Sequential screening for depression in humanitarian emergencies: a validation study of the Patient Health Questionnaire among Syrian refugees

This study utilized data from a cross-sectional survey done with Syrian refugees in a camp in Greece. The goal was to determine if a sequential screening process would be able to accurately assess the number of patients with major depressive disorder (MDD) in the population. While the initial data was collected through the eight-item Patient Health Questionnaire (PHQ-8), this validation study simulated the use of the two-item Patient Health Questionnaire (PHQ-2) as well. The PHQ-2 was used to first screen the data of patients who scored less than 2 on the PHQ-2, who were then ruled out for MDD symptoms. The other patients’ answers were then used in the PHQ-8. The findings were analyzed to see if the two-part process would be able to accurately and efficiently determine who would be most at risk for symptoms of MDD. 

The conclusion of this study was that “The benefits of the sequential screening approach for the classification of MDD presented here are twofold: preserving classification accuracy relative to the PHQ-2 alone while reducing the response burden of the PHQ-8. This sequential screening approach is a pragmatic strategy for streamlining MDD surveillance in humanitarian emergencies.” 

Harnessing Partnerships to Better Map Research Evidence on Migration Health

 Originally posted on: https://weblog.iom.int/harnessing-partnerships-better-map-research-evidence-migration-health

12/19/19

What do we know about the landscape of migration health research? Who is doing the research? What are they researching on? Which migrant categories are included? What are the health related themes? How can we better understand the research and evidence gap in migration and health? What collaborations are taking place, and can we map who funds this research?

These are some of the questions that a group of scholars, policy makers and International Organization for Migration (IOM) staff investigated at a workshop on bibliometrics analysis of migration health research held in November 2019 at IOM’s Global Administrative Centre in Manila, Philippines.

The workshop was the first of this kind, harnessing research collaboration not only within IOM but also with the government agencies, clinicians and research institutions, mainly from South and Southeast Asia.

“Bibliometric analysis is a useful research method as it lets you look at the patterns of research activities such as publications. In any global health field, it is extremely helpful to know where the work is being done, who is doing it, where the collaborations are happening, and what topics are being explored,” said Dr. Margaret Sampson, an international expert on bibliometric analysis who facilitated the workshop.

Jointly organized by IOM, together with the Migration Health and Development Research Initiative (MHADRI) and the Migration & Health South Asia Network, the workshop served as a platform to develop research capacity, with particular focus on researchers in the Global South, in undertaking bibliometric analysis to identify the gaps in research output on migration health.   

BackgroundIn 2018, IOM and MHADRI undertook the first-ever bibliometric analysis of global migration health research in peer-reviewed literature focusing on international migrants. The study revealed major gaps in research productivity especially in the Global South as most literature is from high-income migrant destination countries, despite the significant migration flows within the countries in Asia, Latin America, Africa, Middle East, and Eastern Europe. For example, according to the study, only 6.2 per cent of the total published research output on the health of migrants focused on migrant workers, despite 60 per cent of international migrants represented within this category. Supporting the networking, capacity development of researchers, especially those from developing nations, to undertake migration health-related research was highlighted. The importance of undertaking more in-depth mapping of migration health research output for both international and internal migrants in low to middle income countries were also highlighted in the research by IOM and MHADRI.
 
Geographical distribution of retrieved documents in global migration health (2000–2016). Areas with no color in the map represent regions with no data available or no research output in the field of global migration health. To read the full paper: Bibliometric analysis of global migration health research in peer-reviewed literature (2000–2016)

The Manila Consensus Group forged at the workshop aimed at further refining and testing the search strategies for bibliometrics research and provide analytical rigour to apply these methods for migration health research.

The group committed to developing methodological guidelines in undertaking bibliometric analysis as well as to work on providing a standardized approach to undertaking bibliometric analysis relevant to research on international and internal migration dynamics.

The group committed to publishing these outputs in open source platforms supported by IOM so as to make this publicly available so that researchers, policy makers and UN agencies can utilize to undertake tailored analytics.

“It boils down to how you frame your question, the right key words, and the right way to search – maybe we are making it too wide or too tight – maybe we are not getting the right information. So, the tools and strategies presented were really helpful,” said one of the workshop participants, Dr. Roomi Aziz, Technical Lead Health Data and Communication, Pathways to Impact in Pakistan

The Manila Consensus group will delve into questions focusing on the research productivity relating to migration and health in Philippines, internal migration and health related research in South Asia as well as the research productivity relating to health assessments of migrants and refugees at pre- and post-migration phases and health outcomes in areas ranging from Infectious disease, communicable disease and occupational health.

