"It's because We are 'Loose Girls' That's why We had Children with MINUSTAH Soldiers": A Qualitative Analysis of Stigma Experienced by Peacekeeper-Fathered Children and Their Mothers in Haiti.

Sexual abuse and exploitation (SEA) perpetrated by UN peacekeepers while on mission is a violation of human rights and undermines the goal of upholding human rights in countries that host peacekeeping missions. In addition to survivors, children fathered by peacekeepers are also victims of SEA that need protection. Stigma poses negative life course consequences for SEA survivors and their peacekeeper-fathered children. However, there is a considerable lack of empirical research concerning the stigma experiences of SEA survivors and their children in post-colonial contexts. The present study addresses this knowledge gap by drawing on The United Nations Stabilization Mission in Haiti as a case study to examine the lived experiences of stigma among SEA survivors and their resultant children. Using 18 qualitative semi-structured interviews conducted in 2017 with Haitian women raising peacekeeper-fathered children, we organized qualitative codes according to Link and Phelan's conceptual model of stigma. The stigmatization process was explored through the themes of labeling, stereotyping, separation, and status loss and discrimination, as described by Link and Phelan. In addition, we nuanced the lived experiences of stigma by discussing the buffering roles of familial acceptance, skin phenotype, and the Haitian context. The findings have implications for the UN. We advocate that stigma be recognized and acted upon as a fundamental protection concern for SEA survivors and their children. Accordingly, the UN has an obligation to provide stigma-related supports for victims and complainants as well as to facilitate long-term child support for the children left behind by peacekeepers.

Implementation of a neonatal hepatitis B immunization program in rural Karenni State, Myanmar: A mixed-methods study.

BACKGROUND: Hepatitis B infection is a major health concern in Myanmar. Hepatitis B birth dose vaccination to prevent mother-to-child transmission is not universal, especially in births outside of health care facilities. Little is documented about delivery of immunization programs in rural Myanmar or in conflict-affected regions. To address this gap, this study describes the implementation of a novel community delivered neonatal hepatitis B immunization program in rural Karenni State, Myanmar. METHODS: A mixed-methods study assessed the effectiveness and feasibility of hepatitis B birth dose immunization program. 1000 pregnant women were screened for hepatitis B virus (HBV) infection using point of care testing. Neonates of HBV positive mothers were immunized with a three dose HBV vaccine schedule at birth, 1, and 6 months of age. HBV testing was completed for children at 9 months to assess for infection. Descriptive statistics were collected including demographic data of mothers, neonatal vaccination schedule completion, and child HBV positivity at 9 months. Qualitative data examining barriers to implementation were collected through semi-structured interviews, participant-observation, and analysis of program documents. Themes were codified and mapped onto the Consolidated Framework for Implementation Research. RESULTS: 46 pregnant women tested HBV positive leading to 40 live births. 39 women-child dyads were followed until the 9-month age mark. With the exception of two neonates who received their birth dose past 24 hours, all children received their vaccines on time. None of the 39 children tested positive for HBV at nine months. Themes regarding barriers included adaptability of the program to the rural setting, friction with other stakeholders and not meeting all needs of the community. Identified strengths included good communication and leadership within the implementing ethnic health organization. CONCLUSION: A community delivered neonatal HBV vaccination program by ethnic health organizations is feasible and effective in rural Myanmar.

Malaria amongst febrile children: call for a pediatric malaria assessment tool.

