Community In Lebanon Research Articles

Influence of Psycho-social Support on Stakeholder Engagement in Lebanon’s School Community

Psycho-social Support (PSS) is a practical approach to improve people's well-being affected by humanitarian crises. However, empirical research on how it can improve engagement within academic settings is still limited. To address this gap, the current study investigates the impact of the PSS Program in improving the stakeholders' engagement within the school community in Lebanon by implementing counseling and supportive activities or services. The study selected a mixed research design and a cross-sectional survey to answer the research questions and to test the hypotheses. In April 2021, a sample of 446 respondents was selected from among the school stakeholders in Lebanon using the convenience and purposive sampling techniques. Data collected was coded, cleaned, and entered into Statistical Package for Social Sciences (SPSS) for analysis. The study confirmed that PSS significantly influences stakeholder engagement that lead into stakeholder belongingness, and quality and equity of education. Based on the outcomes, the researcher recommended adopting the PSS program to better the quality of education and assist administrations with more details that improve stakeholder engagement in their schools. The study also shows best practices in the utilization of the PSS to inspire stakeholder engagement during emergencies. Findings are necessary to the ministry of education, school administrators, students, parents, and researchers interested in using PSS in school settings.

A grass-roots science movement to rebuild Lebanon

Najat Saliba is pairing researchers around the world with local communities in Lebanon. Najat Saliba is pairing researchers around the world with local communities in Lebanon.

Design and Implementation of the Amenah Early Marriage Pilot Intervention Among Syrian Refugees in Lebanon.

Implementing and evaluating interventions in humanitarian settings in low- and middle-income countries presents unique challenges that are little addressed in the implementation literature. We document the process of developing, implementing, and evaluating the Amenah pilot intervention that aimed to mitigate the drivers of early marriage in a Syrian refugee community in Lebanon. Adolescent girls' vulnerability to early marriage increases following displacement due to poverty, insecurity, and school disruptions. We delineate how, as a local research team, we triangulated evidence from the international literature and formative community research to make informed decisions during the intervention's design and implementation phases. The pilot was delivered to 203 Syrian refugee schoolgirls aged 11-14 years during the 2017-2018 academic year. It consisted of 16 structured, interactive sessions with girls and a set of facilitated meetings with the girls' mothers, both of which were implemented by trained female community workers from the Syrian refugee community. Process evaluation results showed that sociodemographic factors predicted attendance among mothers, but relationships with peers in the intervention were the only significant predictor of attendance among girls. The primary outcomes of the pilot were attitudinal measures related to education and marriage. Attitudes toward education were highly positive at baseline and did not change over the course of the intervention. There were no significant changes in girls' ideal age at marriage. Among girls aged 13 and older at endline, the mean self-reported expected age at marriage increased slightly from 20.2 to 20.8 years (P<.05). Our results also suggest that girls may adjust their expected age at marriage downward as they become older and if they drop out of school. We reflect in the discussion on some of the challenges encountered and lessons learned for the benefit of researchers intending to conduct community-based interventions in displacement settings.

Does a school snack make a difference? An evaluation of the World Food Programme emergency school feeding programme in Lebanon among Lebanese and Syrian refugee children.

To investigate the effects of providing a daily healthy school snack on children's nutritional, social and educational outcomes and explore stakeholders' perceptions of an emergency school feeding programme (SFP). Convergence triangulation mixed-methods study design. Associations were examined between receiving the school feeding intervention and children's outcomes using multivariable regression models. Quantitative data were complemented with interviews and focus group discussions with parents and staff. In vulnerable communities in Lebanon, the World Food Programme has implemented an emergency SFP targeting Lebanese (attending morning sessions) and Syrian refugee children (attending afternoon sessions) in public schools. Children from ten intervention schools (morning n 403; afternoon n 379) and ten matched control schools (morning n 399; afternoon n 401), as well as twenty-nine parents and twenty-two school staff members. Diet diversity was higher in intervention schools as compared with control with a significantly higher consumption of dairy products, nuts and fruit in both sessions. Child-reported food insecurity experience was lower in children attending the afternoon session of intervention v. control schools. The SFP intervention was associated with higher school engagement and sense of school community in the morning session only. While the SFP was significantly associated with higher attendance for children in afternoon sessions only, it was significantly associated with school retention of children in both sessions. A daily healthy snack potentially acts as an incentive to improve children's nutritional outcomes, school engagement, sense of belonging, equality between students and improvement in children's attendance and retention in public schools.

