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      Using a population-based survey approach to estimate child separation after a natural disaster: findings from post-Hurricane Haiti

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          Abstract

          Introduction

          This study explores findings of a population-based approach to measure the prevalence of unaccompanied and separated children (UASC) during the Hurricane Matthew aftermath in Haiti.

          Methods

          We conducted a cross-sectional survey using two-stage cluster sampling. Participants were asked to provide information on their own household composition, as well as the household composition of their closest neighbour (the Neighborhood Method). The study took place between February and March 2017 in Haiti’s Sud Department, a region severely affected by Hurricane Matthew in October 2016. 1044 primary respondents provided information about their own household, and 4165 people in the household of their closet neighbour. The primary outcome measured was the prevalence of UASC in the Sud Department following Hurricane Matthew. Secondary outcomes of interest included the characteristics of these children, including age, sex, reason for separation and current caregiver.

          Results

          Of the 2046 children currently living in the surveyed households, 3.03% (95% CI 2.29% to 3.77%) were reported to have been separated from their normal caregiver during Hurricane Matthew. Among these 62 children, 9 were unaccompanied, and there were slightly more boys than girls (56% vs 44%, p=0.37). Of the 2060 children who lived in surveyed households when the hurricane hit, 1.12% (95% CI 0.67% to 1.57%) had since departed without their caregiver. The prevalence of separation reported for neighbours’ households was not significantly different from that in respondents’ households (p values between 0.08 and 0.29).

          Conclusions

          This study is the first known attempt to measure the prevalence of child separation following a natural disaster. Overall, the rates of separation were relatively low. Similarities between primary and secondary reports of child separation via the Neighborhood Method indicate that this may be a viable approach to measuring UASC in certain contexts.

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          Most cited references10

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          Emotional and behavioural problems amongst Afghan unaccompanied asylum-seeking children: results from a large-scale cross-sectional study.

          Unaccompanied asylum-seeking children (UASC) are considered at high risk for mental health problems, yet few studies focus on single ethnic populations. This study presents results from the largest Afghan UASC mental health survey in the U.K. Specifically, the study aims to estimate the prevalence of emotional and behavioural problems and to investigate the associations of these problems with demographic variables, cumulative traumatic events, and care and migration variables. A census sample of 222 Afghan UASC was interviewed using validated self-report screening measures. Emotional and behavioural problems were screened using the Hopkins Symptoms Checklist 37A (HSCL-37A). Pre-migration stressful life events were screened using the Stressful Life Events Questionnaire. Administrative data on care and asylum were provided by the local authority social services and the UK Border Agency. Approximately one-third (31.4%) scored above cut-offs for emotional and behavioural problems, 34.6% for anxiety and 23.4% for depression. Ordinary least squares regression indicated a significant dose-response relationship between total pre-migration traumatic events and distress as well as between increased time in the country and greater behavioural problems. Compound traumatic events in the pre-migration stages of forced migration have a deleterious association with UASC well-being. Increased time in country suggests a possible peer effect for these children. Consistent with other studies on refugee children, it should be stressed that the majority of UASC scored below suggested cut-offs, thus displaying a marked resilience despite the experience of adverse events.
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            High levels of mortality, malnutrition, and measles, among recently-displaced Somali refugees in Dagahaley camp, Dadaab refugee camp complex, Kenya, 2011

