COVID-19 and mental health in 8 low- and middle-income countries: A prospective cohort study.

BACKGROUND: The Coronavirus Disease 2019 (COVID-19) pandemic and associated mitigation policies created a global economic and health crisis of unprecedented depth and scale, raising the estimated prevalence of depression by more than a quarter in high-income countries. Low- and middle-income countries (LMICs) suffered the negative effects on living standards the most severely. However, the consequences of the pandemic for mental health in LMICs have received less attention. Therefore, this study assesses the association between the COVID-19 crisis and mental health in 8 LMICs. METHODS AND FINDINGS: We conducted a prospective cohort study to examine the correlation between the COVID-19 pandemic and mental health in 10 populations from 8 LMICs in Asia, Africa, and South America. The analysis included 21,162 individuals (mean age 38.01 years, 64% female) who were interviewed at least once pre- as well as post-pandemic. The total number of survey waves ranged from 2 to 17 (mean 7.1). Our individual-level primary outcome measure was based on validated screening tools for depression and a weighted index of depression questions, dependent on the sample. Sample-specific estimates and 95% confidence intervals (CIs) for the association between COVID-19 periods and mental health were estimated using linear regressions with individual fixed effects, controlling for independent time trends and seasonal variation in mental health where possible. In addition, a regression discontinuity design was used for the samples with multiple surveys conducted just before and after the onset of the pandemic. We aggregated sample-specific coefficients using a random-effects model, distinguishing between estimates for the short (0 to 4 months) and longer term (4+ months). The random-effects aggregation showed that depression symptoms are associated with a increase by 0.29 standard deviations (SDs) (95% CI [-.47, -.11], p-value = 0.002) in the 4 months following the onset of the pandemic. This change was equivalent to moving from the 50th to the 63rd percentile in our median sample. Although aggregate depression is correlated with a decline to 0.21 SD (95% CI [-0.07, -.34], p-value = 0.003) in the period thereafter, the average recovery of 0.07 SD (95% CI [-0.09, .22], p-value = 0.41) was not statistically significant. The observed trends were consistent across countries and robust to alternative specifications. Two limitations of our study are that not all samples are representative of the national population, and the mental health measures differ across samples. CONCLUSIONS: Controlling for seasonality, we documented a large, significant, negative association of the pandemic on mental health, especially during the early months of lockdown. The magnitude is comparable (but opposite) to the effects of cash transfers and multifaceted antipoverty programs on mental health in LMICs. Absent policy interventions, the pandemic could be associated with a lasting legacy of depression, particularly in settings with limited mental health support services, such as in many LMICs. We also demonstrated that mental health fluctuates with agricultural crop cycles, deteriorating during "lean", pre-harvest periods and recovering thereafter. Ignoring such seasonal variations in mental health may lead to unreliable inferences about the association between the pandemic and mental health.

Prioritizing vulnerable populations and women on the frontlines: COVID-19 in humanitarian contexts.

The COVID-19 outbreak has been declared a global pandemic and cases are being reported among displaced populations that are particularly vulnerable to infection. Humanitarian workers on the frontlines of the response are working in some of the most challenging contexts and also face elevated risk of contracting COVID-19 and potential stigmatization or violence in the community. Women humanitarians may be at even greater risk, but their protection is dependent on organization-specific policies and procedures. Without gender balance in leadership positions, the specific needs of women may not be prioritized and women may not be included in decision-making or design of responses. Ensuring gender equitable access to personal protective equipment and information is imperative, but additional measures must be put into place to ensure the protection of women on the frontlines while reducing COVID-19 deaths and adverse health effects among displaced populations.

Homogenization of freshwater lakes: Recent compositional shifts in fish communities are explained by gamefish movement and not climate change.

Globally, lake fish communities are being subjected to a range of scale-dependent anthropogenic pressures, from climate change to eutrophication, and from overexploitation to species introductions. As a consequence, the composition of these communities is being reshuffled, in most cases leading to a surge in taxonomic similarity at the regional scale termed homogenization. The drivers of homogenization remain unclear, which may be a reflection of interactions between various environmental changes. In this study, we investigate two potential drivers of the recent changes in the composition of freshwater fish communities: recreational fishing and climate change. Our results, derived from 524 lakes of Ontario, Canada sampled in two periods (1965-1982 and 2008-2012), demonstrate that the main contributors to homogenization are the dispersal of gamefish species, most of which are large predators. Alternative explanations relating to lake habitat (e.g., area, phosphorus) or variations in climate have limited explanatory power. Our analysis suggests that human-assisted migration is the primary driver of the observed compositional shifts, homogenizing freshwater fish community among Ontario lakes and generating food webs dominated by gamefish species.