A House of Many Mansions: Perceptions of Lebanese Political and Intellectual Elites toward Iran

ABSTRACT Lebanon is believed to be the most religiously diverse country in the Middle East. Lebanese elites play a significant role as identity-makers and parts of regional alliances. The present paper examines Lebanese intellectual and political elites’ perceptions of Iran. To this aim, the author conducted fifteen semi-structured interviews with figures from Lebanese political parties with different political orientations and religious denominations. Using integrated threat theory to analyse the data, the author argues that the Lebanese elite’s view towards Iran illustrates various threat perceptions among members of different religious denominations in conjunction with their political affiliations. It will be discussed that Iran and Hezbollah have turned into an in-group for a particular, albeit a significant portion of the Shia community in Lebanon (mostly affiliated with Hezbollah) and an out-group for many in other religious and political denominations. Accordingly, Iran’s growing regional power is perceived as a realistic and symbolic threat by those who consider Iran (a Shi’ite entity and Hezbollah) the out-group.

Recognition of Hearing Impairment Disability: First Comprehensive Study on the Deaf in Lebanon

People with disabling hearing disabilities face multiple levels of daily-life challenges where access to services and information remain difficult. In Lebanon, no data is available about the hard-of-hearing individuals. The aim of the study is to reflect the current situation of the Deaf community in Lebanon, to compare it with that of the general Lebanese population and propose practical ways to improve their national status and quality of care. A snowball sampling method was used to recruit hard-of-hearing individuals over the age of eighteen, via institutions and schools for the Deaf. Participants were asked to anonymously fill a qualitative questionnaire, individually or in groups in the presence of interpreters. The analysis was descriptive, and 95% binomial exact confidence intervals were constructed to compare parameters with those of the general population. Deaf adults in Lebanon have poorer socioeconomic conditions, lower literacy levels and limited access to information. However, they appear to be physically healthier than the general population while presenting frequent mental health problems and facing discrimination and poorer access to services. There still is no valid data available about the Deaf community in Lebanon. Hard-of-hearing people remain underserved by the current Lebanese healthcare, education, employment and public systems.

Sudanese Refugees and the “Syrian Refugee Response” in Lebanon: Racialised Hierarchies, Processes of Invisibilisation, and Resistance

Abstract By focusing on Sudanese refugees and asylum-seekers in Lebanon, who in 2018 constituted 4 per cent of all persons of concern to United Nations High Commissioner for Refugees (UNHCR) in that country, this article explores how the UNHCR protects and assists refugees not encompassed by the mainstream humanitarian response. The article finds that in terms of refugee recognition, resettlement, and overall protection, Sudanese refugees receive differential treatment when compared with the more dominant refugee groups. More precisely, it argues that the humanitarian practices contribute to structural processes of invisibilisation of the particularities of the protection concerns and circumstances of Sudanese refugees. It spotlights how, while racism and racial discrimination remain major protection concerns for the Sudanese community in Lebanon, humanitarian vulnerability assessments are altogether blind to these categories of harm. In examining how Sudanese refugees respond to and resist such processes of invisibilisation, the article also examines two key collective action approaches through which Sudanese refugees seek to access better protection and assistance: the establishment of representative refugee committees, on the one hand, and refugee protest, on the other. It finds that refugee protest was an important means of countering humanitarian processes of invisibilisation.

Antibiotic Use: Knowledge, Attitude and Practices of a Southern Community in Lebanon

