Background: The number of people living with type 2 diabetes (T2D) is increasing worldwide. The prevalence rate of this disease is generally higher in the migrant population compared to the general population. However significant inequalities in the prevalence of T2D are notable between and within migrant populations. Among them, migrants from sub-Saharan Africa, South America and South Asia are more affected than those of European origin. The act of eating and the corporality play an essential role in the development of this disease. Dietary and body norms systems favorable to the prevention and control of type 2 go against what is vital for most of these people, exposing them to conflicts of norms that are difficult to reconcile. 

Objectif: to identify factors that may influence the acceptance or rejection of dietary and body norm systems favorable to the prevention and control of T2D by Sub-Saharan Africa migrants living with T2D. 

Materials and methods: Scoping review according to the steps described by Arksey and O’Malley (2005) will be conducted. An electronic search of studies from 2011 to 2022, published English, Italian, French or in Portuguese will be conducted in eight databases (CINAHL, Cochrane library, Embase, Google Scholar, PsycInfo, PubMed, Scopus, and Web of Sciences). The grey literature including publication in Open Grey database and Website of non-governmental organizations working on migrant from Sub-Saharan Africa will be searched. All articles related to body norms, dietary behaviors, or determinants of body behaviors and dietary of migrants from Sub-Saharan Africa and those related to factors that influence acceptance or rejection of dietary and body norms systems favorable to the prevention and control of T2D among the migrants from Sub-Saharan Africa living with T2D or at risk to develop this disease will be included. This scoping review will be reported following the Standard Protocol Items: Recommendations for interventional Trials (SPIRIT) and Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. 

Results: The results will focus on factors influencing the acceptance or rejection of dietary and body norms systems favorable to the prevention and control of T2D among the migrants from Sub-Saharan Africa living with T2D or at risk to develop it.

The COVID-19 pandemic highlighted the impact of social inequalities in health (SIH). Various studies have shown significant inequalities in mortality and morbidity associated with COVID-19 and the influence of social determinants of health. The objective of this qualitative case study was to analyze the consideration of SIH in the design of two key COVID-19 prevention and control interventions in France: testing and contact tracing. Interviews were conducted with 36 key informants involved in the design of the intervention and/or the government response to the pandemic as well as relevant documents (n = 15) were reviewed. We applied data triangulation and a hybrid deductive and inductive analysis to analyze the data. Findings revealed the divergent understandings and perspectives about SIH, as well as the challenges associated with consideration for these at the beginning stages of the pandemic. Despite a shared concern for SIH between the participants, an epidemiological frame of reference dominated the design of the intervention. It resulted in a model in which consideration for SIH appeared as a complement, with a clinical goal of the intervention: breaking the chain of COVID-19 transmission. Although the COVID-19 health crisis highlighted the importance of SIH, it did not appear to be an opportunity to further their consideration in response efforts. This article provides original insights into consideration for SIH in the design of testing and contact-tracing interventions based upon a qualitative investigation.

In the fight against infectious diseases, social inequalities in health (SIH) are generally forgotten. Mali, already weakened by security and political unrest, has not been spared by the COVID-19 pandemic. Although the country was unprepared, the authorities were quick to implement public health measures, including a SARS-CoV-2 testing programme. This study aimed to understand if and how social inequalities in health were addressed in the design and planning for the national COVID-19 testing policy in Mali. A qualitative survey was conducted between March and April 2021 in Bamako, the capital of Mali. A total of 26 interviews were conducted with key government actors and national and international partners. A document review of national reports and policy documents complemented this data collection. The results demonstrated that the concept of SIH was unclear to the participants and was not a priority. The authorities focused on a symptom-based testing strategy that was publicly available. Participants also mentioned some efforts to reduce inequalities across geographical territories. The reflection and consideration of SIH within COVID-19 interventions was difficult given the governance approach to response efforts. The urgency of the situation, the perceptions of COVID-19 and the country’s pre-existing fragility were factors limiting this reflection. Over time, little action has been taken to adapt to the specific needs of certain groups in the Malian population. This study (re)highlights the need to consider SIH in the planning stages of a public health intervention, to adapt its implementation and to limit the negative impact on SIH.

ABSTRACT

The association of ideologically motivated violence with mental health disorders raises spe-cific challenges for security agencies and clinical services. The aim of this paper is todescribe the clientele of a specialized intervention program based in Montreal, Quebec, interms of type of violent ideology and clinical presentation. We conducted a retrospectivechart review of 156 individuals referred for violent extremism who received clinical servicesbetween 2016 and 2021. Univariate statistics were used to present a description of clientsociodemographic and clinical characteristics. Roughly a third of clients referred for violentextremism presented non-ideologically based violence (32.6%), followed by 31.4% affiliatedwith far-right extremist ideology and over a quarter (25.6%) holding extremist views on gen-der. Over a third of these individuals had a stress-related (35.7%) and/or mood and anxietydisorder (36.9%), followed by 28% with an autism spectrum disorder diagnosis. The majorityhad some previous contact with mental health services. A significant number of clients dis-playing extremist discourses and/or actions needed psychiatric services but often failed toreceive them because of the reluctance of clinicians to work with individuals perceived ashigh risk; in addition, individuals may be reluctant to engage in services perceived to bepart of a socio-political system they reject. Specialized services are important as a means toprovide mental health care to this group and also to develop knowledge and best practicesfor working with this clientele and provide consultation to mainstream mental health serviceproviders.

