Right To Health Research Articles

Health experiences of pregnant and women with chagas disease in the Atacama, Tarapaca, and Metropolitan regions of Chile. Mistreatment as an indicator of healthcare barriers.

Congenital transmission is one of the most significant forms of Trypanosoma cruzi transmission worldwide. Migrant women, in particular, often face barriers to accessing the healthcare system; one such barrier being that their health rights are not recognised. The situation in Chile is a reality that can be extrapolated to historical territories affected by Chagas disease and that is characterized by migrant populations. This article explores the healthcare experiences of pregnant and women living with Chagas disease, both nationals and migrants, and residents of three regions of Chile. The qualitative research study analyzed the experiences and meanings around the problem of Chagas based on 54 in-depth interviews with women in pregnancy and women who were diagnosed with the disease. The information was processed following the Grounded Theory tenets through the constant encoding feedback procedure, which allowed us to describe and comprehensively understand the phenomenon. The findings indicate that managing information is a sensitive aspect in evaluating healthcare experiences, with the potential to either positively or negatively impact the acceptance of diagnosis and treatment planning. The negative impact is determined by the communicative dimension and how healthcare teams deliver information. Poor attention, poor treatment, and lack of empathy lead patients to reject or distance themseves from the healthcare system. The positive aspects are related to a sensitive, personalized, and highly empathetic treatment. In historically endemic areas, these factors are essential for ensuring continuity in healthcare processes. There is an evident need to understand and value the settings, means, and contents within Chagas´s healthcare contexts. Communication is crucial during diagnostic processes as it determines the assessment, credibility, and trust in the health system, thereby influencing the continuity of treatment, especially in highly sensitive moments such as pregnancy. Therefore, it is necessary to articulate strategies considering information magement with greater empathy and emotional support.

Knowledge, attitude and practice regarding sexual and reproductive health rights among married adolescents in urban slums of Bangladesh: A cross-sectional survey

Background: Adolescents, especially married adolescents living within urban slum communities, encounter significant difficulties in obtaining and exercising their sexual and reproductive health rights (SRHR). This study aimed to determine the knowledge, attitude, and practice of SRHR and its associated factors among married adolescents living in urban slums. Methods: A cross-sectional survey of 500 married adolescent girls living in slums in Dhaka and Gazipur, Bangladesh, was conducted in the icddr,b Health and Demography Surveillance System areas. We interviewed them using a pretested questionnaire to assess their knowledge, attitude, and practice of SRHR. Data on their sociodemographic variables, such as household asset items and age and education, were collected. Principal component analysis was used to create wealth indices. Results: Knowledge of self-care during menstruation and the oral contraceptive pill was almost universal, though knowledge of condoms, abortion, danger signs of pregnancy and sexually transmitted infections was low. They (70%) agreed that young people should have access to menstruation-related hygiene facilities, contraception and sex education, though there was less agreement regarding abortion being a woman’s right. The use of antenatal care and institutional-level delivery was also low. Age, years of schooling and prior pregnancy were positively associated with their knowledge levels. Important attitudinal and practice variations were noted between regions, Gazipur being the most disadvantaged. Conclusion: There are important gaps in knowledge and practice in SRH service-seeking in this slum population. Heterogeneity in the slum population must be recognised to design services that reach the most disadvantaged group.

Quality of family planning counseling and associated factors among reproductive age women who are current contraceptive users at Dessie town health facilities east Amhara, 2023

BackgroundThe role of counseling in Family Planning is to care a woman in navigating the process of choosing a contraceptive method that will allow her to fulfill her family planning goals and exercise her reproductive health rights. The effectiveness and appropriateness of family planning counselling play a crucial role in a client’s decision-making process regarding contraception. The decision for a client to use contraception with effectively and properly it should be ultimately achieved the quality of family planning counclling.The aim of this research is to assess quality of family planning counseling and associated factors among reproductive age women at Dessie town health facilities, east Amhara, Ethiopia, and 2023.MethodsA facility based cross-sectional study was conducted from December 1, 2022- January 30, 2023. Study subjects were selected by using systematic random sampling method. Data was be collected by exit interview of the women and analyzed by SPSS version 26. Bivariable and Multi variable logistic regression were executed to identify associated factors with quality of family planning counseling and the P- Value <0.05 on Multi variable analysis was considered as significantly associated with the dependent variable.ResultThe proportion of women receiving good quality family planning counselling in this study was 36.5%. Contraceptive source [AOR=2.03, 95%CI (1.09, 3.75)], Contraceptive currently used [AOR=0.43, 95%CI (0.26, 0.73)], separate room for family planning counseling [AOR=3.38, 95%CI (1.09, 3.75)] and availability of all methods [AOR=3.10, 95%CI (1.85, 5.21)]were significantly associated with quality of family planning counselling.ConclusionThe proportion of women obtaining good quality FP counseling in this study low. Type of contraceptives currently used, source of contraceptives, separate room for providing family planning counseling and availability of all methods of family planning in the facility are significantly associated with quality of family planning counseling. Therefore, all health profession could be given proper counseling to increase the quality of family planning.