Background: The irrational use of antibiotics is one of the leading causes to antibiotic resistance affecting the public’s health. This study aimed at examining the public’s knowledge, attitude, and practice in a Southern village of Lebanon. Methods: A quantitative cross-sectional survey was conducted in Haddatha Village-Beint Jbeil in South Lebanon during the month of October 2017. The target population for the survey included Lebanese adults (21 years of age or older) that had been living in the Village for at least the past 3 years. Results: All households were targeted, of whom 91 agreed to participate (86%), within the same household, we surveyed only one member. More than half of the respondents were misinformed about antibiotics usage to treat viral infections (60.4%), almost 30% reported that it cures all infections and 26.4% assumed that they can stop taking the antibiotic before completing the course if their symptoms improved. Half of the respondents (48.4%) conveyed expecting their physicians to prescribe antibiotics to treat common cold. On the other hand, 60% do not usually seek medical care when sick because they think that it is not needed. The results, also, showed that almost 30% take antibiotics without a physician’s prescription. Approximately, half of the population reported consuming leftover antibiotics (50.5%), with only 5.6% waiting more than 4 days to start an antibiotic course. Conclusion: This study reflects several misconceptions and poor knowledge regarding antibiotics use, with an exhibition of contentious attitude and practice. Therefore, it is recommended to advocate for policies to control the misuse of antibiotics through public health interventions targeting individuals and their families to limit antibiotic resistance.

Alleviation of Refugee Crisis in Lebanon through Humanitarian Aid Projects of Slovak Development Organizations in the Era of Covid-19 Pandemic

Lebanon hosts the highest number of refugees in the world in relation to its population (every seventh inhabitant is a refugee) In light of the events of Spring 2020, new concerns emerge: how will the living conditions of the domestic and refugee communities in Lebanon, already burdened by the economic crisis, be exacerbated by the Covid-19 pandemic? In this paper, the Slovak intervention by members of Ambrela - Platform for Development Organizations is presented It focuses on preventing and addressing the causes of migration by improving the living conditions of the population and its prospects for finding employment in home communities Study also shows the impact on alleviation of the refugee crisis in Lebanon under the SlovakAid brand by the recent humanitarian crisis related to the Covid-19

Confronting Structural Inequities: The Limits of Participation when Developing a Community Health Intervention with Syrian Refugees and Host Communities in Lebanon.

Lebanon is one of the most unequal countries in the world, whose economy, social welfare and public health system struggle to meet the needs of the Lebanese and over one million Syrian refugees. Researchers applied Community Based Participatory Research (CBPR) methodology in collaboration with a non-governmental organization (NGO) in an underserved Beirut neighborhood from 2014 through 2016, aiming to address health inequities, build social cohesion among refugees and host populations, and empower community members to develop a community health intervention. We recruited a community advisory board (CAB), conducted six focus groups and sixteen individual interviews, and held several community meetings. In response to the study findings, NGO staff, researchers and community members agreed to work together on a trash collection initiative as a community health intervention. Ultimately, we found the CBPR toolkit to be insufficient to the empirical reality: a series of structural challenges due to entrenched local and national hierarchies, ineffective political processes, and inter- and intra-group conflict driven by competition over privatized social services. Together these resulted in a lack of trust in the collaborative process wherein study participants solicited researchers for aid in return for their involvement, mirroring the Lebanese patronage system. Ultimately, the most expedient path toward change was not through empowerment of oppressed community participants, but through the action of already powerful local individuals. In conclusion, structural inequalities limit the participatory and emancipatory possibilities of CBPR research. Power mapping exercises, which are often used in community organizing, offer an important opportunity to assess viability and lay the groundwork for CBPR projects. Academic and popular media in the Middle East often focus on religious, sectarian conflict; however, in our study conflict both between and among social groups was driven by competition over material resources more than cultural or religious differences.

Food Aid Technology

Over half of Syrian refugee households in Lebanon are food insecure with some reliant on an electronic voucher (e-voucher) system for food aid. The interplay between the digitisation of food aid, within the socio-technical context of refugees, and community collaborative practices is yet to be investigated. Through design engagements and interviews with refugees and shop owners we explore the experiences of a Syrian refugee community in Lebanon using the e-voucher system. We provide insights into the socio-technical environment in which the e-voucher system is dispensing aid, the information and power asymmetries experienced, refugee collaborative coping practices and how they interplay with the e-voucher system. We highlight the need for: (1) expanding refugee digital capabilities to encompass understandings of aid technologies and identifying trusted intermediaries and (2) for technologies to support in upholding humanitarian principles and mitigating power and information asymmetries. Lastly, we call for CSCW researchers and humanitarian innovators to consider how humanitarian technologies can enable refugee collaborative practices and adopt everyday security as a lens for designing aid technologies. The paper contributes to CSCW knowledge regarding the interplay between aid technologies and refugees? socio-technical contexts and practices that provides a basis for future technological designs for collaborative technologies for refugee food security.

