The Institute for Global Health and Development
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Item Refugee integration in national health systems of low- and middle-income countries (LMICs): evidence synthesis and future research agenda(Elsevier, 2025-09-12) Olabi, Amina; Palmer, Natasha; Bertone, Maria Paola; Loffreda, Giulia; Bou-Orm, Ibrahim; Sempé, Lucas; Vera Espinoza, Marcia; Dakessian, Arek; Kadetz, Paul; Ager, Alastair; Witter, SophieThis paper reviews evidence on healthcare responses for refugees, documenting the different approaches and their effectiveness and impact in particular in relation to supporting integrating refugees into national health systems. The review adopted a purposeful, iterative approach, utilizing electronic databases, grey literature, and reference lists from relevant studies. A total of 167 studies, primarily from low- and middle-income countries (LMICs), focusing on refugees and forcibly displaced persons with empirical data, were included. The review highlights a substantial literature on refugee health and healthcare access, with well-covered areas including delivery models, access barriers, gaps in coverage, and specific health services such as psychosocial care, non-communicable diseases, mental health, and maternal and child health. However, less attention is given to integration models, health system responses, and their impact on system resilience and social cohesion. Few studies examine the costs, feasibility, or sustainability of integration models, and little research focuses on health system perspectives or comparative analyses. Moreover, the host health system's status, capacity, and needs are often underexplored. Some countries are particularly well-represented in studies, e.g. Turkey, Jordan, Lebanon, Bangladesh, Democratic Republic of Congo (DRC), and Uganda. There is however a paucity of data that would provide the basis for more quantitative or analytical evaluation from a systems perspective. This gap highlights the need for further research on effective integration models, their operational aspects, and their long-term impact on local health systems' resilience and sustainability. To support this research agenda, we propose a conceptual framework to provide analytic guidance for future research on healthcare responses for refugees and health system integration.Item Women’s Experience of Domestic Violence: A Qualitative Study in Hangzhou, China(Springer, 2024-11-30) Yuan, Weiman; Kadetz, Paul; Shen, Xiaohui; Hesketh, TheresePurpose There has been an increasing awareness of Domestic Violence (DV) in China following the announcement of the First Anti-Domestic Violence Law, in 2015 yet, there has been limited in-depth research concerning DV in China -with most focused on prevalence and risk factors. This study aims to capture female DV victims’ experience of violence in China, and identify the perceived causes and impacts of DV. Methods This qualitative research, conducted from June to September 2019 in Hangzhou, China, consisted of in-depth semi-structured interviews with 30 women who had experience of DV. Social cognitive theory served as the theoretical framework and Interpretive Phenomenological Analysis to analyze the data. Results The most common types of physical violence reported included hitting, throwing objects at women, choking, kicking, and slapping. Psychological violence consisted of insults and denigration, physical threats, and enforcement of social isolation. Sexual violence consisted of forced sexual behaviors against women’s willingness. All informants suffered physical or psychological impacts from the violence experienced. Perceived causes of DV included the perpetrator’s personality and childhood experience of violence; victims’ self-blame; conflict between couples that include those concerning raising children and household finances; family conflicts, especially with parents-in-law; social factors including rural-to-urban migration for work, social norms and constraints, and legal constraints to separation. 80% of informants reported that they still cohabit with their abusive partner. Conclusion Our findings provide insights into potential preventative measures for DV from individual, family, and social perspectives, and the need to de-stigmatize and support victims of DV in China.Item An African One Health network for antimicrobial resistance and neglected tropical diseases [Correspondence](Springer, 2024-01-03) Abd El Wahed, Ahmed; Kadetz, Paul; Okuni, Julius Boniface; Dieye, Yakhya; Frimpong, Michael; Ademowo, George Olusegun; Makiala-Mandanda, Sheila; Woldeamanuel, Yimtubezinash; Eltom, Kamal Hassan; Yeboah, Georgina; Käsbohrer, Annemarie; Kajumbula, Henry; Truyen, Uwe; Nakanjako, DamalieItem Prevalence, drivers and surveillance of antibiotic resistance and antibiotic use in rural China: Interdisciplinary study(Public Library of Science, 2023-08-09) Lambert, H.; Shen, X.; Chai, J.; Cheng, J.; Feng, R.; Chen, M.; Cabral, C.; Oliver, I.; Shen, J.; MacGowan, A.; Bowker, K.; Hickman, M.; Kadetz, Paul; Zhao, L.; Pan, Y.; Kwiatkowska, R.; Hu, X.; Wang, D.This study aimed to characterise antibiotic