In 2017, malaria accounted for 435 000 deaths worldwide. Eleven percent (11%) of these deaths occurred in the Democratic Republic of Congo (DRC), where malaria continues to be a leading cause of morbidity and mortality. Children are amongst the most vulnerable to malaria, which causes 40% of childhood deaths in the country. Although many risk factors for developing malaria have been identified, there is a paucity of data available on the sociodemographic risk factors for pediatric malaria. A cross-sectional study including 131 febrile children aged 2 months to 14 years presenting to Heal Africa Hospital due to febrile illness. Guardians of participants answered a questionnaire about household and maternal characteristics, as well as child symptomatology. Malaria status was confirmed via blood smear. Results were analyzed using the chi-square test, likelihood ratios and a logistic regression. The absence of father as head of household (p=0.011) and gestational malaria (p=0.044) were significantly associated with pediatric malaria. This study provides insight into sociodemographic risk factors associated with pediatric malaria in the DRC. While further investigation is required, this study highlights the benefit of considering these factors when approaching the febrile child. A pediatric malaria assessment tool incorporating socio-demographics, symptoms and physical exam findings may guide investigations to reduce unnecessary testing and provide better patient-centred care.

Participant and narrative characteristics associated with host community members sharing experiences of peacekeeper-perpetrated sexual exploitation and abuse in the Democratic Republic of Congo.

INTRODUCTION: Peacekeeper-perpetrated sexual exploitation and abuse (SEA) in the Democratic Republic of Congo (DRC) account for 36% of the global reports of formal SEA allegations to the UN between 2007 and 2021. However, formally reported SEA represents only a fraction of that which occurs, and community experiences of peacekeeper-perpetrated SEA are likely different than those reflected in official UN documents. METHODS: Using mixed-methods, cross-sectional data collected in the DRC in 2018, we used descriptive analysis and multivariate Poisson regression with robust error estimates to examine the participant and narrative characteristics associated with sharing an experience about peacekeeper-perpetrated SEA. RESULTS: Participants in Bukavu (adjusted relative risk (aRR) 0.85, 95% CI 0.79 to 0.91) and Kalemie (aRR 0.75, 95% CI 0.69 to 0.81) were less likely to share narratives about sexual interactions, while civilian UN personnel (aRR 1.16, 95% CI 1.00 to 1.34) were slightly more likely to be implicated in narratives about sexual interactions. Narratives in which the outcome was deemed fair to the woman/girl were more likely to be about sexual interactions (aRR 1.07, 95% CI 1.02 to 1.12). Both the regression analysis and the participants' interpretation of the shared narratives illustrated the significant role poverty played in SEA, suggesting that the outcomes of sexual interactions may have been deemed fair since affected women/girls were perceived to have benefited financially/materially. CONCLUSION: There is significant variation between host communities in the likelihood of sharing narratives about SEA, which could prove useful for informing more targeted SEA prevention initiatives. Narratives about sexual interactions with UN personnel were more often deemed to have fair outcomes for the affected women/girls, likely related to ongoing poverty in host communities and perceived financial/material gain. These findings highlight how extreme poverty may impact perceptions around informed consent as well as fairness and require further study. Perceptions around fair outcomes would disincentivise formal reporting, which needs to be considered when devising community-based complaint networks.

Late abdominal pregnancy in a post-conflict context: case of a mistaken acute abdomen - a case report.

BACKGROUND: Abdominal pregnancies have been reported in both high-income countries as well as low- and middle-income countries. They are frequently missed in routine antenatal care in resource-limited settings and delayed diagnosis is usually associated with poor fetal and maternal outcomes including death. This case report is among the first from eastern Democratic Republic of Congo (DRC), a post-conflict region. CASE PRESENTATION: In this case study, we present a 25 year-old primigravida patient referred to HEAL Africa hospital for management of an acute abdomen at 33-weeks gestation. Her chief complaint was severe abdominal pain associated with each fetal movement for a period of 1 week prior to admission. A diagnosis of peritonitis was made. Emergency laparotomy revealed a normal live 2 kg baby with placental implantation on the greater omentum and small intestine mesentery. The placenta was not removed. Both maternal and fetal outcomes were good. CONCLUSION: Abdominal pregnancy with a normal live fetus at such an advanced gestational age is rare. This case reminds clinicians that abdominal pregnancy remains a differential diagnosis for painful fetal movements.

