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 Peace of mind: A quasi-experimental, mixed-method evaluation of a community-based mental health intervention for persons affected by Neglected Tropical Diseases(Public Library of Science, 2025-09-04) Seekles, Maaike L.; Nganda, Motto; Kadima, Jacob; Sempé, Lucas; Kim, Joy; Omumbu, Pierre; Kukola, Junior; Ngenyibungi, Stephanie M.; Ngondu, Florent; Sabuni, Louis; Dean, LauraEvidence consistently shows high levels of mental distress amongst populations affected by skin NTDs. Self-help groups are thought to be a key intervention strategy to support affected persons. However, to date, self-help interventions have largely been concerned with physical improvements as opposed to psychological outcomes. This paper provides an evaluation of the impact of the ‘Peace of Mind’ intervention in Kasai Province, DRC. Peace of Mind was a community-based, peer-led mental health intervention, combining lay counselling, mutual support, self-care, and income generation activities within a self-help group model to address health, psychosocial and economic impacts of skin-NTDs. This mixed-methods study used a quasi-experimental difference-in-difference approach. A survey measured levels of depression, anxiety, and stigma before and after intervention. To facilitate data matching, machine learning was used to predict (based on age, sex, health zone and disability status) which participants in the baseline would have attended the self-help groups. In addition, qualitative and participatory methods including photovoice, in-depth interviews and key informant interviews were completed to elicit the experiences of group members and health staff. Our findings show that after 6 months of intervention this holistic approach was effective at reducing levels of depression (PHQ-9 score reduction ranging on average from -3.5 to -6.7 points, p < .05) and anxiety (GAD-7 score reduction from -2.0 to -3.3 points, p < .05) in persons affected by skin NTDs. However, the prevalence of depression (64%) and anxiety (52%) remained high with suicidal thoughts reported by 35% of respondents at endline. Whilst we found no impact on stigma scores, qualitative data indicated improvements to self-esteem and ability to take part in community life. To our knowledge, this is the first study in the DRC to evaluate the impact of a community-based, peer-led intervention on mental health outcomes of persons affected by skin-NTDs. Holistic self-help groups have the potential to serve as a key component of integrated NTD/mental health service provision at community-level. However, this should be accompanied by the integration of stigma-reduction strategies, the strengthening of primary health care capacities, and the establishment of mental health services at secondary and tertiary care levels.Item ‘The Lost Peace’: Evidencing the Syndemic Relationship between Neglected Tropical Diseases and Mental Distress in Liberia(MDPI AG, 2024-08-17) McCollum, Rosalind; Barrett, Carrie; Zawolo, Georgina; Johnstone, Rachel; Godwin-Akpan, Tiawanlyn G.; Berrian, Hannah; Chowdhury, Shahreen; Kollie, Jerry; Kollie, Karsor; Rogers, Emerson; Parker, Colleen; Phillip, Maneesh; Sempé, Lucas; Seekles, Maaike; Smith, John Solunta; Seekey, Wede; Wickenden, Anna; Zaizay, Zeela; Theobald, Sally; Dean, LauraNeglected Tropical Diseases (NTDs) are a group of chronic infectious diseases of poverty affecting over one billion people globally. Intersections of NTDs, disability, and mental ill-health are increasingly evidenced but are rarely studied from a mixed-methods perspective. Here, we advance syndemic understandings by further assessing and contextualising the syndemic relationship between NTDs (particularly their associated disability) and mental distress in Liberia. Participatory qualitative methods, including body mapping (56 participants), social mapping (28 participants), and in-depth interviews (12) provided space for persons affected by NTDs to narrate their experiences. Simultaneously, 201 surveys explored experiences of common mental health conditions among persons affected by skin NTDs. An intersectionality approach was applied within the analysis for both qualitative and quantitative methods informed by Meyer’s minority stress model, adapted for NTDs. Qualitative data was analysed thematically and gender-disaggregated, univariable and multivariable analyses were applied to survey data for the outcome measures depression (PHQ-9) and anxiety (GAD-7). Disability was associated with higher levels of depression and anxiety (p < 0.001). An interaction between disability and being a women increased incidence risk ratio of depression (p < 0.001). In alignment with qualitative findings, persons affected experienced additional generalised (financial concerns), external (experience of stigma) and internal (experience of pain and physical symptoms) minority stressors, to varying degrees, which contributed towards their mental distress, and mental health conditions. These findings were used to co-develop a syndemic-informed person-centred health system response to address the suffering associated with NTDs and mental distress, including a focus on strengthening relationships between formal and informal community health actors and the broader health system.Item Balance de la Estrategia de Acompañamiento Pedagógico en Áreas Rurales de Perú en la Lógica del Presupuesto de Resultados(2015-12-17) Sempé, LucasLa presente investigación analiza la estrategia nacional llamada “Acompañamiento pedagógico” promovida por el Ministerio de Educación del Perú desde el año 2008, centrada