KEYWORDS

Violent extremism; clinicalservices; mental health care;specialized intervention

Introduction : Au Burkina Faso, le manque d’études sur les itinéraires thérapeutiques en santé mentale limite la compréhension des obstacles associés au recours aux soins. Comme dans plusieurs pays d’Afrique subsaharienne, cette situation se traduit par une difficulté des systèmes de santé à adapter l’offre de soins disponible à la réalité des personnes souffrant de troubles mentaux.
But de l’étude : Dans cette étude, des observations participantes ont été faites ; sept groupes de discussion et 25 entretiens individuels ont ainsi été organisés afin d’explorer les représentations sociales et l’utilisation des soins existants en santé mentale. Différents acteurs ont été interrogés : patients, soignants, accompagnants et informateurs clés.
Résultats : Une analyse thématique a révélé la présence de trois systèmes de soins dans la ville de Bobo-Dioulasso : 1) les soins psychiatriques associés à une fonction diagnostique et à la prise en charge de pathologies graves ou déclenchées par des causes « naturelles », 2) les soins traditionnels perçus comme ayant une fonction de guérison pour les pathologies « surnaturelles », mais associés à un risque d’escroquerie, et 3) les soins informels prodigués par la famille identifiés comme représentant le pilier des itinéraires thérapeutiques.
Conclusions : Cette étude révèle qu’à travers la diversité des ressources consultées, l’entourage direct représente le principal pourvoyeur de soins et que les contraintes financières constituent l’obstacle principal aux recours aux soins. Ce constat nous amène à formuler des recommandations relatives à l’élaboration d’éventuelles politiques publiques à l’échelle nationale ainsi qu’à l’organisation des services de santé dans la ville de Bobo-Dioulasso.

Introduction

UNICEF estimates that there are as many as 100 million street-involved youth (SIY) globally. Marginalized conditions put SIY at higher risk of HIV and adverse outcomes once HIV-positive. The objective of this analysis was to describe barriers and facilitators of accessing HIV prevention, testing, and treatment services as Phase I of an implementation study evaluating the use of peer navigators to increase access to HIV services.

Methods

Semi-structured interviews, focus group discussions (FGD), and theatre testing were conducted with individuals who identify as SIY, health care providers, and community stakeholders living in Canada (Toronto, Montreal, London) and Kenya (Eldoret, Huruma, Kitale). Data were analyzed using a directed content approach, guided by the socio-ecological model (SEM).

Results

Across the six sites were 195 participants: 64 SIY, 42 healthcare providers, and 97 community-based stakeholders. Barriers were identified at the societal (e.g. intersectional stigma and discrimination), public policy (e.g., inadequate access to basic needs, legal documentation, lack of health insurance, and limited community-based funding), institutional (e.g. lack of inclusive education and training, inadequate HIV educational outreach, and restrictive service provision), interpersonal (e.g., ineffective communication from healthcare providers), and intrapersonal levels (e.g. lack of trust and associated fear, low perception for healthcare, and lack of self-esteem). These contributed to limited HIV services utilization among SIY. Conversely, numerous facilitators were also identified at the public policy (e.g. affordable HIV services and treatment), institutional (e.g. available and accessible HIV prevention tools, HIV education and awareness programs, and holistic models of care), interpersonal level (e.g., systems navigation support, peer support, and personal relationships), and intrapersonal levels (e.g. self-efficacy) as positively supporting SIY access to HIV services.

Conclusion

Intersectional stigma was a critical barrier in all sites, and policies and programs that foster welcoming environments for youth from diverse backgrounds and living circumstances may be better able to respond to the HIV service needs of this high risk population. Social support and navigation services were reported to facilitate access to HIV services in all sites.

Background: Chronic malnutrition in children is a growth disorder resulting from a prolonged lack of nutrient intake. It is a widespread health issue in West and Central Africa where it affects one third (1/3) of children under five (05). This paper highlights the mitigation of child’s gender-based chronic malnutrition risk through maternal education.

Methods: This paper uses data from the 2010 Demographic and Health Survey in Burkina Faso. Univariate and bivariate descriptive analysis techniques, multilevel logistic regression and interaction analyses were used. Analyses were conducted separately for children aged 0-5 months, 6-23 months and 24-59 months.

Results: The results showed that boys are at greater risk of suffering from chronic malnutrition than girls, even after considering control factors. This gender-based effect was observed in children in the 6-23 month and 24–59-month age subgroups. Furthermore, the interaction analysis showed that this gender effect is more pronounced in and even specific to children of uneducated mothers because of the latter’s inappropriate hygiene and sanitation practices.

Conclusion: These results suggest that intensifying policies to encourage girls’ schooling and strengthening hygiene and sanitation measures among children would reduce or even eliminate gender-based inequalities in chronic malnutrition among children in Burkina Faso. 