MOPOELA WAW MOPOOPATATO : BENTUK PENINGKATAN PEMAHAMAN HAK-HAK KESEHATAN BAGI MASYARAKAT SEBAGAI PEKERJA DI DESA MALEO

The people of Maleo village who work in several companies in Maleo village and its surroundings are less aware of the health rights that must be obtained while working in the company. Therefore, this community service is carried out in the form of Observation and Data Collection, legal counseling, focus group discussions and the preparation of SOPs for complaints regarding the fulfillment of workers' rights. The results of the community service carried out by this team The results of the community service carried out by the community service team after carrying out various community service programs are the existence of valid data on the number of people in Maleo village who work in several companies around Maleo village, the formation of community understanding and knowledge of the health rights that must be obtained by every worker, the knowledge of various problems of fulfillment of rights experienced by workers, and the formation of SOPs for complaints and follow-up handling of problems of fulfillment of rights that are specifically related to the health rights of workers.

How the Struggle for Public Health in the Jim Crow South Reflected and Reinforced Systemic Racial Health Inequality

Abstract The twenty-first century COVID-19 epidemic revealed a U.S. public health system that countenanced health inequities and a U.S. public that resisted disease containment policies. This crisis, however, was only the most recent chapter in a longer struggle in the United States to institutionalize public health. We focus on two early twentieth-century public health campaigns in the American South, the unhealthiest U.S. region at the time. Black southerners—denied basic health, political, economic, and social rights under a rising Jim Crow regime—self-organized health services networks, including through the Tuskegee Woman’s Club, the Negro Organization Society of Virginia, and the Moveable School (1890s–1915). Around the same time, a philanthropic project, the Rockefeller Sanitary Commission (RSC, 1909–1914), seeded state-level public health agencies in eleven southern states, thereby installing public health in a top-down manner. We use archival data sources to explore key similarities and differences in the public health concerns and coalition-building approaches of each campaign and southern resistance to their efforts. We find Black-led campaigns often blurred the color line to form coalitions that provided services to the underserved while tackling environmental health risks at the community level. In contrast, RSC affiliates in southern states, as directed by RSC administrators, provided health services as short-term public dispensaries. Services reached Black and White communities willing to participate but in a manner that did not overtly challenge Jim Crow-era practices. Southern resistance to public health expansion persisted under each approach. The legacies of these struggles remain; the political-economic and ideological forces that limited public health expansion while marginalizing Black community health efforts reverberate in public health inequities today.

Digital solidarity and adaptation: applications developed for refugees in host countries.

The scale of international migration is growing day by day, and the issue of refugees constitutes a significant agenda item for all countries. In today's digital age, characterized by technological advancements, refugees are also benefiting from the advantages of technology. With various applications downloaded to their mobile phones, refugees can directly access all kinds of information about the countries they are heading to and even communicate with each other to share experiences. This study explores how mobile phone applications can be developed to serve the refugees in the familiarizing themselves with the receiving culture. In the study, a total of 10 applications prepared for refugees on Android and iOS platforms, selected by random sampling and purposeful sampling methods, were examined. These applications were analyzed using the qualitative content analysis method. As a result, when the applications developed in host countries were examined, it was observed that the most needed basic information for refugees, such as housing, education, finding a job, health, language, daily words, legal documents, rules, and fundamental rights, was provided. Additionally, in the 10 refugee applications examined, Global Positioning System (GPS) and Geographic Information System (GIS) were used as locative media for mapping locations. Location-based data and maps that show where refugees are located are extremely important for them. These maps are believed to help reduce stress, make them feel safe, and facilitate the adaptation process by showing refugees the nearest shelters, dining places, hospitals, transportation, and asylum locations.