en escuelas multi-grado rurales con lengua castellana y bilingues. La investigación se centra en los logros de aprendizaje de sus estudiantes así como evaluar y recomendar mejoras en su implementación. El primer objetivo fue determiner si existe diferencia significativa entre escuelas que han recibido acompañamiento pedagógico y aquellas que no han recibido en las pruebas nacionales tomadas a alumnus de segundo grado de primaria en comprensión lectora y matemáticas. Para ello se realizaron diversos tests de análisis de varianzas mixtas. Los hallazgos demuestran que han habido interacciones estadísticamente significativas entre recibir acompañamiento pedagógico por 3 años, lo cual indica que la estrategia es efectiva a fin de mejorar los aprendizajes de los estudiantes. La segunda meta de la investigación fue analizar la estrategia de acuerdo a la lógica subyacente en la política nacional de presupuesto por resultados en la que se enmarca la estrategia. Se realizó una revision y análisis documental, centrándose en el diseño lógico, focalización, organización y gasto público. Se encontraron inconsistencias en el diseño, problema de cobertura y la ausencia de estándares claros de organización.Item Diseño de un sistema de seguimiento de egresados y una estrategia para la implementación de dicho sistema(Mejoramiento de la Calidad de la Educación Superior PROCALIDAD, 2018-01-02) Mori Valenzuela, Jorge; Sempé, Lucas; Colquehuanca Achulli, Raymundo; Guerrero Ortiz, Luis; Andrade Pacora, Patricia; Gargurevich Valdéz, José; Silva Martínez, JoséEl documento caracteriza y describe el proceso del Seguimiento a Egresados en Instituciones de Educación Superior - IES, y sus vínculos con los mecanismos de toma de decisiones que favorezcan a los egresados en su inserción y trayectoria laboral, así como con los procesos institucionales de diseño curricular y de formación académica de la IES. La consultoría fue realizado por el consorcio conformado entre ENACCION y la Universidad Marcelino Champagnat.Item Multidisciplinary interventions for reducing the avoidable displacement from home of frail older people: a systematic review(BMJ Publishing Group, 2019-11-02) Sempé, Lucas; Billings, Jenny; Lloyd-Sherlock, PeterObjectives To synthesise existing literature on interventions addressing a new concept of avoidable displacement from home for older people with multimorbidity or frailty. The review focused on home-based interventions by any type of multidisciplinary team aimed at reducing avoidable displacement from home to hospital settings. A second objective was to characterise these interventions to inform policy. Design A systematic search of the main bibliographic databases was conducted to identify studies relating to interventions addressing avoidable displacement from home for older people. Studies focusing on one specific condition or interventions without multidisciplinary teams were excluded. A narrative synthesis of data was conducted, and themes were identified by using an adapted thematic framework analysis approach. Results The search strategy was performed using the following electronic databases: the American National Library of Medicine and the National Institutes of Health (PubMed), Scopus, Cochrane Library (Central and CDRS), CINAHL, Social Care Online, Web of Science as well as the database of the Latin American and Caribbean Health Sciences Literature. The database search was done in September 2018 and completed in October 2018. Overall 3927 articles were identified and 364 were retained for full text screening. Fifteen studies were included in the narrative review. Four themes were identified and discussed: (1) types of interventions, (2) composition of teams, (3) intervention effectiveness and (4) types of outcomes. Within intervention types, three categories of care types were identified; transitional care, case-management services and hospital at home. Each individual article was assessed in terms of risk of bias following Cochrane Collaboration guidelines. Conclusions The review identified some potential interventions and relevant topics to be addressed in order to develop effective and sustainable interventions to reduce the avoidable displacement from home of older people. However the review was not able to identify robust impact evidence, either in terms of quantity or quality from the studies presented. As such, the available evidence is not sufficiently robust to inform policy or interventions for reducing avoidable displacement from home. This finding reflects the complexity of these interventions and a lack of systematic data collection.Item Meeting the complex challenge of health and social care provision for rapidly-ageing populations: introducing the concept of “avoidable displacement from home”(SciELO - Scientific Electronic Library Online, 2020-04-03) Lloyd-Sherlock, Peter; Billings, Jenny; de Souza Aredes, Janaína; Freire Neto, João Bastos; Camarano, Ana Amélia; Macedo Coelho Filho, João; Firmo, Josélia Oliveira Araújo; Kalache, Alexandre; Macinko, James; Sempé, Lucas; Giacomin, Karla CristinaThe increasing numbers of people at very old ages pose specific policy challenges for health and social care and highlight the need to rethink established models of service provision. The main objective of this paper is to introduce the concept of “avoidable displacement from home” (ADH). The study argues that ADH builds on and adds value to existing concepts, offering a holistic, person-centered framework for integrated health and social care provision for older people. It also demonstrates that this framework can be applied