Cette table ronde se penche sur le phénomène du transnationalisme, qui a fait l’objet d’un intérêt important depuis les années  1990 dans diverses disciplines des sciences sociales (Glick Schiller, Basch et Blanc-Szanton, 1992; Green, 2019; Portes, Guarnizo et Landolt, 1999;  Khagram et Levitt, 2008; Mohanty, 2003; Moosa-Mitha et Ross-Sheriff, 2010; Vertovec, 2009). Bien qu’il ne constitue plus une nouveauté, le champ des études transnationales est en évolution constante, ce qui nécessite que l’on continue à s’y intéresser et que l’on tente d’en saisir les contours fluides et changeants. De plus, il appert que les connaissances qui ont été produites en abondance depuis les années 1990 ont été moins mobilisées en travail social (Furman, Negi et Salvador, 2010), et ce, même si les travailleuses sociales partout sur la planète sont de plus en plus confrontées aux réalités de la globalisation et du transnationalisme au quotidien (Moosa-Mitha et Ross-Sheriff, 2010; Vatz Laaroussi et Bolzman, 2010). À noter que le Québec s’avère néanmoins plutôt bien représenté au sein des travaux sur les réseaux transnationaux mobilisés par les personnes immigrantes et réfugiées (Arsenault, 2010; Blain, Rodriguez del Barrio, Caron et al., 2019, 2022; Montgomery, Le Gall et Stoetzel, 2010; Rachédi, Le Gall et Leduc, 2010; Vatz Laaroussi et Bolzman, 2010) ainsi que les militants et militantes œuvrant au sein de réseaux de solidarité transnationaux (Kouri-Towe, 2015; Mahrouse, 2014). Toutefois, s’intéresser aux impacts de ces réalités sur le travail social serait incomplet sans une prise en compte des héritages coloniaux qui existent souvent dans l’ombre du transnationalisme, alors que la globalisation a réellement débuté à l’époque des empires européens à travers les voyages impériaux et l’occupation des territoires par les colons européens dans les Amériques, en Afrique et en Asie (Caron et Lee, 2019; Lee et Ferrer, 2014). Cette articulation critique des approches transnationales et décoloniales au sein des pratiques des panélistes qui la composent est d’ailleurs au cœur de la posture de plusieurs des autrices et auteurs de cette table ronde.

Objectives

High mortality rates, anxiety and distress associated with Ebola virus disease (EVD) are risk factors for mood disorders in affected communities. This study aims to document the prevalence and risk factors associated with depressive symptoms among a representative sample of individuals affected by EVD.

Design

Cross-sectional study.

Setting

The current study was conducted 7 months (March 11, 2019 to April 23, 2019) after the end of the ninth outbreak of EVD in the province of Equateur in the Democratic Republic of the Congo (DRC).

Participants

A large population-based sample of 1614 adults (50% women, Mage=34.05; SD=12.55) in health zones affected by the ninth outbreak in DRC.

Primary and secondary outcome measures

Participants completed questionnaires assessing EVD exposure level, stigmatisation related to EVD and depressive symptoms. The ORs associated with sociodemographic data, EVD exposure level and stigmatisation were analysed through logistic regressions.

Results

Overall, 62.03% (95% CI 59.66% to 64.40%) of individuals living in areas affected by EVD were categorised as having severe depressive symptoms. The multivariable logistic regression analyses showed that adults in the two higher score categories of exposure to EVD were at two times higher risk of developing severe depressive symptoms (respectively, OR 1.94 (95% CI 1.22 to 3.09); OR 2.34 (95% CI 1.26 to 4.34)). Individuals in the two higher categories of stigmatisation were two to four times more at risk (respectively, OR 2.42 (95% CI 1.53 to 3.83); OR 4.73 (95% CI 2.34 to 9.56)). Living in rural areas (OR 0.19 (95% CI 0.09 to 0.38)) and being unemployed (OR 0.68 (95% CI 0.50 to 0.93)) increased the likelihood of having severe depressive symptoms.

Conclusions

Results indicate that depressive symptoms in EVD affected populations is a major public health problem that must be addressed through culturally adapted mental health programs.

Background: Migrants commonly maintain transnational ties as they relocate and settle in a new country. There is a growing body of research examining transnationalism and health. We sought to identify how transnationalism has been defined and operationalized in migrant health research in high income countries and to document which populations and health and well-being outcomes have been studied in relation to this concept.

Methods: We conducted a scoping review using the methodology recommended by the Joanna Briggs Institute (JBI). We searched nine electronic databases; no time restrictions were applied. Studies published in English or French in peer-reviewed journals were considered. Studies were eligible if they included a measure of transnationalism (or one of its dimensions; social, cultural, economic, political and identity ties and/or healthcare use) and examined health or well-being.

Results: Forty-seven studies, mainly cross-sectional designs (81%), were included; almost half were conducted in the United States. The majority studied immigrants, broadly defined; 23% included refugees and/or asylum-seekers while 36% included undocumented migrants. Definitions of transnationalism varied according to the focus of the study and just over half provided explicit definitions. Most often, transnationalism was defined in terms of social connections to the home country. Studies and measures mainly focused on contacts and visits with family and remittance sending, and only about one third of studies examined and measured more than two dimensions of transnationalism. The operationalization of transnationalism was not consistent and reliability and validity data, and details on language translation, were limited. Almost half of the studies examined mental health outcomes, such as emotional well-being, or symptoms of depression. Other commonly studied outcomes included self-rated health, life satisfaction and perceived discrimination.

Conclusion: To enhance comparability in this field, researchers should provide a clear, explicit definition of transnationalism based on the scope of their study, and for its measurement, they should draw from validated items/questions and be consistent in its operationalization across studies. To enhance the quality of findings, more complex approaches for operationalizing transnationalism (e.g., latent variable modelling) and longitudinal designs should be used. Further research examining a range of transnationalism dimensions and health and well-being outcomes, and with a diversity of migrant populations, is also warranted.

Offering a transnational perspective on the processes of identity transmission and identity construction of mixed families in various parts of the world, this book provides an overview of how local, national, global contexts and inter-group relations structure the development of specific forms of belonging and identification.

Featuring nine rich ethnographic studies situated in geographic areas less covered by scholarship on mixed families such as Québec, Morocco, Italy, France, Switzerland, Belgium, the Philippines, Thailand and Israel, the book’s contributions reveal how families’ everyday lives are shaped by historical and sociopolitical contexts, as well as by transnational dynamics and mobility trajectories. The studies illustrate the context-specific realities that shape social definitions of mixedness—whether religious, national, cultural, ethnic or racial—at local and transnational levels.