Promoting Sexual and Reproductive Health Rights (SRHR) to the Adolescents in Bangladesh: Policy Prospects and Challenges

Sexual and reproductive health and rights (SRHR) are a concept of human rights applied to the sexuality and reproduction of human beings. Most Bangladeshis, especially adolescents in rural areas, are still unaware of these rights for countless reasons. A significant barrier towards such awareness is created. There has been some research in recent times covering various aspects of SRHR in Bangladesh. Nevertheless, the element that makes this research unique is that it is aiming to analyze in a doctrinal or qualitative manner if the existing laws and policies are enough to ensure that adolescents have access to knowledge and information on SRHR, or whether any major or minor reforms to existing legal framework are necessary. The research would like to prove the necessity of enacting legally enforceable national policies to ensure that adolescents in Bangladesh have access to SRHR education, which is very important in protecting their sexual and reproductive health and well- being.

Protocol for a qualiquantitative study of accessibility of sexual and reproductive health services among women with motor disabilities in Morocco

Introduction Approximately 1.3 billion people worldwide live with a disability, underlining the need for equitable health care for this group is important. Inclusive health systems are consistent with global health priorities, respond to United Nations sustainable development goals and economically viable. Despite advancements in Morocco’s health system and legal framework, significant disparities remains inaccessing sexual and reproductive health (SRH) services for women with disabilities. This study explores barriers and facilitators affecting access to SRH services for these women, aiming to provide recommendations for more inclusive services and improved health outcomes. Methods Using a mixed approach, this study assessSRH access for women with motor disabilities in two cities in Morocco, selected for their socio-demographic, cultural and and healthcare diversity. Quantitative data will be generated through questionnaires administrered to 400 participants, while qualitative information will come from 20 to 30 interviews. Recruitment involves working with health professionals, NGOs and social media campaigns to ensure a diverse sample. Data analysis includes NVivo for qualitative data and descriptive/inferential statistics for quantitative data. Conclusion The study aims to explore the perspectives of women with disabilities and health professionals regarding SRH services. It will provide recommendations for making SRH services more equitable and inclusive, ultimately improving health out comes and uphold health rights for women with disabilities.

Innovative tools from WHO Europe to protect children from digital marketing of unhealthy products

Abstract Children in the WHO European Region are extensively exposed to marketing of unhealthy products, including tobacco, alcohol, HFSS foods, and gambling, which negatively influences their dietary choices, behaviors, and perceptions of a norm, threatening their health rights. Recognizing the urgency to protect children’s developmental potential and rights, WHO has actively addressed this issue both within Europe and globally. In 2010, WHO issued recommendations for Member States on marketing foods and beverages to children. Building on these efforts, the CLICK framework for monitoring digital marketing to children was introduced in 2018. In 2023, WHO released guidelines urging countries to adopt comprehensive, mandatory policies to protect children from HFSS food marketing. Despite political commitments and policies, children and adolescents continue to be exposed to unhealthy product marketing, increasing their risk of NCDs as online activity rises. At the same time, while efforts have focused on restricting specific products, rapid changes in digital marketing strategies necessitate broader measures. Emerging trends include promoting brand loyalty among young children through brand characters and logos. Tools and support are urgently needed to monitor and implement WHO recommendations in online settings, including brand marketing. Despite WHO recommendations, few countries have implemented mandatory policies. Reliable monitoring mechanisms are essential. To address this gap, the WHO Regional Office for Europe developed the KidAd platform to monitor children’s exposure to digital advertising.