“The workshop provided an excellent opportunity to build research capacity among Global South scholars, to enable them to go back and take deep dives to understand the research productivity in the field of migration health in their local areas and use that as evidence to move the field forward,” said Associate Professor Charles Hui, Chairperson of MHADRI network and Chief of Infectious Diseases at Children’s Hospital Eastern Ontario, Ottawa.

In addition to harnessing the synergies created through this initiative, IOM seeks to work with member states, partner organizations and research networks to replicate such mapping and collaboration in other regions.


References:

2019     The BMJ Migration health series
2018     Sweileh WM, Wickramage K, Pottie K, Hui C, Roberts B, Sawalha AF, and Zyoud SH 
             Bibliometric analysis of global migration health research in peer-reviewed literature (2000–2016). BMC Public Health, 2018, 18:777
2018     The UCL–Lancet Commission on Migration and Health: the health of a world on the move

World Migration Report 2020

The International Organization for Migration has just published its 2020 World Migration Report. Read and download it here!

Chapter 7 of the report (“Migration and Health: Key issues, governance and current knowledge gaps”) was written by MHADRI steering committee members Jo Vearey (Vice Chair), Charles Hui (Chair) and Kolitha Wickramage (Secretariat).

“The World Migration Report 2020 presents key data and information on migration as well as analysis of complex and emerging migration issues. Some of the topics covered in the report include human mobility and environmental change, migrants’ contributions in an era of disinformation, children and unsafe migration, migration and health, among others.”

The Director General of the IOM addresses the goals of the report (and indeed of the IOM as an agency) in his foreword:

“As the United Nations’ migration agency, IOM has an obligation to demystify the complexity and diversity of human mobility. The report also acknowledges IOM’s continuing emphasis on fundamental rights and its mission to support those migrants who are most in need. This is particularly relevant in the areas in which IOM works to provide humanitarian assistance to people who have been displaced, including by weather events, conflict and persecution, or to those who have become stranded during crises.”

“Likewise, IOM remains committed to supporting Member States as they draw upon various forms of data, research and analysis during policy formulation and review processes. Indeed, this is reflected in IOM’s Constitution where the need for migration research is highlighted as an integral part of the Organization’s functions. The World Migration Report is a central component of this important function.