The articulation of local and transnational perspectives on mixed families will be of interest to students and scholars of migration, transnationalism, families, ethnicity, race and racism in the social sciences (anthropology, sociology, history, social work, international relations and global studies). The book will also be of interest to policymakers, as well as activists and practitioners working in organizations offering services to mixed individuals, migrants, and their families.

Background

International and migrant students face specific challenges which may impact their mental health, well-being and academic outcomes, and these may be gendered experiences. The purpose of this scoping review was to map the literature on the challenges, coping responses and supportive interventions for international and migrant students in academic nursing programs in major host countries, with a gender lens.

Methods

We searched 10 databases to identify literature reporting on the challenges, coping responses and/or supportive interventions for international and migrant nursing students in college or university programs in Canada, the United-States, Australia, New Zealand or a European country. We included peer-reviewed research (any design), discussion papers and literature reviews. English, French and Spanish publications were considered and no time restrictions were applied. Drawing from existing frameworks, we critically assessed each paper and extracted information with a gender lens.

Results

One hundred fourteen publications were included. Overall the literature mostly focused on international students, and among migrants, migration history/status and length of time in country were not considered with regards to challenges, coping or interventions. Females and males, respectively, were included in 69 and 59% of studies with student participants, while those students who identify as other genders/sexual orientations were not named or identified in any of the research. Several papers suggest that foreign-born nursing students face challenges associated with different cultural roles, norms and expectations for men and women. Other challenges included perceived discrimination due to wearing a hijab and being a ‘foreign-born male nurse’, and in general nursing being viewed as a feminine, low-status profession. Only two strategies, accessing support from family and other student mothers, used by women to cope with challenges, were identified. Supportive interventions considering gender were limited; these included matching students with support services’ personnel by sex, involving male family members in admission and orientation processes, and using patient simulation as a method to prepare students for care-provision of patients of the opposite-sex.

Conclusion

Future work in nursing higher education, especially regarding supportive interventions, needs to address the intersections of gender, gender identity/sexual orientation and foreign-born status, and also consider the complexity of migrant students’ contexts.

Highlights
Poor Ebola virus disease (EVD) knowledge is associated to risky rumors, misconceptions, and inappropriate practices.

A large proportion of participants did not have sufficient knowledge on EVD transmission, prevention and treatment methods.

More than half of participants had misconceptions about EVD and were not aware of appropriate practices.

Results will facilitate the development of education programs that should equip them to prevent the spread of the EVD.

Background
Children exposed to violence are at risk of a range of adverse outcomes. Given the unique cultural and social context, understanding what fosters children’s resilience in resource-limited areas such as sub-Saharan Africa, is vital.
Objectives
Using data from the International Survey of Children’s Well-Being (ISCWeB), this paper explores individual-, family-, and school-level factors associated with positive outcomes for children who have experienced some form of violence in Khomas region, Namibia.
Method and participants
Using a cross-sectional survey design, the ISCWeB questionnaire, assessing cognitive, affective, and psychological dimensions of well-being, child protection factors and violence exposure was administered to 2124 Grade four and six children.
Results
Our sample had a mean age of 11.2 years. Overall, 56.8 % of children reported at least one incident of violence from an adult caregiver at home and 86.0 % of children reported some form of peer violence at school. Materially deprived children experienced higher incidence of both family and peer violence. The quality of children’s relationships at home (β = 0.17, p < 0.001), and school (β = 0.07, p < 0.001) emerged as important protective factors for children’s well-being for both types of violence, suggesting that supportive family and school relationships may be more important to the subjective well-being of children who experienced violence than material wellbeing, violence severity, and individual child factors.
Conclusions
Providing positive social interaction and emotional security in contextually and culturally appropriate ways within children’s proximal systems should be prioritized while challenging norms that support violence in Namibian families and schools.
Keywords: Children; Family violence; Bullying; Subjective well-being; Namibia

The perception of epidemic risk has been associated with the production of narratives in which figures such as villains and heroes emerge. This article critically analyzes social media users’ construction of heroic figures during the 2013–2016 Ebola epidemic. We used international Twitter and Facebook comments as our raw material, collected by key word extraction. A thematic analysis resulted in a descriptive typology of three heroic figures: the martyr, the warrior, and the saviour. Our analysis showed that heroic status (highly associated with willingness to take high risks on behalf of others) was mostly conferred on common individuals and ‘insiders’ living in the Ebola-afflicted communities – often deemed ‘unsung’ – rather than the foreigners frequently heroised in previous crises. We deconstruct this heroisation dynamic, showing that it is a socially strategic move because it is embedded in a potential instrumentalization of heroes. First, this production of ‘everyday heroes’ may encourage the involvement of lay people in the epidemic response, by conveying that anyone can become a health hero. Second, we show that this heroisation process maintains the status quo by encouraging adherence to biomedical discourses, and by individualising the narrative and neglecting the structural changes needed to address the epidemic. Finally, we caution against discourses that seem socially ‘progressive’ but may be used as a smokescreen to hide discriminatory dynamics, and we recommend changes in communication strategies.

Ce projet a été réalisé auprès de 2124 élèves de la région de Khomas, en Namibie, et révèle ce que les enfants pensent de leur maison, de leur école, de leur quartier, de leurs amis et de leur famille. Cette initiative fait partie d’un plus vaste projet qui couvre plus de 40 pays et inclut plus de 126 000 enfants.