Rejection, acceptance and the spectrum between: understanding male attitudes and experiences towards conflict-related sexual violence in eastern Democratic Republic of Congo.

BACKGROUND: Female survivors of sexual violence in conflict experience not only physical and psychological sequelae from the event itself, but often many negative social outcomes, such as rejection and ostracisation from their families and community. Male relatives - whether husbands, fathers, brothers - play a key role in determining how the family and community respond to a survivor of sexual violence. Understanding these perspectives could help improve services for survivors of sexual violence, as well as their families and communities. METHODS: This study draws on qualitative data gathered from focus groups of 68 men in the eastern region of Democratic Republic of Congo. Men were asked about their experiences as relatives of women who had experienced sexual violence. RESULTS: Two dominant themes arose throughout the focus groups: factors driving rejection and pathways to acceptance. Factors driving rejection included: fear of sexually transmitted infections, social stigma directed toward the husbands themselves, and an understanding of marriage and fidelity that is incompatible with rape. Men also touched on their own trauma, including struggling with witnessing a rape that took place in public, or caring for a survivor with a child from rape. They noted that the economic burden of medical treatment for survivors was a salient factor in the decision to reject. Pathways to acceptance included factors such as the love of their spouse or relative, survivors' potential to give continued financial contribution to the family, the need to keep the family together to care for children in the home, and pressure from people of importance in the community. CONCLUSION: This study provides unique insight into how male relatives respond to close family members who have experienced sexual violence. This is particularly critical since the reaction of a male relative after rape can be the most pivotal factor in promoting or impeding recovery for a survivor. These results emphasise the importance of services that focus not only on the survivor of violence herself, but also on key family members that can ideally help support her recovery.

Stigmatisation and rejection of survivors of sexual violence in eastern Democratic Republic of the Congo.

Studies report that between 6 per cent and 29 per cent of survivors of sexual violence in eastern Democratic Republic of the Congo (DRC) are rejected by their families and communities. This research project was designed to provide insights into survivors' experiences of stigmatisation and rejection. Surveys were conducted with 310 women as they sought psychosocial services in eastern DRC. In total, 44.3 per cent of women reported suffering rejection after sexual violence. The majority of women felt that their status in the household (58.0 per cent) and community (54.9 per cent) diminished after rape. The odds of rejection were greater among women reporting ongoing displacement, pregnancy owing to sexual violence, worsening family relations, and diminished community status. This work highlights the extremely high levels of loss associated with the war in eastern DRC, particularly among survivors of sexual violence. The rejection of a survivor of rape has concrete and devastating psychosocial consequences.

'They have embraced a different behaviour': transactional sex and family dynamics in eastern Congo's conflict.

The decades-long conflict in eastern Democratic Republic of the Congo (DRC) has resulted in major changes to local economies, strained social networks and insecurity. This environment forces many to pursue unconventional and, at times, socially stigmatised avenues for income. This paper explores the ways in which individuals in eastern DRC engage in, and are affected by, the commoditisation of sex within the context of decades of violent conflict. Focus group discussions conducted with men and women in 2009-2010 highlight how the war in the region has placed individuals, particularly women, in dire economic circumstances, while also changing their roles within families. In the face of severe poverty, women and girls may choose to engage in transactional sex in order to support themselves and their families. Discussants detailed how engaging in transactional sex due to an economic imperative has nonetheless damaged women's relationships with family members between spouses as well as parents and their children through breach of trust and failure to provide. These focus group discussions elucidate how transactional sex is both a symptom of, and a catalyst for, changes within family dynamics in eastern DRC.

Drivers of men's use of intimate partner violence in conflict-affected settings: learnings from the Democratic Republic of Congo.