Health service utilization and adherence to medication for hypertension and diabetes among Syrian refugees and affected host communities in Lebanon.

MethodsThis study uses data from a 2015 household survey of Syrian refugees and Lebanese host communities. A total of 1,376 refugee and 686 host community households were surveyed using a cluster design with probability proportional to size sampling. Differences in outcomes of interest by population group were examined using Pearson’s chi-square and t-test methods and the crude and adjusted odds of care-seeking and interrupted medication adherence among Syrian refugees were estimated using logistic regression.ResultsFindings identified significant gaps between refugees and host community members in care-seeking, health facility utilization, out-of-pocket payments for care, and medication interruption. While host community members had better access to care and fewer reports of medication interruption compared to refugees, out-of-pocket spending for the most recent care visit was significantly higher among host community care-seekers. Refugee care-seekers most frequently received care at primary health facilities, choosing to do so mainly for reasons related to cost, whereas host community care-seekers predominantly utilized private clinics with greater concern for quality and continuity of care.ConclusionFurther efforts are needed to facilitate lower and more predictable health service costs for refugees and vulnerable host community members, as is continued communication on available subsidized care.PurposeTo characterize care-seeking, health service utilization and spending, and medication prescribing and adherence for hypertension and diabetes among Syrian refugees and host communities in Lebanon.Electronic supplementary materialThe online version of this article (10.1007/s40200-020-00638-6) contains supplementary material, which is available to authorized users.

Understanding (in)tolerance between Hosts and Refugees in Lebanon

AbstractWith the growth in political, ethnic, and religious conflicts across the globe, intolerance is manifested across different societies especially in the context of (forced) migration and refugees. The purpose of this study is to examine intolerance as a complex social problem. Specifically, this research seeks to explore the perceptions and conceptions of (in)tolerance between refugees from Syria and host communities in Lebanon identifying the degree and the different forms in which tolerance and intolerance materialize. This will allow different agents such as non-governmental organizations (NGOs), policymakers, and relevant authorities to develop adequate interventions to tackle this phenomenon through a social marketing approach and improve (refugee) crisis response plans. The situation has emerged following the Syrian conflict (2011–present) and the arrival of 1.5 million refugees into Lebanon. This number thus constitutes a challenge to both the hosts and the refugees in Lebanon, a small country. A qualitative study was conducted based on semi-structured interviews to investigate the perceptions and conceptions of the target audiences, citizens, refugees, leaders, and NGO staff/volunteers. Results show the existence of a phenomenon of intolerance; its relevant aspects, namely discrimination, prejudice, stereotypes, racism, and scapegoating; and the rise of violence–tension and fear as emerging themes of intolerance manifestations in the context of the Syrian refugee crisis in Lebanon.

Impact of spirituality and religiosity on suicidal risk among a sample of lebanese psychiatric in-patients

Objectives To evaluate the prevalence of suicidality among the psychiatric inpatients community in Lebanon, and to elucidate the effect of religiosity and spirituality on suicidal thoughts or behaviours. Methods A total sample of 159 patient consecutively admitted to a psychiatric hospital was interviewed. The Ask Suicide-screening Questionnaire (ASQ) was used to assess suicidal risk; the Mature Religiosity Scale (MRS) and the Spirituality Index for Well Being (SIWB) scales were used to assess religiosity and spirituality. Results We found that 45.6% of the participants screened positively on the ASQ, including 37.5% with acute suicidal ideation. A backward logistic regression, taking the negative/positive screening ASQ as the dependent variable, showed that a positive family history of suicide and depression were significantly associated with higher positive suicidal screening, whereas higher spirituality was significantly associated with lower positive suicidal screening. When forcing the mature religiosity scale as an independent variable, the results remained the same. Conclusion Spiritual well-being might be considered an important factor to explore among psychiatric patients. Psychiatric inpatients have a high risk for suicide; the challenge remains for clinicians to identify upon admission patients that are most likely to die from suicide. Key points A positive family history of suicide and depression was significantly associated with higher suicidality. Higher spirituality, but not religiosity, was significantly associated with lower suicidality. Spiritual well-being might be considered an important factor to explore among psychiatric patients. The challenge remains for clinicians to identify patients that are most likely to die from suicide upon admission.