There has been much talk about decolonizing global health lately. The movement, which has arisen in various communities around the world, suggests an interesting critique of the Western dominant model of representations. Building upon the ‘decolonial thinking’ movement from the perspective of Francophone African philosophers, we comment on its potential for inspiring the field of global healthinterventions. Using existing literature and personal reflections, we reflect on two widely known illustrations of global health interventions implemented in sub-Saharan Africa – distribution of contraceptives and dissemination of Ebola virus prevention and treatment devices – featuring different temporal backdrops. We show how these solutions have most often targeted the superficial dimensions of global health problems, sidestepping the structures and mental models that shape the actions and reactions of African populations. Lastly, we question the ways through which the decolonial approach might indeed offer a credible positioning for rethinking global health interventions.

In January 2010, Haiti was hit by a terrible earthquake that pushed thousands of people to migrate. Many of them chose to settle in Quebec, Canada. Years after the earthquake, many Haitians continue to migrate to the Quebec province. Several studies however have shown that this population’s socioeconomic status is lower than the provincial average. Given the potential multiple stressors that affect Haitian migrants in Quebec, there are concerns about their health status.

Located at the intersection of international migration studies and global health, this paper offers an in-depth qualitative investigation of Haitian migrants’ representations of both their situation and self-perceived health in Montreal, Quebec. Our perspective on migrant health was inspired by the World Health Organisation’s framework on the social determinants of health and recent studies in the field of migrant health. We collected and analysed qualitative data from 23 key informants (i.e., 12 women and 11 men, aged 21-76 years old) from diverse socioeconomic backgrounds. The analysis of the data from these people’s narratives revealed the importance of structural determinants such as social position, and intermediate determinants such as living and working conditions. Our analysis also highlighted several interrelations between those determinants. Specifically, participants reported coping with issues related to migrant status, income, occupation, language, and racism, and challenging living and working conditions, and stress. This study underscored the importance of social support brought by relatives, friends, as well as community-based organisations and religious practices.

Our findings were coherent with available literature looking at the determinants of health of racialized and migrant minorities in other high-income regions of the world. Our conclusive remarks featured reflections on three cross-cutting issues and their practical implications for policy and practices.

Objectives: We describe the knowledge translation strategies in two projects and share lessons learned about knowledge sharing and uptake.

Methods: To generate findings for dissemination: (1) the Republic of Côte d’Ivoire (RCI) project relied on a multiple case study design to document barriers and facilitators to implementing a community-led prevention strategy targeting Ebola virus disease; and (2) the Tunisia project used several designs to assess a mental health training’s effectiveness, and a case study design to explore contextual factors that may influence anticipated outcomes.

Results: To share findings with participants, the RCI project relied on workshops and a pamphlet, and the Tunisia project relied on a structured half-day dissemination workshop and research summary. Facilitators that may have encouraged sharing and using findings include involving champions in dissemination activities, ongoing collaboration, and developing/implementing context-specific knowledge sharing strategies. Barriers include omitting to assess strategies, limited consideration of a wider audience, and the exclusion of a knowledge translation training component.

Conclusions: Our experiences might be useful to contexts involved in global and public health research that wish to address the « know-do gap. »

Background
Migrant families’ transnational ties (i.e., connections to their countries of origin) may contribute to their hardships and/or may be a source of resiliency. A care approach that addresses these transnational ties may foster a positive identity and give coherence to experiences. We conducted an integrative review to determine what is known about transnational ties and the care of migrant families during pregnancy, postpartum and early childhood.

Methods
We searched 15 databases to identify literature reporting on a health or social program, service, or care experience of migrant families during pregnancy up to age five in a Western country (i.e., Canada, US, Australia, New Zealand or a European country). Information regarding if and how the service/program/care considered transnational ties, and care-providers’ perceptions of transnational ties, was extracted, analyzed and synthesized according to transnational ‘ways of belonging’ and ‘ways of being’.

Results
Over 34,000 records were screened; 69 articles were included. Care, programs and services examined included prenatal interventions (a mhealth app, courses, videos, and specialized antenatal care), doula support, maternity care, support groups, primary healthcare and psycho-social early intervention and early childhood programs. The results show that transnational ties in terms of ‘ways of belonging’ (cultural, religious and linguistic identity) are acknowledged and addressed in care, although important gaps remain. Regarding ‘ways of being’, including emotional, social, and economic ties with children and other family members, receipt of advice and support from family, and use of health services abroad, there is very little evidence that these are acknowledged and addressed by care-providers. Perceptions of ‘ways of belonging’ appear to be mixed, with some care-providers being open to and willing to adapt care to accommodate religious, cultural and linguistic differences, while others are not. How care-providers perceive the social, emotional and economic ties and/or the use of services back home, remains relatively unknown.

Conclusion
Significant knowledge gaps remain regarding care-providers’ perceptions of transnational ‘ways of being’ and whether and how they take them into account, which may affect their relationships with migrant families and/or the effectiveness of their interventions. Continued efforts are needed to ensure care is culturally safe for migrants.

While there is increasing attention to the perspectives of people caught up in human trafficking – attention that has helped illuminate the cloudy nature of consent and agency in situations of human trafficking – the perspectives of children are relatively absent from the debate. Western notions of childhood downplay children’s agency and decision-making. In this chapter, the results of a study that explored the perspectives of over 50 West African children “rescued” by Nigeria’s NAPTIP, a governmental agency mandated to fight human trafficking and protect its victims, are shared. One theme that emerged strongly from the children’s narratives was the centrality of their quest for education, training, and other life opportunities as a factor that led them into situations of human trafficking, a situation likely to exist in other contexts as well. The children’s desire for education was often part of what led them away from home, kept them in their situations of trafficking, and made many of them unwilling to return home after being “rescued” by NAPTIP. These findings suggest a critical need to provide for children’s educational needs if we hope to combat child trafficking, as well as the need to provide meaningful alternatives to children we purport to “rescue.”