prescribing and dispensing patterns in rural health facilities in China and determine the community prevalence of antibiotic resistance. We investigated patterns and drivers of antibiotic use for common respiratory and urinary tract infections (RTI/UTI) in community settings, examined relationships between presenting symptoms, clinical diagnosis and microbiological results in rural outpatient clinics, and assessed potential for using patient records to monitor antibiotic use. This interdisciplinary mixed methods study included: (i) Observations and exit interviews in eight village clinics and township health centres and 15 retail pharmacies; (ii) Urine, throat swab and sputum samples from patients to identify potential pathogens and test susceptibility; (iii) 103 semi-structured interviews with doctors, patients, pharmacy workers and antibiotic-purchasing customers; (iv) Assessment of completeness and accuracy of electronic patient records through comparison with observational data. 87.9% of 1123 recruited clinic patients were prescribed antibiotics (of which 35.5% contained antibiotic combinations and >40% were for intravenous administration), most of whom had RTIs. Antibiotic prescribing for RTIs was not associated with presence of bacterial pathogens but was correlated with longer duration of infection (OR = 3.33) and presence of sore throat (OR = 1.64). Fever strongly predicted prescription of intravenous antibiotics (OR = 2.87). Resistance rates in bacterial pathogens isolated were low compared with national data. 25.8% of patients reported antibiotics use prior to their clinic visit, but only 56.2% of clinic patients and 53% of pharmacy customers could confirm their prescription or purchase included antibiotics. Diagnostic uncertainty, financial incentives, understanding of antibiotics as anti-inflammatory and limited doctor-patient communication were identified as key drivers of antibiotic use. Completion and accuracy of electronic patient records were highly variable. Prevalence of antibiotic resistance in this rural population is relatively low despite high levels of antibiotic prescribing and self-medication. More systematic use of e-records and in-service training could improve antibiotic surveillance and stewardship in rural facilities. Combining qualitative and observational anthropological methods and concepts with microbiological and epidemiological investigation of antibiotic resistance at both research design and analytic synthesis stages substantially increases the validity of research findings and their utility in informing future intervention development.Item Unpacking Social Factors of Antimicrobial Resistance in Rural China(2022-02) Kadetz, PaulItem Critical Conversations and A Call to Action!: A collective report from the June 2020 virtual gathering(Queen’s University Library, 2021-10-24) Arif, Shehla; Avery, Leanne; Ba-Aoum, Mohammed; Baillie, Caroline; Baptiste, Sara; Brownwell, Sarah; Byrne, Chris; Catalano, George; Chahim, Dean Mohammed; Cunningham, Andrew; Feinblatt, Eric; Fernandez, Steve; Forero, Camilo Andres Navarro; Gupta, Minoo; Haralampides, Katy; Harnisch, Emma; Herring, Callie; Hobbs, Rachel; Hyde, Rosie; Iyer, Deepak; Jones, Sharon; Kadetz, Paul; Kilic-Bahi, Semra; Lander, Daniel Chapman; Leaning, Foha; Lehr, Jane; Lurkis, Elisa; Lynch, Ellen; Major, Justin; Matovic, Darko; McCann, Jerry; McMillan, Janice; Mir, Darakhshan; Newbold, Chelsea; Osorio, Carlos; Ottinger, Gwen; Petroff, Meera; Rozo, Juan David Reina; Riley, Donna; Schlemer, Lizabeth T.; Shafer, Alex; Shetler, Melissa; Smit, Renee; Stefanski, Kelly; Stein, Debbie; Stenger, Katelyn; Stoddard, Elisabeth; Taylor, Jessica; Telliel, Yunus; Thornton, Jacqueline; Trenshaw, Kyle; Tshirgi, Necla; Tushaus, Chase; Ulakovic, Nicole; Vega, Julianne; Wallin, Patric; Wertz, Robert; Yoffee, Elicia; Zarazaga, JessieCritical Conversations are held by members of the greater Engineering, Social Justice, and Peace network in the activist tradition of reflecting on our public engagement and collectively discovering ways of deepening our action. The particpants are selected based on their submissions (Expressions of Interest) in response to the Call for Participation in the Critcial Conversations disseminated through the ESJP website (esjp.org). For years, we have gathered in locations immersed in nature. In 2018 and 2019, the gathering took place in Cala Munda, organized by Caroline Baillie and Eric Feinblatt, in the beautiful Catskills mountains in upstate New York in the U.S.A. We want to feel our connection with the land while we engage in critical conversations on the intersection of the engineering field with social justice and peace. Caroline Baillie facilitates these conversations employing forest pedagogy. Through this pedagogy, we open our hearts to the forest for seeking guidance on how our profession can help restore, heal, and serve people, planet, and life instead of its current practice of destroying, pillaging, and harming nature. In the throes of the coronavirus pandemic, the urgency of action was evident in 2020 like never before. On June 26 and 27, 2020, a group of up to 40 