SenseMaker® as a monitoring and evaluation tool to provide new insights on gender-based violence programs and services in Lebanon.

Monitoring and evaluation (M&E) of gender-based violence (GBV) programs is challenging in humanitarian settings. To address these challenges, we used SenseMaker® as a mixed methods M&E tool for GBV services and programs in Lebanon. Over a three-month period in 2018, a total of 198 self-interpreted stories were collected from women and girls accessing GBV programs from six service providers across five locations. The resultant mixed-methods analysis provided holistic and nuanced insights on how perceived benefits differed by type of GBV program, how motivations for accessing programs differed by location, and how feelings while accessing programs differed by participant nationality. SenseMaker reinforced the intersectionality between events leading up to the accessed services, the experiences of accessing the services, and subsequent outcomes as a result of having accessed the services, helping to contextualize the findings within the broader experiences of participating women and girls. Limited literacy and technology skills among participants proved to be a challenge and future work should investigate how technology might facilitate use of the tool among participants with lower literacy and technology skills in addition to exploring the feasibility and added value of SenseMaker as an M&E tool in acute humanitarian settings.

Self-interpreted narrative capture: A research project to examine life courses of Amerasians in Vietnam and the United States.

When American troops withdrew from Vietnam in April 1975, they left behind a large number of children fathered by American GIs and born to local Vietnamese women. Although there is some documentation of experiences of GI children who immigrated to the United States, little is known about the life courses of Amerasian children who remained in Vietnam, and no comparative data has been collected. To address this knowledge gap, we used an innovative mixed qualitative - quantitative data collection tool, Cognitive Edge's SenseMaker®, to investigate the life experiences of three specific cohorts of GI-fathered children from the Vietnam War: (1) those who remained in Vietnam, (2) those who immigrated to the United States as babies or very young children and (3) those who immigrated to the United States as adolescents or adults. The current analysis reflects on the implementation of this mixed-methods narrative data collection and self-interpretation tool as a research methodology in Vietnam and the United States and outlines some of the challenges and lessons learned including recruitment of a hard to reach population, low response rates in the United States and feasibility of using such narrative capture to conduct such research in the United States and in Vietnam.

Making sense of child, early and forced marriage among Syrian refugee girls: a mixed methods study in Lebanon.

INTRODUCTION: The Syrian conflict has resulted in over 2.3 million child refugees in the Middle East and the prevalence of early marriage has reportedly increased among displaced Syrian families. This study explores the underlying factors contributing to child marriage among Syrian refugees in Lebanon with the goal of informing community-based strategies to address the issue. METHODS: In July-August 2016, trained interviewers collected self-interpreted stories in Lebanon using Cognitive Edge's SenseMaker, a mixed-method data collection tool. Participants included married and unmarried Syrian girls, Syrian parents as well as married and unmarried men. Each participant shared a story about the experiences of Syrian girls and then interpreted the story by plotting their perspectives on a variety of questions. Patterns in the responses were analysed in SPSS and the accompanying qualitative narratives were reviewed to facilitate interpretation of the quantitative results. RESULTS: 1422 self-interpreted stories from 1346 unique participants were collected with 40% of shared stories focused on (n=332) or mentioning (n=245) child marriage. Quantitative data summarised the different perspectives of female and male participants. Syrian girls and mothers were more likely to share stories about protection/security and/or education and were more likely to report that girls were overprotected. Male participants were more likely to share stories about financial security as well as sexual exploitation of girls and more often reported that girls were not protected enough. Despite these gendered perspectives, many of the shared narratives highlighted similar themes of financial hardship, lack of educational opportunities and safety concerns around sexual and gender-based violence (SGBV). CONCLUSIONS: A complex myriad of factors contribute to early marriage including poverty, lack of educational opportunities and concerns about SGBV. Sexual exploitation under the guise of marriage is a reality for some Syrian girls. Gender-specific strategies to address child marriage might be more effective in reducing this harmful practice.