Ensuring the right to health care for detained adolescents: cross-sectoral strategies and policy innovations

Abstract This presentation will draw attention to the health concerns of adolescents deprived of liberty, stressing that incarceration of minors should be a last resort. Notwithstanding, when governments allow for incarceration of minors, they must guarantee this does not translate into deprivation of basic human rights and that international treaties are respected, including access to high quality healthcare. This talk outlines the development of a policy brief based on data from the UN global study, which identifies essential health interventions for minors in various forms of detention-migration, youth detention, and adult detention where children reside with their parents. Using case studies from Greece, India, and the United States, shortcomings in existing health systems in detention contexts are stressed. A more recent policy brief focusing exclusively on children detained in the context of migration will be used to provide good practice case studies, where appropriate actions such as changes in legislation were put in place, namely in Canada, South Africa, Ukraine and Ireland. A key focus of the presentation will be the importance of cross-ministerial collaboration, as healthcare in the criminal justice system frequently falls under the jurisdiction of ministries other than health, complicating health policy implementation. The speaker will discuss integrated approaches that involve various sectors to ensure the health rights of detained youth are addressed. The presentation aims to illuminate the systemic changes needed to protect the health of detained adolescents, urging policymakers, healthcare providers, and advocates to adopt holistic and inter-sectoral strategies. The talk will also refer to policy actions and recommendations for Member States to support them in addressing challenges so they may achieve the principles of equivalent care and continuity of care that reflects the recommendations of the United Nations Global Study on Children Deprived of Liberty.

4.Q. Scientific session: Global landscapes of healthcare worker migration: advancing effective and equitable solutions

Abstract Background Healthcare workforce migration not only increased in numbers, the mobility flows and migration patterns are also changing and becoming more diverse. The labour market push-and-pull factors and related risks of ‘brain-drain’ are still relevant and many countries, especially in the western world, heavily rely on foreign-born and foreign-trained healthcare workers to mitigate shortages and respond to the healthcare workforce crisis. However, this migration pattern increasingly co-exists with other patterns, blurring the categories of hosting and sending countries. For instance, some low- and middle-income countries have created the export of skilled healthcare workers as business model, others invest in healthcare worker education without advancing national labour market capacities. There is also an increase in crisis migration caused by wars, climate change, and other conflicts, yet these refugee healthcare workers are often excluded from the formal labour market. These examples illustrate that health policy across countries largely failed to respond to the changing global landscapes of migration and to govern education, recruitment and retention more effectively. The healthcare workforce debate is primarily driven by health labour market needs, while health policy and human rights remain marginal. There is also a lack of comprehensive data and research, that would allow for evidence-based decision-making. Ineffective policy and existing governance gaps exacerbate the global healthcare workforce crisis, increase stress and workload of the healthcare workers, and often ignore worker and human rights. Objectives This workshop looks beyond labour market push-pull factors and highlights the complexity of healthcare worker migration. It makes the diverse needs, stakeholder interests, and institutional frameworks visible that shape mobility patterns of healthcare worker, seeking to identify capacity for more effective governance and good-practice examples. The following major questions will be discussed, among others: What data and research are needed to better understand the global migration landscapes? What can we learn from cross-country knowledge exchange and good practice experiences? How can public health advance more equitable and effective education, recruitment and retention policy, and what role could global contracts and international organisations play? The interactive discussion will be facilitated by a commentary on global capacity building for equitable healthcare worker migration and the action taken by WHO. The presenters and the audience will advance knowledge exchange and critically explore novel solutions to the healthcare workforce crisis that are more sensitive to the needs of both individual migrant healthcare workers and less well-resourced countries, in the global South as well as within Europe. Key messages • Increasingly divers patterns of healthcare worker migration call for novel governance approaches that align labour markets, health policy needs, and human rights. • More effective, equitable and ‘humanised’ governance of healthcare worker migration needs a global public health and human rights approach.

Factors influencing abortion care-seeking outside of formal healthcare settings: lived experiences from Rwandan young women

BackgroundInformal abortions, commonly known as unsafe abortions, refer to all induced abortions that occur outside of formal healthcare settings conducted without the assistance of a licensed, trained healthcare provider. Despite the legalization of safe induced abortion care services, informal abortions continue to be among the major causes of maternal mortality and morbidity among young women in Rwanda living in rural areas with limited or no access to safe abortion care services. The purpose of this qualitative study was to gain an in-depth understanding of the lived experience of seeking informal abortions from the perspective of young women in rural Rwanda and to identify the underlying factors for these women seeking abortion care services outside of the formal healthcare setting.MethodsThis qualitative study was guided by a descriptive phenomenology in rural Rwanda, specifically in a selected district located in the Northern Province of Rwanda. Ten young women between 18 and 24 years of age, who had the experience of seeking informal abortion services from informal providers within the last eight years participated in audio-recorded, in-depth, face-to-face interviews. Collected data were analyzed using Colaizzi’s (1978) seven steps of the phenomenological method.ResultsThe study found that young Rwandan women still seek unregulated abortions to end their unintended pregnancies due to limited access to or utilization of sexual reproductive health and rights services. Among the reasons for seeking abortion care services outside of the formal healthcare setting in Rwanda were sociocultural and economic factors and the stigma associated with terminating unintended pregnancies before marriage.ConclusionIn light of the findings of this study, the authors recommend the Ministry of Health and its stakeholders to expand access to comprehensive adolescent and youth-friendly reproductive health and reproductive rights while addressing the sociocultural stigma through public awareness and economic factors that play a big role in unregulated abortions rather than safe abortion care services.