across different levels, ranging from macro policymaking to organizational and individual decision-making. The paper pays attention to the Brazilian context but argues that ADH is a universally applicable concept.Item School-level inequality measurement based categorical data: a novel approach applied to PISA(Springer, 2021-05-03) Sempé, LucasThis paper introduces a new method to measure school-level inequality based on Item Response Theory (IRT) models. Categorical data collected by large-scale assessments poses diverse methodological challenges hinder measuring inequality due to data truncation and asymmetric intervals between categories. I use family possessions data from PISA 2015 to exemplify the process of computing the measurement and develop a set of country-level mixed-effects linear regression models comparing the predictive performance of the novel inequality measure with school-level Gini coefficients. I find school-level inequality is negatively associated with learning outcomes across many non-European countries.Item Estimation of all-cause excess mortality by age-specific mortality patterns for countries with incomplete vital statistics: a population-based study of the case of Peru during the first wave of the COVID-19 pandemic(Elsevier, 2021-08-20) Sempé, Lucas; Lloyd-Sherlock, Peter; Martínez, Ramón; Ebrahim, Shah; McKee, Martin; Acosta, EnriqueBackground All-cause excess mortality is a comprehensive measure of the combined direct and indirect effects of COVID-19 on mortality. Estimates are usually derived from Civil Registration and Vital Statistics (CRVS) systems, but these do not include non-registered deaths, which may be affected by changes in vital registration coverage over time. Methods Our analytical framework and empirical strategy account for registered mortality and under-registration. This provides a better estimate of the actual mortality impact of the first wave of the COVID-19 pandemic in Peru. We use population and crude mortality rate projections from Peru's National Institute of Statistics and Information (INEI, in Spanish), individual-level registered COVID-19 deaths from the Ministry of Health (MoH), and individual-level registered deaths by region and age since 2017 from the National Electronic Deaths Register (SINADEF, in Spanish). We develop a novel framework combining different estimates and using quasi-Poisson models to estimate total excess mortality across regions and age groups. Also, we use logistic mixed-effects models to estimate the coverage of the new SINADEF system. Findings We estimate that registered mortality underestimates national mortality by 37•1% (95% CI 23% - 48•5%) across 26 regions and nine age groups. We estimate total all-cause excess mortality during the period of analysis at 173,099 (95% CI 153,669 - 187,488) of which 108,943 (95% CI 96,507 - 118,261) were captured by the vital registration system. Deaths at age 60 and over accounted for 74•1% (95% CI 73•9% - 74•7%) of total excess deaths, and there were fewer deaths than expected in younger age groups. Lima region, on the Pacific coast and including the national capital, accounts for the highest share of excess deaths, 87,781 (95% CI 82,294 - 92,504), while in the opposite side regions of Apurimac and Huancavelica account for less than 300 excess deaths. Interpretation Estimating excess mortality in low- and middle-income countries (LMICs) such as Peru must take under-registration of mortality into account. Combining demographic trends with data from administrative registries reduces uncertainty and measurement errors. In countries like Peru, this is likely to produce significantly higher estimates of excess mortality than studies that do not take these effects into account.Item Building the capacity of community health workers to support health and social care for dependent older people in Latin America: a pilot study in Fortaleza, Brazil(BioMed Central, 2021-10-02) Neto, João Bastos Freire; de Moraes, Gerídice Lorna Andrade; de Souza Aredes, Janaína; Giacomin, Karla Cristina; de Melo, Luciane Ponte; Sempé, Lucas; Lloyd-Sherlock, PeterBackground Brazil is seeing rapid population ageing, which is leading to new demands on primary health care services. There is a need to develop and assess the effectiveness of new interventions to build the capacity of staff, including community health workers, to meet the needs of groups such as care-dependent older people and their care-givers. This study examines the feasibility of a small training intervention piloted in the Brazilian city of Fortaleza. Methods The study evaluated participants’ own assessments of key knowledge and skills related to the needs of care-dependent older people, both before and after the training intervention. It also assessed their capacity to implement a simple screening tool of geriatric risk factors. Results The participant self-assessments indicate significant improvements in their perceived knowledge and capacity in responding to the health needs of care-dependent older people. Additionally, participants were able to successfully conduct the home visits and screening for risk factors. Conclusions The study demonstrates the feasibility of developing interventions to enhance the capacity of community health workers to meet the needs of dependent older people in countries like Brazil. The evidence of effectiveness, though limited and subjective, provides justification for a larger, formally evaluated intervention. The experience of Fortaleza provides valuable lessons for other cities and countries in the region which are facing similar challenges.