Objectives
The Ebola virus disease (EVD) is associated with major mental health consequences (e.g., depression, anxiety, PTSD). Studies have shown a need for relevant and effective programs to address mental health consequences associated to EVD. This systematic review aimed to describe programs implemented following EVD outbreaks and to evaluate their effectiveness and relevance in order to provide evidence-based data to improve mental health services.

Methods
We first searched EMBASE, PubMed, PsycINFO, PILOTS, Cochrane Library and MEDLINE for a systematic review on EVD and on MHPSS programs. Then, we searched the grey literature. The search generated 2827 publications. Eleven studies were retained according to the PRISMA statement.

Results
This systematic review revealed that most programs were implemented by international organizations in collaboration with local partners. Many of them were implemented following WHO mhGAP and Psychological First Aid guidelines. Programs were implemented in hospitals, Ebola treatment centres, communities among different categories of individuals exposed to EVD (survivors, health workers and volunteers, other frontline workers, children, adults, etc.). Only two of the identified programs which integrated cultural factors were empirically evaluated. Results from the evaluations showed mental health improvement for both children and adults.

Conclusions
This study provides the first systematic review on MHPSS programs among communities affected by EVD. This study shows the need to increase efforts to systematically document and evaluate the implemented programs. Results also provide preliminary evidence about the value of culturally sensitive MHPSS programs and of the implication of local mental health professionals.

Objective
We aimed to quantify the extent to which country-level trends in HIV incidence in Sub-Saharan Africa (SSA) were influenced by gender inequalities, measured by gender gaps in educational attainment, income, and a Gender Inequality Index (GII).

Study design
We examined the relation between gender inequality and HIV incidence using country-level panel data from 24 SSA countries for the period between 2000 and 2016.

Methods
Our goal was to estimate the relation between within-country changes in gender inequality and HIV incidence. We compared results from fixed effects and random effects models for estimating the effect of gender inequalities on changes in HIV incidence. Based on the results of the Hausman test, the fixed effects model was selected as the preferred approach.

Results
HIV incidence decreased by nearly one-half over the period from 2000 to 2016. We estimated that a one percent increase in the GII was associated with a 1.6 percent increase in HIV incidence (95% confidence interval = [0.21%; 3.00%]), after adjusting by country-level socio-economic and governance variables.

Conclusions
Our study suggests that addressing gender inequalities is a potential strategy to reduce HIV incidence in the SSA region. To control HIV infection, policymakers and public health practitioners should support relevant interventions for promoting gender equality. Further work is needed to identify specific interventions to improve gender inequality and to examine their impacts on changes in HIV incidence.

Evidence about psychological experiences surrounding female genital mutilation/cutting (FGM/C) remains weak and inconclusive. This article is the first of a series that deploys qualitative methods to ascertain the psychological experiences associated with FGM/C through the lifecycle of women. Using the free listing method, 103 girls and women, aged 12 to 68 years from rural and urban Izzi communities in Southeastern Nigeria, produced narratives to articulate their perceptions of FGM/C. Sixty-one of them had undergone FGM/C while 42 had not. Data was analysed using thematic analysis and the emerging themes were related to experiences and disabilities in the psychological, physical, and social health domains. While physical experiences were mostly negative, psychological experiences emerged as both positive and negative. Positive experiences such as happiness, hopefulness, and improved self-esteem were commonly described in response to a rise in social status following FGM/C and relief from the stigma of not having undergone FGM/C. Less commonly reported were negative psychological experiences, e.g., shame when not cut, anxiety in anticipation of the procedure, and regret, sadness, and anger when complications arose from FGM/C. Some participants listed disruption of daily activities, chronic pain, and sleep and sexual difficulties occurring in the aftermath of FGM/C. Most participants did not list FGM/C as having a significant effect on their daily living activities. In light of the association of FGM/C with both positive and negative psychological experiences in the Izzi community, more in-depth study is required to enable policy makers and those campaigning for its complete eradication to rethink strategies and improve interventions.

• Opening up dialogue with children and youth can add to research and support participation.
• Young people’s advisory groups contribute a valuable ethical dimension to research practice.
• Institutional ethics requirements can create challenges for ethical practice with children and youth.
• Young people and adults may have differing expectations of the role and process of advisory groups.
• Virtual communications can facilitate dialogue, but have limitations in the Global South.

This study aimed to analyze main groups accused on social media of causing or spreading the 2014–2016 Ebola epidemic in West Africa. In this analysis, blame is construed as a vehicle of meaning through which the lay public makes sense of an epidemic, and through which certain classes of people become “figures of blame”. Data was collected from Twitter and Facebook using key word extraction, then categorized thematically. Our findings indicate an overall proximate blame tendency: blame was typically cast on “near-by” figures, namely national governments, and less so on “distant” figures, such as generalized figures of otherness (“Africans”, global health authorities, global elites). Our results also suggest an evolution of online blame. In the early stage of the epidemic, blame directed at the affected populations was more prominent. However, during the peak of the outbreak, the increasingly perceived threat of inter-continental spread was accompanied by a progressively proximal blame tendency, directed at figures with whom the social media users had pre-existing biopolitical frustrations. Our study proposes that pro-active and on-going analysis of blame circulating in social media can usefully help to guide communications strategies, making them more responsive to public perceptions.

Objectives :Violence committed by extremists has serious violent and non-violent public health consequences. Researchers have hypothesized an association between experiencing discrimination and support for radicalization. This study examines the relationship between perceived discrimination and support for violent extremism among youth and young adults in Belgium.

Methods:  A total of 2037 young adults between the ages of 16 and 30 participated in the study. We used multivariate linear regression to determine the association between sociodemographic characteristics, experiences of perceived discrimination, and scores on the Radical Intention Scale (RIS).