An observational study in Roma women in Greece: measuring health factors in an understudied group

Abstract Background The Roma have always been one of the most vulnerable and at the same time understudied minority groups in Europe, living under difficult conditions and experiencing discrimination. The aim of the present work was to summarize the health and lifestyle profile of Roma women living in various regions of Greece. Methods A multi-center, observational study was implemented in April-June 2022, in the context of a national program entitled “Empowering Young Roma Women in matters of health, prevention and human rights: a new methodological approach”. Roma women, living in 5 areas of Greece, and health professionals working with Roma groups were considered as eligible to participate. A two-step, methodological approach was followed: a. qualitative study with Focus Groups and b. questionnaire-based survey. Results In total, n = 41 participants in FGs, and n = 99 responders in survey were recorded. 40% of participants were smokers (&amp;gt;10-15 cigarettes/day). Main quitting reasons, were “to set a good example and cost’. Increased consumption of ultra-processed foods and beverages, low plant-based foods intake, frequent breakfast omission and eating-out were reported by the vast majority of participants. Only 15% of responders had undergone typical, gynecological, screening tests while 1 in 5 responders used contraception. Regarding vaccinations, even if about 8 in 10 women seemed to comply with the obligatory vaccines for their children, a high vaccination reluctancy in 70% of the study sample was recorded in case of vaccination in adulthood. Conclusions This study stands one of the very few that underscore the vulnerability of Roma women in terms of poor health literacy, unhealthy lifestyle behaviours and low motivation to typical preventive measures. Improving access to primary health care services and tailored, culturally sensitive training is crucial. Key messages • Social inclusion of the increasing population of Roma women is crucial. • Health promotion, taking into consideration Roma women’s special needs, shall be a decisive factor of this process.

Implementing mental health quality practices for vulnerable populations in five EU countries

Abstract Issue Mental ill-health has been a leading cause of disability in Europe for many years, with the COVID-19 pandemic increasing incidences of both poor mental health and mental disorders. Vulnerable groups such as children, migrants, individuals with existing mental health issues, and healthcare workers are particularly affected but often lack tailored mental health support. Description of the problem The MENTALITY project aims to alleviate mental health distress worsened by the COVID-19 pandemic focusing on vulnerable groups. It also involves developing capacity-building tools and disseminating research results to increase awareness and knowledge sharing. Five EU countries are currently piloting four distinct good practices to address mental health issues among vulnerable populations. Specifically, Poland is aiming to support migrants (including Ukrainian and Spanish-speaking populations), Latvia is focusing on the healthcare workforce, and Romania and Slovakia are concentrating on users and community services. Meanwhile, Greece and Slovakia are implementing initiatives for children. The implementation phase began in January 2024 with a duration of 6 months. Results By consulting with relevant stakeholders, a Situation Analysis and Needs Assessment framework has been conducted, allowing for informed decisions regarding the elements to be pilot. Partners have developed country specific piloting plans and external evaluators are leading a common framework for monitoring and evaluation, ensuring regular assessment of the project’s progress. Lessons The innovative MENTALITY project aspires to enhance community-based mental health systems and promote improved mental health services across EU Member States during crises by adopting a preventative approach. Preliminary results show that the initiatives within the project were much needed and have already begun to demonstrate promising outcomes in addressing mental health challenges at both individual and community levels. Key messages • The MENTALITY project aims to address mental health distress of vulnerable populations in times of crisis. • The project seeks to advance equality in health and social rights for all individuals living in the EU.

