In round 3, 131 international experts ranked the importance of detailed research questions on the public health step awarded the highest priority in round 2. In round 2, "developing, implementing and evaluating interventions" was the step of the public health approach awarded the highest priority for four of the six types of violence considered (i.e. child maltreatment, intimate partner violence, armed violence and sexual violence) but not for youth violence or elder abuse. In contrast, "scaling up interventions and evaluating their cost-effectiveness" was ranked lowest for all types of violence. In round 3, research into "developing, implementing and evaluating interventions" that addressed parenting or laws to regulate the use of firearms was awarded the highest priority. The key limitations of the study were response and attrition rates among survey respondents. However, these rates were in line with similar priority-setting exercises. These findings suggest it is premature to scale up violence prevention interventions. Developing and evaluating smaller-scale interventions should be the funding priority.
Some evidence showed that multidisciplinary rehabilitation in Western countries is effective for ... more Some evidence showed that multidisciplinary rehabilitation in Western countries is effective for treating war-related trauma, but it remains unclear whether this approach is applicable to civilians living in resource-poor countries affected by war. In 2012-14, Danish Institute against Torture (DIGNITY) conducted a randomized controlled trial (RCT), in partnership with Kosova Rehabilitation Centre for Torture Victims (KRCT), to examine the effects of multidisciplinary intervention among victims of torture and war in Kosovo. A single-center, randomized, parallel-arm, single-masked, waiting-list controlled trial was implemented in northern Kosovo. Thirty-four participants meeting the recruiting criteria were randomized to either intervention group, which received integrated treatments plus a once-daily multivitamin, or the waiting list group, which received multivitamin alone. The integrated treatments consisted of 10 weekly individual 60-min sessions of cognitive behavioral therapy (CBT), based on an adapted prolonged exposure therapy manual, an individual 20-min breathing exercise with an emWave biofeedback device, and 90-min group physiotherapy. The waiting list group also received the same treatment after the intervention group had completed their sessions. Outcome assessments were conducted at 3, 6 and 9 months after baseline assessment. Outcomes measures consisted of 4 subtypes: mental, emotional, physical health, functioning and social outcomes, i.e. PTSD, depression, anxiety, chronic pain, anger and hatred expression, body mass index, handgrip strength, standing balance, income, employment rate and disability score. Over 1/3 of PTSD cases were successfully treated. Inconsistent patterns with mental health and chronic pain outcomes were observed while there was a definite impact of intervention on functioning and social outcomes, i.e. the employment rate, which increased nearly 15 %, and the monthly wage, which rose 45-137 %. There was also a noticeable improvement in handgrip strength and disability score; the feelings of anger and hatred diminished. However, most of these changes did not reach statistical significance. The impact of bio-psycho-social intervention is likely sensitive to the context of post-war economy in Kosovo and the treatment goals. The potential for improving the emotional well-being and employment outcome in victims was demonstrated. A larger scale RCT in a similar setting is needed, with close monitoring of treatment integrity and data reliability. Clinicaltrials.gov (NCT01696578).
Background: To develop an evidence-based rehabilitation programme, we investigated injury and pai... more Background: To develop an evidence-based rehabilitation programme, we investigated injury and pain complaints in relation to collective exposure to violence and human rights violations the population in Mitrovic district of Kosovo. Methods: The population-based study consists of two elements: household survey and functional assessment at a mobile clinic (presented in the part II). A cross-sectional two-stage cluster sampling was used. The survey was conducted in September-October 2008. We surveyed 1,115 households with a population of 6,845. Results: Around 7% of the population had been tortured and 20% had mental or physical pain complaints. Pain complaints increased with age over 35 years old. An association was found between the proportion of family members with pain complaints and a decline in the household income because of the injury of a family member. A family's affiliation with the Kosovo Liberation Army and participation in a protest prior to 1999 were related to being...
Aims: This is a case study of conflict epidemiology with an initial effort to assess organized an... more Aims: This is a case study of conflict epidemiology with an initial effort to assess organized and political violence (OPV) and human rights violations at the population level in Bangladesh. Background: Since 1972, ruling parties in Bangladesh have systematically used torture/inhuman treatment against political opponents and criminals. Methods: The population-based study consists of two parts: household survey and OPV screening at a mobile clinic (presented in the part II). Multistage cluster sampling method was used in the household survey: 22 clusters with a sample size of 1,101 households (population of 4870) were selected in the Meherpur district. Results: Overall level of violence and human rights abuse (including torture) is high. 75% households reported that family members had witnessed violent actions against relatives or friends. The annual injury rate was 36%, life experience of violence-attributable injury was 50% and pain experience within 2 week preceding the survey was...