Results:  Sex, religion, generation status, and language were associated with experiencing discrimination. Sex and language were associated with scores on the RIS. Discrimination based on language and political views was independently associated with scores on the RIS. Discrimination experienced during interactions with the police/justice system was also associated with RIS scores.

Conclusions : Public health primary prevention programs and policies that target the relationship between discrimination and sympathy for violent radicalization need to be situated on micro- to macro-levels. Of primary importance is the development of partnerships between stakeholders in public health, legal, political, and educational sectors to develop strategies to diminish discrimination and promote positive civic engagement among youth.

Introduction Every year, up to 1 billion children are victims of violence worldwide. Most child abuse takes place in the context of punishment. The Families First Programme, an adaptation of the Positive Discipline in Everyday Parenting Programme to the West Java context, is a parenting support programme anchored on children’s rights that gives parents guidance on child development, parenting and positive discipline practices. This trial will evaluate the effectiveness of the Families First Programme compared with a waitlist control group.

Methods and analysis This is a pragmatic, parallel-group, stratified, cluster-randomised controlled trial. Twenty rural and urban villages in the Cianjur District, Indonesia, involving 720 caregivers of children up to 7 years of age, will be randomised. Villages will receive either a parenting programme consisting of 10 group sessions and four home visits over 3 months and standard community health and social services or just the latter. After completion of the trial period, the programme will be offered to those in the delayed group. Outcome data will be collected before randomisation (baseline), immediately postintervention (3 months postrandomisation) and 6 months later (9 months postrandomisation). The primary outcome will be frequency of physical and emotional punishment as measured by a weighted sum from three self-report items. Primary outcome analysis will use Poisson regression with generalised estimating equations and assess the interaction between intervention and time over baseline and 3 and 9 months postrandomisation assessments. Concurrent process evaluation will be conducted to assess programme satisfaction and facilitators and barriers to the implementation of the programme generalisable to other settings.

Ethics and dissemination Ethics approval was obtained from McGill University and Universitas Katolik Indonesia Atma Jaya. Results will be published in peer-reviewed journals and presented at scientific conferences and events for decision-makers, including in the participating communities.

Objectif
Évaluer les stratégies d’interventions dans la lutte contre le choléra à Uvira dans la perspective de les
renforcer
Matériel et méthodes.
L’étude a été évaluative recourant à des entrevues avec des acteurs impliqués dans la lutte contre le choléra et à la revue documentaire. Elle concerne la période de 2013 à 2016. Les données quantitatives relatives aux nombres de nouveaux cas et des décès ont été analysées à l’aide d’Excel. L’analyse des données qualitatives a été faite par thème en fonction des questions de recherche et au regard de la stratégie nationale de lutte contre le choléra en RDC.

Résultats
La corrélation entre les stratégies de lutte contre le choléra mises en place par les acteurs et les stratégies nationales de lutte contre le choléra reste relativement très faible dans la zone de santé. Des inadéquations entre ces deux groupes de stratégies sont ainsi relevées au cours de l’étude. Les effets positifs des différentes interventions mises en œuvre se traduisent par la diminution du nombre des nouveaux cas de choléra de 28% entre 2014 (1839 cas) et 2015 (1316 cas) et une certaine stagnation depuis 2016 autour de 1392 cas par an. L’efficacité des interventions est perçue efficace par seulement par 25% des membres de la  communauté contre 62% des agents des organisations; les effets des interventions sont estimés durables par 38% des membres de la communauté contre 68 % des agents des organisations et 34% des membres de la communauté (68% des agents des organisations) pensent que la participation communautaire est sollicitée lors des interventions de lutte contre le choléra. Par contre, la grande majorité des membres de la communauté (87%) et des agents des organisations (99%) jugent pertinentes les interventions de lutte contre le choléra au cours de l’étude. La faible implication de la communauté dans les actions de lutte contre le choléra et le caractère urgentiste des interventions sont fortement fustigés.

Conclusion
L’élimination du choléra en tant que problème de santé publique fait face à plusieurs défis dont le plus important semble être l’accès durable à plus de ressources par tous les acteurs, principalement l’État. L’implication plus visible des autorités politico-administratives est souhaitée.

Climate change is one of today’s major challenges, among the causes of population movements and international migration. Climate migrants impact health systems and how they respond and adapt to their needs and patterns. But to date, the resilience of health systems in the context of climate change has been little explored.

The purpose of this article is to show the importance of studying, from an interdisciplinary perspective, the relationships between climate change, migration, and the resilience of health systems.
Resilience is an old concept, notably in the field of psychology, and is increasingly applied to the study of health systems. Yet, no research has analysed the resilience of health systems in the context of climate change.

While universal health coverage is a major international goal, little research has to date focused on the existing links between climate, migration, health systems and resilience.

We propose an interdisciplinary approach relying on the concept of health system resilience to study adaptive and transformative strategies to articulate climate change, migration and health systems

We examine patient–provider interactions for Indigenous childbirth evacuees. Our analysis draws on in-depth interviews with 25 Inuit and First Nations women with medically high-risk pregnancies who were transferred or medevacked from northern Quebec to receive maternity care at a tertiary hospital in a southern city in the province. We supplemented the patient data with interviews from eight health care providers. Three themes related to patient–provider interactions are discussed: evacuation-related stress, hospital bureaucracy, and stereotypes. Findings show that the quality of the patient–provider interaction is contingent on individual health care providers’ ability to connect with Indigenous patients and overcome cultural and institutional barriers to communication and trust-building. The findings point to the need for further training of medical professionals in the delivery of culturally safe care and addressing bureaucratic constraints in the health care system to improve patient–provider communication and overall relationship quality.