Lebanon Shiite Woman in the Middle of Discrimination Feminist Literary Criticism Analysis of the Novel Hikayah Az-Zahra

This article reveals a picture of discrimination against women that occurs in a Shiite Muslims community in Lebanon. As is well known, Shi'a Muslims are second only to Sunnis in Lebanese Muslims as a whole, even though both populations are balanced. Islam itself became the second religion after Christianity in Lebanon and there are still several other religions (sects). Lebanon accommodates the growth of many religions that have a variety rules for their followers, so there is often attraction in making decisions regarding state laws and regulations, especially relating to women. Feminist Literary Criticism is used to explain all literary phenomena relating to women that aesthetically spread in the Hikayah az-Zahra novel which is the object of the research, this is due to the peculiarities of women which can only be explained using their own perspective. The results of this study will show a variety of forms of discrimination against women in Shiite circles, which are part of the daily lives of Lebanese people in situations of prolonged conflict. Shiite women, represented by the character of Zahra, cannot even expect protection from anywhere, including family members.

Effects of the Mother-Child Education Program on Parenting Stress and Disciplinary Practices Among Refugee and Other Marginalized Communities in Lebanon: A Pilot Randomized Controlled Trial

Few randomized controlled trials (RCTs) have explored the implementation and impact of early childhood parenting education programs in very fragile contexts and humanitarian settings. We tested the effects of a group-based intervention, the Mother-Child Education Program (MOCEP), on parenting stress and practices among two refugee communities and one other marginalized community in Beirut, Lebanon. A pilot wait-list RCT was conducted to assess the program's impact on maternal, child (average age: 4 years), and dyadic outcomes. A total of 106 mother-child dyads were randomly assigned to either the intervention group (n= 53) or the wait-list control group (n= 53). Analysis was conducted by modified intention-to-treat and supplemental analyses through multiple imputation of missing post-intervention data. Forty families (38%) withdrew early from the study. After completing the program, mothers in the intervention group showed a reduction in their harsh parenting practices, as indexed by the Disciplinary Style Questionnaire (Cohen's d=-0.76, 95% CI=-1.24,-0.27) and in their level of parenting stress, as indexed by the Parenting Stress Index-Short Form (PSI-SF; Cohen's d=-0.90, 95% CI=-1.39,-0.40). Exploratory but underpowered analyses of dyadic interactions revealed reductions in the PSI were associated with a reduction in harsh parenting after the intervention. However, we did not detect any positive impact on behavioral or emotional outcomes among the children. Our analyses suggest that MOCEP had a positive impact on disciplinary practices and parenting stress in a context of high fragility, but that broader effects on maternal and child outcomes may be dependent on program attendance and the availability of other services. We discuss implications of this pilot study for practice and research of a largely unexplored area of program evaluation. Mother and Child Education Program in Palestinian Refugee Camps; https://clinicaltrials.gov; NCT02402556.

TRUSTING THE PHARMACIST IN DELIVERING MEDICATION INFORMATION: A COMMUNITY-BASED PERSPECTIVE

Objective: Optimal disease management is influenced by a solid patient-health provider relationship; which includes trust in the provider. The study compares respondents’ trust in pharmacists and physicians for the delivery of drug information.&#x0D; Methods: Residents of 3 rural communities in Lebanon, aged 40 and above, were invited to participate in the study, 760 accepted. Participants were asked who they trust the most with information about their medication: their physician or their pharmacist.&#x0D; Results: Of the total sample, 154 chose the pharmacist as their most trusted source of medication information (20%). Characteristics associated with choosing the pharmacist were: being a male (29.3% vs 16.2% p&lt;.001), of younger age (31.5% among&lt;50 y, 18.8% among 50-64 y, and 14.6% among 65+years p&lt;.001), single (31.6% vs 21.9% married and 9.3 others, p=0.023), working (39.2% vs15.7% p&lt;.001), and insured (2.3% vs 16.4% p=0.048). The multivariate logistic regression model revealed that having a family member with hypertension (OR=1.86 95% 1.23-2.82), or cardiovascular (OR=3.39 95%CI 1.55-7.45) increased the likelihood of trusting pharmacists over medical doctor. On the other hand, a self-report of cardiovascular disease (OR=0.34 95% CI 0.12-0.95) and taking medication (OR=0.41 95% CI 0.25-0.67) were associated with a decrease in the trust in the pharmacist in favor of the physician.&#x0D; Conclusion: Although pharmacists are the drug specialists, the majority of the Lebanese rural community residents reported higher trust in their physicians with information about their medication(s).