            Background Following a rapid influx of over 200,000 displaced Somalis into the Dadaab refugee camp complex in Kenya, Médecins Sans Frontières conducted a mortality and nutrition survey of the population living in Bulo Bacte, a self-settled area surrounding Dagahaley camp (part of this complex). Methods The survey was conducted between 31st July and 10th August 2011. We exhaustively interviewed representatives from all households in Bulo Bacte, collecting information on deaths, births, and population movements during the recall period (15th February 2011 to survey date), in order to provide estimates of retrospective death rates. We recorded the mid-upper arm circumference and presence or absence of bipedal oedema of all children of height 67-<110 cm to provide estimates of global and severe acute malnutrition. Results The surveyed population included 26,583 individuals, of whom 6,488 (24.4%) were children aged under 5 years. There were 360 deaths reported during the 177 days of the recall period, of which 186 (52%) were among children aged under 5 years. The crude death rate for the entire recall period was 0.8 per 10,000 person-days. The under-5 death rate was 1.8 per 10,000 person-days. More than two-thirds of all deaths were reported to have been associated with diarrhoea (25%), cough or other breathing difficulties (24%), or with fever (19%). Measles accounted for a reported 17% of all deaths; this was due to a measles outbreak that occurred between June and October 2011. Global acute malnutrition was observed in 13.4%, and severe acute malnutrition in 3.0%, of children measuring 67-<110 cm. Among children measuring 110-< 140 cm, 9.8% met the admission criteria for entry into the nutritional programme. Trends of decreasing death rates and malnutrition prevalence with length of stay in Bulo Bacte were observed. Conclusions We report high death rates and prevalence of malnutrition among this population, reflecting at least a partial failure of the various humanitarian and governmental actors to adequately safeguard the welfare of this population. An outbreak of measles and long delays before registration should not have occurred. The recommendations for measles vaccination among crisis-affected populations should be revised to take into account the epidemiologic context. Organisations must be sensitive and reactive to changes in the health status of the populations they assist.
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              Measuring violence against women amidst war and displacement in northern Uganda using the "neighbourhood method".

              Gender-based violence is viewed as a significant problem in conflict-affected regions throughout the world. However, humanitarian organizations typically have been unable to reliably estimate the incidence of rape, intimate partner violence and other forms of sexual abuse in such settings. Such estimates are required to inform programming in contexts such as northern Uganda. We sought to establish incidence rates for gender-based violence in internally-displaced-persons camps in northern Uganda. The assessments involved a "neighbourhood methodology," in which adult female heads of household reported about their own, their sisters' and their neighbours' experiences. 299 households were selected for interview across four camps by using systematic random sampling. Interviews were completed by 204 respondents (5 women having declined interview and 90 not having been successfully contacted). These respondents reported on themselves, a total of 268 sisters and 1206 neighbours. Reports with respect to these alternative populations produced estimates of overall incidence of intimate partner violence in the past year of 51.7% (95% CI 44.8 to 58.7; respondents), 44.0% (95% CI 41.2 to 46.9; respondents' sisters) and 36.5% (95% CI 30.7 to 42.3; respondents' neighbours). In the same period, estimates of incidence of forced sex by husbands were 41.0% (95% CI 34.2% to 47.8%), 22.1% (95% CI 17.0 to 27.2) and 25.1% (95% CI 22.5 to 27.6), respectively, with incidence of rape by a perpetrator other than an intimate partner estimated at 5.0% (95% CI 2.0% to 8.0%), 4.2% (95% CI 1.8 to 6.6) and 4.3% (95% CI 3.1 to 5.5), respectively. Gender-based violence-particularly intimate partner violence-is commonplace in postconflict Uganda. The neighbourhood method provides a promising approach to estimating human right violations in humanitarian settings.
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                Author and article information

                Journal
                BMJ Glob Health
                BMJ Glob Health
                bmjgh
                bmjgh
                BMJ Global Health
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2059-7908
                2018
                17 May 2018
                : 3
                : 3
                : e000784
                Affiliations
                [1 ]departmentDepartment of Population and Family Health, Mailman School of Public Health , Columbia University , New York City, New York, USA
                [2 ]departmentDepartment of Epidemiology, Mailman School of Public Health , Columbia University , New York City, New York, USA
                [3 ]departmentRory Meyers College of Nursing , New York University , New York City, New York, USA
                [4 ]Save the Children , London, UK
                Author notes
                [Correspondence to ] Dr Lindsay Stark; ls2302@ 123456cumc.columbia.edu
                Article
                bmjgh-2018-000784
                10.1136/bmjgh-2018-000784
                5969727
                3ac0a51b-6b34-4d84-9006-cb3547ca0cf1
                © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                : 19 February 2018
                : 30 April 2018
                : 01 May 2018
                Funding
                Funded by: USAID’s Office of Foreign Disaster Assistance;
                Categories
                Research
                1506
                Custom metadata
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                health services research,community-based survey,cross-sectional survey,child health

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