In this era of heightened interest and activity towards migration and migrants, we hope this 2020 edition of the World Migration Report becomes a key reference point for you. We hope it helps you to navigate this high-profile and dynamic topic during periods of uncertainty, and that it prompts reflection during quieter moments. But most importantly, we hope that you learn something new from the report that can inform your own work, be it in studies, research and analysis, policymaking, communication, or migration practice.”

~~~

Seasonal migration and health in India: Constraints for research and practice

Divya Ravindranath and Divya Varma

Ideas for India for more evidence-based policy (Published March 2019)

Seasonal migrants in India engage in temporary informal work in work environments that actively flout labour laws on wages, work hours, and living conditions. The most significant impact of this is on the health outcomes of workers and their children. In this note, Varma and Ravindranath describe the roadblocks in conducting in-depth enquiries into migrants’ health status and healthcare-seeking behaviour, and designing and implementing health programmes conducive to their needs.

Read full article here

How Labour Conditions at Construction Sites are Leading to Higher Rates of Child Malnutrition

Divya Ravindranath, Sep 27 2019

This commentary focuses on female workers in construction sites in India, and the impact of mothers’ work on the health and nutrition of their children. The sector provides good opportunities for work, but it also affects children’s health outcomes.

“A study of 131 migrant children living at various construction sites in Ahmedabad showed that half of the children surveyed were underweight (low weight for age), 41% were stunted (low height for age) and 22% were wasted (low weight for height). According to the National Family Health Survey (2015-’16), 35.5% of children under the age of five in the country are underweight, 38.4% are stunted, 21% are wasted.”

The article highlights various reasons why children are in this condition. Mothers do not have time or comfortable environments to breastfeed exclusively, and can also have difficulty finding the time to wean at the proper age. Mothers don’t have access to affordable, healthy food, so older children eat a lot of packaged food. The water in construction sites is often contaminated and not potable. Utilizing health services means taking time off work, which results in a loss of wages.

The author argues that NGO’s can be one way to help alleviate the situation, but they can be difficult to access as well. Dr Ravindranath’s main recommendation is that “it is also critical to view the role of parental work environment and migration as factors contributing to undernutrition. Policies and interventions designed to address undernutrition must consider these as key factors without which such children would continue to be denied a chance of improved nutrition and better health.”

Read full commentary here

The Health of Nepali Migrants in India: A Qualitative Study of Lifestyles and Risks

(Featured image shows first two themes out of a total five from this research)

Authors: Pramod R. Regmi, Edwin van Teijlingen, Preeti Mahato, MSc; Nirmal Aryal, Navnita Jadhav, Padam Simkhada, Quazi Syed Zahiruddin, and Abhay Gaidhane

International Journal of Environmental Research and Public Health, https://doi.org/10.3390/ijerph16193655, (Published Sep 2019).

Current research on Nepali migrant workers in India neglects work, lifestyle, and health care access in favor of focusing on sexual health. This article aims to gain a broader sense of migrant workers’ health by conducting focus groups and interviews. The researchers analyzed their data and determined five different themes:

  1. Accommodation
  2. Lifestyle, networking, and risk-taking behaviours
  3. Work environment
  4. Support from local organisations
  5. Health service utilisation

This qualitative study demonstrates that health risks for Nepali migrant workers’ emerge because of a wide range of factors. The authors recommend a larger quantitative study to gain more insight.

Read the full article here.

Major depressive disorder prevalence and risk factors among Syrian asylum seekers in Greece

Danielle N. Poole, Bethany Hedt-Gauthier, Shirley Liao, Nathaniel A. Raymond, & Till Bärnighausen

BMC Public Health, https://doi.org/10.1186/s12889-018-5822-x, (Published July 2018).

This research provides necessary information on the mental health (specifically major depressive disorder or MDD) of refugees from Syria, as this information has not been collected or analyzed thoroughly as of yet. The researchers surveyed 135 Syrian refugees in a camp in Greece, specifically screening for MDD. The authors found that 44% of participants had symptoms of major depression. They found that women had an increased likelihood of MDD, and that time spent in the camp had a trend towards increased risk of depression.

“The development of depression during the asylum process is likely to undermine individual and societal functioning, which are essential for the survival and eventual resettlement of forced migrants. Depression is also likely to lead to adverse acculturation outcomes.”

To read the full article, click here.

‘And when a certain health issue happen, they try to cover it’: Stakeholder perspectives on the health of temporary foreign workers and their families

Bukola Salami, RN, PhD; Kathleen Hegadoren, RN, PhD; Anna Kirova, PhD; Salima Meherali, RN, MN, PhD; Christina Nsaliwa, PhD; & Yvonne Chiu, LLD

Social Work in Health Care, https://doi.org/10.1080/00981389.2017.1379458 (Published Sep 2017).

Like our other recent highlighted articles, this one again focuses on Alberta, Canada. This research was an exploratory study into the health and wellbeing of temporary foreign workers (TFWs) in the province.

They asked two primary research questions:

  • “What are the perspectives of stakeholders on the health and well-being of TFWs and their families in Alberta?”
  • “What do they see as potential threats to child and family health in this population?”