Lessons learned in the provision NCD primary care to Syrian refugee and host communities in Lebanon: the need to ‘act locally and think globally’

Prevention and control of non-communicable diseases (NCDs) remain inadequate in resource-scarce countries, particularly in conflict situations. This paper describes a multicomponent intervention for management of hypertension and diabetes among older adult Syrian refugees and the Lebanese host community and reflects on challenges for scaling up NCD integration into primary care in humanitarian situations. Using a mixed method approach, the study focused on monitoring and evaluation of the three components of the intervention: healthcare physical facilities and documentation processes, provider knowledge and guideline-concordant performance, and refugee and host community awareness. Findings revealed overall high compliance of healthcare workers with completing data collection forms. Their knowledge of basic aspects of hypertension/diabetes management was adequate, but diagnosis knowledge was low. Patients and healthcare providers voiced satisfaction with the program. Yet, interruptions in medicines' supplies and lapses in care were perceived by all study groups alike as the most problematic aspect of the program. Our intervention program was aligned with internationally agreed-upon practices, yet, our experiences in the field point to the need for more 'local testing' of modified interventions within such contexts. This can then inform 'thinking globally' on guidelines for the delivery of NCD care in crisis settings.

Implementation Evaluation of the Mother‐Child Education Program Among Refugee and Other Vulnerable Communities in Lebanon

Despite the knowledge that quality early childhood development programs, including those that target parental knowledge and behaviors, are essential for ameliorating the negative effects of early-life adversity, robust analyses of their implementation and impact in highly vulnerable settings are scarce. To address this knowledge gap, we conducted a pilot wait-list randomized controlled trial (RCT) to assess the impact and the process of implementing and evaluating the Mother-Child Education Program (MOCEP) among refugee families and one low-income community in Beirut, Lebanon. This paper focuses on the analysis of MOCEP's implementation (i.e., key enablers of and barriers to the application and evaluation of the program). Our analysis suggests that, despite multiple challenges, implementation and robust evaluations of early childhood parenting programs in fragile contexts are feasible and urgently needed. This study illustrates how implementation evaluations are a key component of RCTs and crucial to identifying strategies to optimize program uptake and maximize impact.

Pediatric Burns Among Refugee Communities in Lebanon: Evidence to Inform Policies and Programs.

Burn-related injury is a global public health problem with significant rates of morbidity and mortality. The adverse effect of burn leads to substantial functional, psychological, and economic repercussions. Low- and middle-income countries, including Lebanon, carry a disproportionately greater burden of burn injuries. This study adopted a mixed method approach to explore burn-related injuries in a sample (n = 347) of refugee children settling in Lebanon. We reviewed 179 cases of patients records that met the criteria of a child aged 0 to 19 years and has sustained a burn due to living conditions. War-related burn injuries were excluded. The findings demonstrate that there is a significantly higher proportion of 0- to 4-year-olds with burn injuries (53.6%) compared with the older age groups. Scald burns, caused by boiling liquid, were the most common cause of burns (58.6%), followed by fire/open flame (12.8%) and heat contact (6.7%). Upper trunk and arm burns were significantly higher than other body parts (35.2%), females were among the potential at-risk group with due to boiling liquids caused by food preparation and serving. Fifteen to nineteen years showed a high proportion of fire/flame burn caused by labor accident. Qualitative analysis of case reports further confirmed our findings and emphasized the impact of low socioeconomic status, overcrowded living conditions and open floor cooking and heating on increasing risk of pediatric burns. Additional research is needed to increase understanding on risk factors pertaining to pediatric burns in the refugee community with a view to integrating appropriate preventive measures and informing evidence-based policies and programs.