Background: Currently, there is a significant lack of knowledge concerning urban malaria patterns... more Background: Currently, there is a significant lack of knowledge concerning urban malaria patterns in general and in Abidjan in particular. The prevalence of malaria, its distribution in the city and the fractions of fevers attributable to malaria in the health facilities have not been previously investigated.
Background An estimated 200 million persons in sub-Saharan Africa (SSA) live currently in urban c... more Background An estimated 200 million persons in sub-Saharan Africa (SSA) live currently in urban centres in malaria endemic areas. The epidemiology and control of urban malaria poses a number of specific challenges in comparison to rural areas, most notably the heterogeneous spatial distribution of transmission and the low state of immunity in the population. Interestingly, much less is currently known about malaria in urban settings than in rural areas. As a result there is an essential need for more information on disease burden, distribution and control strategies. In this multi-country study we undertook to study systematically key malariological features in four large SSA cities: Abidjan (Cote d’Ivoire), Ouagadougou (Burkina Faso), Cotonou (Benin) and Dar es Salaam (United Republic of Tanzania). Objectives The general objective of this series of case studies was to further our understanding of malaria transmission and epidemiology in the urban environment in SSA, in view of deve...
Background: Globally, violence disproportionately affects young people, leading to injury, hospit... more Background: Globally, violence disproportionately affects young people, leading to injury, hospitalisation, death, social dysfunction, and poor mental wellbeing. Moreover, it has far-reaching economic consequences for whole nations, due to loss of productivity. Research suggests that attaining a higher level of education promotes factors which insulate youths from poverty and violence. Purpose: In this study we investigated the outcomes, the cost, and the efficiency of a non-formal education program with an additional psychosocial component. The short-term outcome measure was an increase in educational attainment, a crucial step for youth empowerment. The program analysed was the Alternative Learning System (ALS) offered by the Balay Rehabiliation Centre in Bagong Silang, an urban slum in Manila, which targeted out of school youth. Methods: The cost-effectiveness analysis of ALS compared to a ‘do nothing approach’ was performed from the perspective of the service provider. The study...
Currently, there is a significant lack of knowledge concerning urban malaria patterns in general ... more Currently, there is a significant lack of knowledge concerning urban malaria patterns in general and in Abidjan in particular. The prevalence of malaria, its distribution in the city and the fractions of fevers attributable to malaria in the health facilities have not been previously investigated. A health facility-based survey and health care system evaluation was carried out in a peripheral municipality of Abidjan (Yopougon) during the rainy season of 2002, applying a standardized Rapid Urban Malaria Appraisal (RUMA) methodology. According to national statistics, approximately 240,000 malaria cases (both clinical cases and laboratory confirmed cases) were reported by health facilities in the whole of Abidjan in 2001. They accounted for 40% of all consultations. In the health facilities of the Yopougon municipality, the malaria infection rates in fever cases for different age groups were 22.1% (under one year-olds), 42.8% (one to five years-olds), 42.0% (> five to 15 years-olds)...
Aim: To investigate the association between maternal post-traumatic stress disorder (PTSD) during... more Aim: To investigate the association between maternal post-traumatic stress disorder (PTSD) during pregnancy and offspring DNA methylation and cortisol levels. Materials & methods: Blood genome-wide DNA methylation and cortisol was measured in the youngest child of 117 women who experienced sexual violence/torture during the Kosovo war. Results: Seventy-two percent of women had PTSD symptoms during pregnancy. Their children had higher cortisol levels and differential methylation at candidate genes ( NR3C1, HTR3A and BNDF) . No methylation differences reached epigenome-wide corrected significance levels. Conclusion: Identifying the biological processes whereby the negative effects of trauma are passed across generations and defining groups at high risk is a key step to breaking the intergenerational transmission of the effects of mental disorders.