The authors found that stakeholders perceive TFWs as experiencing several different types of specific health challenges: mental health, family health, and occupational health. They also found that workers confront barriers in accessing mental health services as well as the fact that income and social status are social determinants of health.

If you wish to read the rest of the article, click here. Institutional access restrictions apply.

Transnationalism, parenting, and child disciplinary practices of African immigrants in Alberta, Canada

Dominic A. Alaazi, Bukola Salami, Sophie Yohani, Helen Vallianatos, Philomina Okeke-Ihejirika, Christina Nsaliwa

Child Abuse and Neglect, https://doi.org/10.1016/j.chiabu.2018.09.013 (Published December 2018)

This article focuses on the parental disciplinary practices of African migrants in Alberta, Canada. The authors themselves are members of the immigrant community and so were better able to research these practices in a supportive and reflexive manner.

“We found that African immigrant parents used corporal discipline, persuasive discipline, and a hybrid of the two, as well as emerging practices involving transnational fostering and emotional isolation of children who persistently misbehaved. These practices, in their totality, appeared to be influenced by the transnational experiences of parents and precepts that are traceable to Canada’s legal and educational systems.”

Child discipline is a controversial subject, and these authors nuance the topic of discipline in African immigrant households by examining how parents negotiate new environments and expectations by adjusting practices as needed.

Read the full article here. (Note that institutional restrictions on access apply).

[re-post] #DecolonizeGlobalHealth: Rewriting the narrative of global health

 

#DecolonizeGlobalHealth: Rewriting the narrative of global health

Re-posted from http://www.internationalhealthpolicies.org/

February 11, 2019

Published online: http://www.internationalhealthpolicies.org/decolonizeglobalhealth-rewriting-the-narrative-of-global-health/

A Filipino physician and 2014 Emerging Voice for Global Health, Renzo Guinto (@RenzoGuinto) is a Doctor of Public Health candidate at the Harvard T.H. Chan School of Public Health.

The history of the field of global health is always traced back to tropical medicine, an earlier discipline started by former Western empires. Generally, the focus of tropical medicine was the study of infectious diseases prevalent in colonies in the tropics. The purpose was to find measures to protect the colonizers from acquiring these diseases and bringing them back to their home countries. Today, while almost all colonies have already been emancipated and the study of such diseases has evolved into ‘international health’ and later ‘global health,’ tropical medicine remains embedded in some academic institutions in the Global North (ex. London School of Hygiene and Tropical Medicine, Institute of Tropical Medicine-Antwerp) and the term is still widely used in former colonies (ex. The University of the Philippines College of Public Health is a SEAMEO-‘TropMed’ Collaborating Center).

Nevertheless, while global health’s mission has already expanded from protecting colonizers from disease to improving health equity worldwide, it can be argued that there are still some signs of colonialism lingering in the field. Old colonial powers still very much control the restricted space of global health policy and decision-making – though the rise of China’s Silk and Belt Road and the backlash against globalization as shown by Brexit and Trumpism may also be initial signs of (global health) crumbling empires. Recent decades have seen the birth of neocolonizers – from non-state actors without legitimacy to emerging economies demanding a seat at the table – that rather than offer a new narrative, end up helping perpetuate the status quo. Meanwhile, dissidents and emerging voices from the Global South still largely assume token positions in global health discussions instead of playing meaningful roles in global health operations – though I would be remiss to ignore programs such as the Emerging Voices for Global Health from which I greatly benefited and that are attempting to, borrowing this blog’s tagline, switch the poles in international health policy.

The past months have seen a surge of interest in the idea to decolonize global health. Late last year, I started a hashtag #DecolonizeGlobalHealth on Twitter which generated some initial feedback and suggestions, especially from fellow young Global South voices. Some even reiterated that the growing movement towards advancing women leadership in global health is deeply intertwined with progress in global health decolonization. Last week, my fellow students at Harvard organized a conference on the decolonization of global health, whose slots were not just immediately filled but which was also widely anticipated in livestream worldwide. (I missed the conference because I’m currently based in the Philippines finishing my doctoral thesis. As part of my decolonization project, it was my intentional choice to focus on a community-based action project in my home country rather than write a global health policy paper for an international organization.) In the past weeks, I was approached by some colleagues asking what can be done to move this conversation from Twitter to the real world.

But what do we really mean by #DecolonizeGlobalHealth? In order to prevent this new concept to end up becoming a buzzword that will later fade away, it is vital that the global health community of scholars and practitioners unpack, examine, and reflect upon this idea. From my view, there are at least three areas of inquiry where researchers and policy-makers can ask questions, debate ideas, and find answers.

1) The analysis of global health. All global health action emanates from a certain understanding of the world. There are values, assumptions and premises on which decisions and relational arrangements are based, and frameworks for analysis define the boundaries and dictate who is included and who is not. Just a few years ago, developing countries were still generally seen as mere recipients of charity and generosity, bereft of good ideas and innovation, and possessing limited potential for leadership. Along the same lines, ‘capacity-building’ of poor countries was (is?) a ‘white man’s burden’ of the ‘developed world’. Today, arguably, new narratives are evolving, moving away from the traditional donor-recipient relationship towards country ownership and partnership – though some may feel that this is more rhetoric than practice.