Legal perspectives on climate change and inequalities

Abstract In many areas of public health policy, litigation has delivered significant, long-lasting impacts. Examples include tobacco control, increasing access to treatments for HIV, and addressing air pollution and climate change. Litigation is an established part of public health’s advocacy toolbox in national courts, and increasingly in international courts and tribunals. In responding to climate change, in addition to potential policy and law reform, climate change litigation creates opportunities for public scrutiny and debate by raising awareness of inaction or harm caused by governments or private sector polluters, and sparking wider community mobilisation for climate action. Where climate change litigation is based on human rights claims, credible science-based evidence of the health and other human rights impacts of climate change is essential. Public health professionals are increasingly involved in assembling and presenting such evidence, often focusing on vulnerable populations. However, the multiple intersecting identities of vulnerable populations have not been sufficiently explored. For example, how does intersectional disadvantage influence the ways in which evidence of the impact of climate change is assembled and assessed? How are these issues addressed in the courts? Examples include older women (KlimaSeniorinnen v. Switzerland), young people, from both the global South and global North, in urban or remote areas, or with different pre-existing health conditions (Sacchi et al. v. Argentina et al), and Indigenous people, including women and children (Daniel Billy and others v. Australia; Teitiota and others v. New Zealand). Multiple identities can compound vulnerability. For example, young people may be more vulnerable both due to their physical immaturity and due to eco-anxiety and other mental health impacts. This presentation will explore these issues, and the critical role of public health professionals in legal action to address climate change.

Empowering Young Roma Women in matters of health and primary care: an innovative training program

Abstract Background Roma communities are rather diverse groups with different level of knowledge, beliefs and motivations in relation to their health. Raising awareness and self-efficacy of these individuals is a challenging field in the EU public health agenda. Objectives To address this challenge, the program entitled “Empowering Young Roma Women in matters of health, prevention and human rights: a new methodological approach” was developed with the aim to empower Roma women in terms of health and prevention topics pilot testing different educational methods. A two-step co-design approach was performed to determine the training content, tools, methods. The training was implemented in 5 areas throughout Greece (Volos, Chalkida, Thiva, Agia Varvara, Zefyri) in Jan-Oct 2023, including 3 phases: a. Train-the-trainers, b. Training the Roma women and c. Training evaluation. Results The educational material developed for health and prevention included 4 units (gynaecological health issues, vaccinations, smoking and nutrition). Each unit consisted of a theoretical background to develop the material, a presentation for future trainers, a presentation for trainees, a brochure, and a poster. For the training a new methodological approach was tested i.e. a health professional or Roma women (after being trained) to deliver the training. In total, 548 pre-post questionnaires were collected. Most trainees, understood the content of the training, acquired new knowledge and found the information interesting and possible to include in their daily life. 80% trainees expressed their satisfaction with the overall presentation. Regarding knowledge improvement based on the type of trainer only a slightly greater degree of improvement was observed for Roma trainers. Conclusions It is crucial to develop culturally appropriate health interventions by directly working with communities, to understand their particular needs, and to ensure they receive the information needed to make informed decisions. Key messages • Maintaining and promoting health is a decisive factor of social inclusion. • Tailor-made training of ethnic minorities shall be an integral part of the EU public health agenda.

Advancing Children’s Participation Rights in Healthcare Through Play

Abstract Within the vulnerable clinical context, children’s participation rights are easily compromised in relation to their protection and service provision. Unfortunately, failure to engage children in medical conversations can make this stressful context even more acute. In response to this problem, this Article presents the legal, philosophical and evidence-based arguments for incorporating play as a child-friendly intervention to engage young patients in meaningful participation in clinical settings. Play as the natural language of children can make them receive and assimilate medical information without fear. Play is also a well-recognised mechanism of child agency and their most natural form of participation, and as such can become a springboard for engaging and empowering children in healthcare.

Brave global spaces: Researching digital health and human rights through transnational participatory action research

In this paper we reflect on our experience with applying Transnational Participatory Action Research (TPAR) to a multi-country study of digital health and human rights of young adults living with and affected by HIV in five low- and middle-income countries (LMICs), and identify some lessons learned for future projects. First, we propose a definition of TPAR based on our experience and our analysis of power in the project. We present an overview of the research design and implementation, which melded diverse working cultures and research methods. Next, we describe how we adapted outputs, working methods and terminology to meet the diverse and specific needs of civil society organizations, community-led networks and academics working in diverse national and transnational spaces. This required us to understand and adapt to the different temporalities at play. The creation of brave spaces and the development of an intersectional lens were key to addressing tensions that naturally emerged in our collaboration. Finally, we summarize lessons learns and challenges for the next stage of the project.