Despite the importance of adequate supervision to child wellbeing, the academic conversation around this topic is scattered across disciplines and for this reason is difficult to follow. Researchers and decision-makers would benefit from a preliminary overview of conceptualizations, cultural variations, and facilitators and barriers to providing supervision to children in low- and middle-income countries (LMICs). A scoping review was conducted. Two searches of the literature were run within Embase, Medline, PsycInfo, Social SciencesFull Text, ERIC, SocIndex with Full Text, and Academic Search Complete. Additional papers were identified through a call to experts. Out of 2049 publications initially identified, 44 studies met our inclusion criteria, thus reflecting the scarcity of scientific evidence in LMICs. Child supervision was addressed in the literature in terms of links to psychological, health, social and academic outcomes, suggesting a multidisciplinary interest in the topic. However, a vague conceptualization of child supervision emerged across studies. Of importance, cultural and socio-economic influences interacted to shape caregivers’ vision of the family, the child, and the decision-making process regarding supervision practices. Barriers and/or facilitators to adequate child supervision were addressed only in 18 studies. There was substantial variation in how cultural influences on child supervision were taken into account across studies. Our review aims to inform and guide future research and action on child supervision practices in LMICs and calls for a more coherent and comprehensive body of literature on this matter. Programming and policy efforts should take socio-economic and cultural influences into account, as well as be tailored according to the specificities of each child, caregiver(s), and setting.

Recent changes in U.S. immigration policies and enforcement have precipitated a 300% rise in arrests and planned deportations. Although some family members face deportation, other family members may have state-sanctioned status. Such mixed status puts hundreds of thousands of families at risk of forced separation and associated mental health problems. Building on cross-cultural work with refugee families and other groups and on work with families separated by parental incarceration, the authors provide recommendations to guide clinicians working with families who are separated or who fear separation. Mental health problems among separated families can in part be addressed through identifying the origins of distress, elucidating family structures and roles, strengthening communication practices, linking with legal and economic resources, and facilitating decision making through distress reduction.

The mental health needs of children and adolescents living with HIV (ALHIV) in Namibia are poorly understood, despite the dramatic improvement in their survival. ALHIV in resource poor contexts face particular risk factors, such as poverty, orphanhood, and poor social support. This study examines the mental health of ALHIV in Namibia, and the factors that contribute to mental health problems. A case-control design assessed emotional and behavioural symptoms of distress, risk and protective factors among adolescents aged 12-18 years. Case participants were 99 HIV-positive adolescents. Case controls were 159 adolescents from the same community who were not known to be HIV seropositive at the time of the study. Control group participants were selected from schools using a stratified random sampling. A larger proportion of HIV-positive adolescents were orphaned (62.6% vs. 20.8%, p < .001); the groups showed no differences in poverty factors. HIV-positive adolescents scored lower than the control group on total perceived social support (p < .05) and caregiver support (p < .05), but no differences in perceived friend support and support from a self-selected person were present. HIV-positive adolescents reported significantly more total emotional and behavioural difficulties (p = .027) and conduct problems (p = .025), even after controlling for socio-demographic factors. However, after controlling for the effects of orphanhood, group differences in mental health outcomes were no longer significant. Furthermore, mediation analysis suggested that social support completely mediated the relationship between HIV status and mental health (standardised pathway coefficients = .05, p = .021). Policies and programmes that aim to strengthen social support and take orphanhood status into consideration may improve the mental health of adolescents living with HIV.

This Working Paper examines the concept of the vulnerability of migrants which has become a key term in the UN’s negotiations for a Global Compact on Safe, Orderly and Regular Migration. The authors argue that the concept must be interpreted inclusively and related to the human rights obligations of states through the UN conventions. All too often migrants are vulnerable because of state action. States must ensure that they deliver on their human rights obligations in ways which reduce the vulnerability of migrants.

Morocco has become a permanent transit country for tens of thousands of sub-Saharan migrants heading to Europe. Many of these migrants are women who have a precarious legal status and can no longer reach Europe, whose borders have been considerably securitized since September 11, 2001. They also have no wish to risk their lives again returning south across the Sahara Desert. This paper discusses the results of an exploratory research project conducted in Morocco on the relationships between the sub-Saharan migrant women’s traumatic experiences, social invisibility, and emotional distress in the context of a massive securitization of Euro-Mediterranean borders.

For women living with HIV infection in India, stigma is a pervasive reality and the greatest barrier to accessing treatment, quality of life and survival. Defining stigma according to Goffman as a socially conceived abnormality, this paper then draws on Engel’s biopsychosocial model for chronic disease to show the pervasive nature of stigma as a continuum affecting all dimensions of life for married, monogamous Indian women with positive HIV sero-status.
Two distinct perspectives were identified in the literature: 1) Public: social and relational stigma, or 2) Private: internalised psychological stigma. Only four of the twenty published works reviewed noted interrelationships between these public and private spheres. Only one of those employed an ethnographic
methodology to understand stigma from the perspective of the women themselves.
While concepts associated with stigma among women living with HIV are diversely employed in research, by considering them as a whole through an intersectional biopsychosocial lens, this paper attempts to provide a basis for implementing integrated and tailored responses. Once the manifestations and interconnected causes of particular groups of HIV-positive women’s marginalisation are identified from their perspective, corresponding HIV-care programs and research activities can be designed. Such programs can be tailored with dual objectives: 1) to respond in a coordinated manner to the particular women’s own identified and prioritised daily needs across biomedical treatment and social and psychological support, and 2) to work to promote change in social constructions of stigma that form barriers to care.