educators, researchers, activists, and field practitioners, from 4 continents, met virtually for the 4th Annual Critical Conversations – almost thrice as large as the 2018 and 2019 groups that met in-person. The virtual format allowed for broader participation – both in numbers as well as geographical locations. Though we were physically separated in the online gathering, situated in our respective modern, often disconnected-from-nature enclaves, our hearts and minds were engaged in envisioning transition to a just and egalitarian society. In keeping with the need of the moment, our focus was on brainstorming action projects that we can implement in the near future. The retreat facilitated the formation of action teams, which spent the summer discussing possible action items moving forward. These teams are now looking for a more permanent structure with team leaders, team members, an infrastructure, and social media presence. This is a call to action! We carried out these deliberations in an open-space format, wherein the agenda for the two days was set by the participants. In the two sessions on day one, using this participatory approach, we were able to sift six main themes that participants were interested in exploring in-depth. On day two, we divided ourselves into six teams and each team took a deeper dive into their theme of choice. Five of these teams have written summaries of their deliberations and proposed their Calls to Action for the engineering community, which we report below.Item A multi-country phase 2 study to evaluate the suitcase lab for rapid detection of SARS-CoV-2 in seven Sub-Saharan African countries: Lessons from the field(Elsevier, 2023-03-03) Ceruti, Arianna; Dia, Ndongo; Bakarey, Adeleye Solomon; Ssekitoleko, Judah; Andriamandimby, Soa Fy; Malwengo-Kasongo, Padra; Ahmed, Rasheeda H.A.; Kobialka, Rea Maja; Heraud, Jean Michel; Diagne, Moussa Moise; Dione, Marie Henriette Dior; Dieng, Idrissa; Faye, Martin; Faye, Ousmane; Rafisandratantsoa, Jean Théophile; Ravalohery, Jean-Pierre; Raharinandrasana, Claudio; Randriambolamanantsoa, Tsiry H.; Razanajatovo, Norosoa; Razanatovo, Iony; Rabarison, Joelinotahina H.; Dussart, Phillipe; Kyei-Tuffuor, Louis; Agbanyo, Abigail; Adewumi, Olubusuyi Moses; Fowotade, Adeola; Raifu, Muideen Kolawole; Okitale-Talunda, Patient; Kashitu-Mujinga, Gracia; Mbelu-Kabongo, Christelle; Ahuka-Mundeke, Steve; Makaka-Mutondo, Anguy; Abdalla, Enas M.; Idris, Sanaa M.; Elmagzoub, Wisal A.; Ali, Rahma H.; Nour, Eman O.M.; Ebraheem, Rasha S.M.; Ahmed, Huda H.H.; Abdalla, Hamadelniel E.; Elnegoumi, Musab; Mukhtar, Izdihar; Adam, Muatsim A.M.; Mohamed, Nuha Y.I.; Bedri, Shahinaz A.; Hamdan, Hamdan Mustafa; Kisekka, Magid; Mpumwiire, Monica; Aloyo, Sharley Melissa; Wandera, Joanita Nabwire; Agaba, Andrew; Kamulegeya, Rogers; Kiprotich, Hosea; Kateete, David Patrick; Kadetz, Paul; Truyen, Uwe; Eltom, Kamal H.; Sakuntabhai, Anavaj; Okuni, Julius Boniface; Makiala-Mandanda, Sheila; Lacoste, Vincent; Ademowo, George Olusegun; Frimpong, Michael; Sall, Amadou Alpha; Weidmann, Manfred; Wahed, Ahmed Abd ElBackground : The COVID-19 pandemic led to severe health systems collapse, as well as logistics and supply delivery shortages across sectors. Delivery of PCR related healthcare supplies continue to be hindered. There is the need for a rapid and accessible SARS-CoV-2 molecular detection method in low resource settings. Objectives : To validate a novel isothermal amplification method for rapid detection of SARS-CoV-2 across seven sub-Sharan African countries. Study design : In this multi-country phase 2 diagnostic study, 3,231 clinical samples in seven African sites were tested with two reverse transcription Recombinase-Aided Amplification (RT-RAA) assays (based on SARS-CoV-2 Nucleocapsid (N) gene and RNA-dependent RNA polymerase (RdRP) gene). The test was performed in a mobile suitcase laboratory within 15 minutes. All results were compared to a real-time RT-PCR assay. Extraction kits based on silica gel or magnetic beads were applied. Results : Four sites demonstrated good to excellent agreement, while three sites showed fair to moderate results. The RdRP gene assay exhibited an overall PPV of 0.92 and a NPV of 0.88. The N gene assay exhibited an overall PPV of 0.93 and a NPV 0.88. The sensitivity of both RT-RAA assays varied depending on the sample Ct values. When comparing sensitivity between sites, values differed considerably. For high viral load samples, the RT-RAA assay sensitivity ranges were between 60.5 and 100% (RdRP assay) and 25 and 98.6 (N assay). Conclusion : Overall, the RdRP based RT-RAA test showed the best assay accuracy. This study highlights the challenges of implementing rapid molecular assays in field conditions. Factors that are important for successful deployment across countries include the implementation of standardized operation procedures, in-person continuous training for staff, and enhanced quality control measures.Item Health diplomacy or health dependency: A critical assessment of China’s health aid to Madagascar(The China Global South Project, 2020-07-21) Kadetz, Paul
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