To establish global research priorities for interpersonal violence prevention using a systematic ... more To establish global research priorities for interpersonal violence prevention using a systematic approach. Research priorities were identified in a three-round process involving two surveys. In round 1, 95 global experts in violence prevention proposed research questions to be ranked in round 2. Questions were collated and organized according to the four-step public health approach to violence prevention. In round 2, 280 international experts ranked the importance of research in the four steps, and the various substeps, of the public health approach. In round 3, 131 international experts ranked the importance of detailed research questions on the public health step awarded the highest priority in round 2. In round 2, "developing, implementing and evaluating interventions" was the step of the public health approach awarded the highest priority for four of the six types of violence considered (i.e. child maltreatment, intimate partner violence, armed violence and sexual violence) but not for youth violence or elder abuse. In contrast, "scaling up interventions and evaluating their cost-effectiveness" was ranked lowest for all types of violence. In round 3, research into "developing, implementing and evaluating interventions" that addressed parenting or laws to regulate the use of firearms was awarded the highest priority. The key limitations of the study were response and attrition rates among survey respondents. However, these rates were in line with similar priority-setting exercises. These findings suggest it is premature to scale up violence prevention interventions. Developing and evaluating smaller-scale interventions should be the funding priority.
Some evidence showed that multidisciplinary rehabilitation in Western countries is effective for ... more Some evidence showed that multidisciplinary rehabilitation in Western countries is effective for treating war-related trauma, but it remains unclear whether this approach is applicable to civilians living in resource-poor countries affected by war. In 2012-14, Danish Institute against Torture (DIGNITY) conducted a randomized controlled trial (RCT), in partnership with Kosova Rehabilitation Centre for Torture Victims (KRCT), to examine the effects of multidisciplinary intervention among victims of torture and war in Kosovo. A single-center, randomized, parallel-arm, single-masked, waiting-list controlled trial was implemented in northern Kosovo. Thirty-four participants meeting the recruiting criteria were randomized to either intervention group, which received integrated treatments plus a once-daily multivitamin, or the waiting list group, which received multivitamin alone. The integrated treatments consisted of 10 weekly individual 60-min sessions of cognitive behavioral therapy (CBT), based on an adapted prolonged exposure therapy manual, an individual 20-min breathing exercise with an emWave biofeedback device, and 90-min group physiotherapy. The waiting list group also received the same treatment after the intervention group had completed their sessions. Outcome assessments were conducted at 3, 6 and 9 months after baseline assessment. Outcomes measures consisted of 4 subtypes: mental, emotional, physical health, functioning and social outcomes, i.e. PTSD, depression, anxiety, chronic pain, anger and hatred expression, body mass index, handgrip strength, standing balance, income, employment rate and disability score. Over 1/3 of PTSD cases were successfully treated. Inconsistent patterns with mental health and chronic pain outcomes were observed while there was a definite impact of intervention on functioning and social outcomes, i.e. the employment rate, which increased nearly 15 %, and the monthly wage, which rose 45-137 %. There was also a noticeable improvement in handgrip strength and disability score; the feelings of anger and hatred diminished. However, most of these changes did not reach statistical significance. The impact of bio-psycho-social intervention is likely sensitive to the context of post-war economy in Kosovo and the treatment goals. The potential for improving the emotional well-being and employment outcome in victims was demonstrated. A larger scale RCT in a similar setting is needed, with close monitoring of treatment integrity and data reliability. Clinicaltrials.gov (NCT01696578).
Background: To develop an evidence-based rehabilitation programme, we investigated injury and pai... more Background: To develop an evidence-based rehabilitation programme, we investigated injury and pain complaints in relation to collective exposure to violence and human rights violations the population in Mitrovic district of Kosovo. Methods: The population-based study consists of two elements: household survey and functional assessment at a mobile clinic (presented in the part II). A cross-sectional two-stage cluster sampling was used. The survey was conducted in September-October 2008. We surveyed 1,115 households with a population of 6,845. Results: Around 7% of the population had been tortured and 20% had mental or physical pain complaints. Pain complaints increased with age over 35 years old. An association was found between the proportion of family members with pain complaints and a decline in the household income because of the injury of a family member. A family's affiliation with the Kosovo Liberation Army and participation in a protest prior to 1999 were related to being...
Aims: This is a case study of conflict epidemiology with an initial effort to assess organized an... more Aims: This is a case study of conflict epidemiology with an initial effort to assess organized and political violence (OPV) and human rights violations at the population level in Bangladesh. Background: Since 1972, ruling parties in Bangladesh have systematically used torture/inhuman treatment against political opponents and criminals. Methods: The population-based study consists of two parts: household survey and OPV screening at a mobile clinic (presented in the part II). Multistage cluster sampling method was used in the household survey: 22 clusters with a sample size of 1,101 households (population of 4870) were selected in the Meherpur district. Results: Overall level of violence and human rights abuse (including torture) is high. 75% households reported that family members had witnessed violent actions against relatives or friends. The annual injury rate was 36%, life experience of violence-attributable injury was 50% and pain experience within 2 week preceding the survey was...
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