Territorial colonialism may be long over, but the colonization of the mind, of culture, of domestic politics and of the economy continues and reparations are yet to be realized. Meanwhile, colonial powers did not just dominate over foreign lands – the Western mindset of progress and capitalist ‘development’ (copied pretty much everywhere in the world now) also exerted enormous pressures on the very Earth that sustains our health and wellbeing, leading to the climate crisis that puts our future health at great risk in return. The new frame of planetary health offers the best form of hope – but it will require a deep expression of humility from planetary colonizers of all forms – countries and corporations alike.

2) The institutions of global health. Who are the agents of modern-day colonialism in global health? This question requires scrutiny of a wide range of actors – from formal institutions such as the WHO and World Bank, to non-state players such as the Gates Foundation and the pharmaceutical industry, to influential personalities that control what Richard Horton once called (on Twitter) the ‘old boys’ club’ of global health – whether they are in Lancet Commissions, Twitter feeds, or conference organizing committees. One time, I saw an academic tweeting a photo of an all-white global health meeting – I thought ‘global’ was more colorful than that!

Promoting diversity and inclusion in boards and staff of global health organizations is a good first step. For instance, apart from UN agencies and philanthropic foundations, I have always wondered about the composition of global health departments in elite schools of public health. A quick count of faculty members in my alma mater, Harvard Chan School, shows that out of 35 primary faculty at the Department of Global Health and Population, only 13 have non-Western-sounding names and 14 are non-white or white Latin Americans. Only 1 professor worked in a developing country immediately prior to joining the faculty, which may indicate that almost everyone from the Global South stayed in the US or Europe either prior or shortly after graduate school. One piece of good news is that a Brazilian professor just got appointed as department chair, replacing a Sudanese who served for seven years.

But decolonizing global health actors is more than having additional Global South seats in still-colonial organizations. Colorful composition does not automatically mean transformed structures and changed values. To decolonize institutions, there is a need to retell the story, rewrite the rules, and even redesign the system.

3) The processes of global health. Finally, apart from critiquing the starting framework and the cast of characters, it is also important to investigate the processes that animate the global health space. The management of organizations, shaping of rules, making of decisions, generation of knowledge, and allocation of resources are just some examples.

Let me describe two processes that receive little attention. Part of the decolonization of processes is to level the playing field so that emerging scholars and practitioners from the Global South can have a chance. The first are the procedures and requirements governing journal publications. I once had my Global South-perspective commentary about a novel emerging issue rejected not because of it being not well-written but because of ‘oversubscription’ and ‘lack of space.’ Meanwhile, a colleague from the Global North who has clearly penetrated the ‘old boys’ club’ published six commentaries within a six-month period in that same journal – or at a rate of one article per month!

Another area that needs to be examined is the recruitment of global health professionals and how their work is recognized. To illustrate, a year-long stint done in a developing country by a colleague from a rich country will be counted as ‘global health experience.’ Meanwhile, coming from a developing country in the process of health reform, my decade-long contributions at home will be considered only ‘domestic work.’ This means there is a high chance that the development bank, which counts the number of countries an applicant has worked in, will hire the other and not me.

Some initial steps: write, mobilize, reflect

To start global health’s decolonization and rewrite its narrative, more Global South scholars and practitioners must begin writing and talking about global health – its analysis, institutions, and processes – as they see it. There is nothing to fear about sounding politically incorrect – after all, there is nothing politically correct about colonialism. But there is always room for a respectful conversation.

As an indication of the need for alternative global health stories, only seven of the global health books included in a list recently generated from a Twitter survey are written by a Global South author (plus Global Health Watch by the People’s Health Movement, and not counting Harvard-based Amartya Sen). Meanwhile, Paul Farmer – the white Harvard doctor who would cure the world – has six books out of 100 – five written by him, and one about him. (Don’t get me wrong – I admire him and his work.)

Another essential step is to ensure that the decolonization discourse does not only occur in Twitter-verse and global health reunions. Decolonization begins at home, and so movement-building at the country level is crucial. A Global South expert sitting comfortably at a desk in Geneva is not decolonization. #DecolonizeGlobalHealth must inspire a new generation of global health leaders to question the status quo and take bold action at home and elsewhere.

Finally, for us who were educated in schools of public health that are based in former colonizers or were agents of colonialism themselves, we need to be constantly reflexive about our position of privilege. We might not be noticing it, but in our pursuit to decolonize global health, we could very well end up becoming neocolonizers ourselves.