Key mental health differences in conflict-related sexual violence and how sex, severity, and early intervention impact on improvement: a retrospective observational study

BackgroundConflict-related sexual violence (CRSV) is a significant health and human rights issue in humanitarian contexts, but there is a need of further research on differences between sexes in terms of severity of symptoms and improvement. Consequently, we explored the differences in severity and outcomes among male and female survivors of CRSV who received mental health and psychosocial support (MHPSS) in an armed conflict setting.MethodsWe retrospectively analysed medical records from 3442 CRSV survivors in a MHPSS programme in Borno State, Nigeria, between 2018 and 2019. Patient characteristics, severity (measured with Clinical Global Impression of Severity Scale [CGI-S scale]), and improvement (measured with Clinical Global Impression of improvement [CGI-I] scale) were assessed by an attending counsellor. We assessed predictors for severity and improvement using a multivariable logistic regression analysis and time to improvement by sex using Kaplan Meier (K–M) curves and Cox regression.ResultsWe included 3442 patients who had at least one CRSV event in this study (2955 [85.9%] female, 486 [14.1%] male, one unknown). The most prevalent categories of symptoms were depression (49.9%; n = 1716), post-traumatic (25.6%; n = 879), and anxiety (20.3%; n = 697) symptoms. Most patients had mild (59.0%; n = 1869/3170) or moderate (36.4%; n = 1153/3170) symptoms at baseline, with 4.7% having severe symptoms (n = 148/3170). The logistic regression analysis (n = 1106), showed male patients had a 59% higher odds of severe symptoms at baseline than female patients (aOR 1.59; 95% CI 1.04–2.45). Among males, those older than 55 years had three times higher odds of presenting severe symptoms than younger patients (aOR 3.65; 95% CI 1.43–9.34). Women aged 36–55 years were more likely to present improvement than younger female patients (aOR 1.32; 95% CI 1.11–1.58). For both sexes, prompt attention after a CRSV event (≤ 3 days) positively predicted improvement (aOR 13.9; 95% CI 1.48–130 males, aOR 2.11; 95% CI 1.22–3.64 females) compared to late attention. Time to improvement did not differ between sexes, with an average of at least three consultations needed to achieve improvement.ConclusionsOur study suggests that psychological attention of survivors within the first 72 h should be a priority. MHPSS programmes addressing CRSV should be inclusive to all patients, and gender-neutral approaches to ensure access, safety, confidentiality, and non-discrimination for all survivors should be developed.

Psychometric Evaluation of Women's Knowledge of Healthcare Rights and Perception of Resource Scarcity during Maternity.

Background/Objectives: Resources to cope with maternity and women's participation are essential modulators of maternal well-being. Therefore, it is relevant that the psychosocial factors of woman be monitored during maternity to promote adequate healthcare. This study involved the design and the validation of two new tools that identify women's knowledge of healthcare rights (MatCODE) and perception of resource scarcity (MatER) during pregnancy, labor and early postpartum; Methods: The content validity was carried out using the Aiken's V coefficient and the content validity index (CVI-i) based on five experts. In addition, for the face validity, the pilot cohort was considered the INFLESZ scale. Finally, the questionnaires were applied to 185 women, which allowed to assess the construct validation by factorial and Rasch analysis. The divergent validity was also studied with validated psychological questionnaires; Results: MatCODE and MatER questionnaires received CVI-i and Aiken's V > 0.80 values, and the INFLESZ demonstrated acceptable semantic understanding. The analysis confirms the unidimensionality of the questionnaires, with fit values for MatCODE of RMSEA = 0.113 [0.105; 0.122] and for MatER of RMSEA = 0.067 [0.063; 0.072]. The divergent validity showed significant and consistent correlations with the constructs assessed. For MatCODE, ω = 0.95 and α = 0.94, and for MatER, ω = 0.79 and α = 0.78; Conclusions: MatCODE and MatER are useful new tools for monitoring maternal healthcare, with adequate psychometric characteristics in the Spanish context.