BACKGROUND: Intimate partner violence against women (IPVAW) is prevalent in conflict-affected settings. Yet, there is limited knowledge about the risk factors that influence men's use of IPVAW in conflict-affected settings. This paper adopts a transdisciplinary perspective to understand how experiences hypothesized to increase men's use of IPVAW relate to each other and to men's use of IPVAW. The findings may help researchers and interventionists to better select and target interventions for IPVAW in conflict-affected settings. METHODS: We used baseline data from the Tushinde Ujeuri project in the Democratic Republic of Congo. Men with at least partial data for the variables of interest were included in the analysis (n = 2080). We estimated a structural equation model that explored how five constructs - interpersonal violence, mental health, socioeconomic adversity, gender inequitable attitudes, and conflict violence - influenced men's self-reported past-year use of physical and/or sexual IPVAW. RESULTS: The model had acceptable fit (χ2 = 1576.574, p = 0.000; RMSEA = 0.041; CLI = 0.882; SRMR = 0.055). There was a statistically significant path from interpersonal violence to IPVAW (ß = 0.875; OR = 2.40). Interpersonal violence also was linked to gender inequitable attitudes (ß = 0.364), which were linked to increased use of IPVAW (ß = 0.180; OR = 1.20). Moreover, interpersonal violence was linked to trauma symptoms (ß = 0.331), which were linked to increased use of IPVAW (ß = 0.238; OR = 1.27). Use of IPVAW decreased as conflict exposures increased (ß=-0.036; OR = 0.96), and there was no path from socioeconomic adversity to IPVAW. CONCLUSIONS: Our findings suggest interpersonal violence exposures, trauma symptoms, and gender inequitable attitudes are all risk factors for the use of IPVAW in a conflict-affected setting. While continuing to focus on gender inequitable attitudes and norms, interventionists should also consider addressing men's experiences of victimization and mental wellbeing. Doing so can help to improve trauma symptoms and may hold promise to reduce IPVAW in conflict-affected settings.

Promising practices for the monitoring and evaluation of gender-based violence risk mitigation interventions in humanitarian response: a multi-methods study.

BACKGROUND: Risks of gender-based violence (GBV) are exacerbated in humanitarian crises. GBV risk mitigation interventions aim to reduce exposure to GBV and ensure that humanitarian response actions and services themselves do not cause harm or increase the risk of violence. The 2015 IASC Guidelines for Integrating Gender-Based Violence Interventions in Humanitarian Action ('GBV Guidelines') are a globally endorsed resource that provides comprehensive guidance for all humanitarian actors and sectors on GBV risk mitigation. While uptake of GBV risk mitigation approaches across multiple humanitarian sectors has occurred, there is limited understanding of how to monitor and evaluate GBV risk mitigation interventions. METHODS: A multi-methods study was conducted in 2019 to identify promising practices for the monitoring and evaluation (M&E) of GBV risk mitigation interventions in non-GBV sectors and to develop a set of illustrative case examples. The study included a comprehensive desk review of 145 articles, documents and resources from the published and grey literature, as well as 11 in-depth interviews and five focus group discussions with humanitarian practitioners. Using Dedoose software and a codebook developed a priori, qualitative data were transcribed and coded and a content analysis was conducted. Excerpts focusing on promising practices from the qualitative data and the desk review were analyzed together and grouped by thematic area. Similar promising practices were combined and consolidated to create a final list, and case examples were identified. RESULTS: Current promising practices for M&E of GBV risk mitigation activities in the following categories are described: (1) Coordination and collaboration, (2) Designing M&E approaches and tools for GBV risk mitigation activities, (3) Contextualization, (4) Developing and selecting indicators, (5) Data collection, (6) Data analysis and use of findings, (7) Potential safety concerns for affected populations and staff, and (8) Staff capacity and engagement. These are supplemented with seven diverse case examples to illustrate application of the promising practices using real-world examples. CONCLUSION: This paper highlights current promising practices for M&E of GBV risk mitigation interventions in humanitarian response. Further application of these practices-alongside ongoing documentation of emerging approaches-will be critical to ensuring that GBV risk mitigation interventions are more rigorously tested with the aim of building the evidence base on the effectiveness of different GBV risk mitigation interventions within specific humanitarian sectors.

Sexual violence trends between 2004 and 2008 in South Kivu, Democratic Republic of Congo.

INTRODUCTION: For more than a decade, conflict in the Eastern Democratic Republic of Congo (DRC) has been claiming lives. Within that conflict, sexual violence has been used by militia groups to intimidate and punish communities, and to control territory. This study aimed to: (1) investigate overall frequency in number of Eastern DRC sexual assaults from 2004 to 2008 inclusive; (2) determine if peaks in sexual violence coincide with known military campaigns in Eastern DRC; and (3) study the types of violence and types of perpetrators as a function of time. METHODS: This study was a retrospective, descriptive, registry-based evaluation of sexual violence survivors presenting to Panzi Hospital between 2004 and 2008. RESULTS: A total of 4,311 records were reviewed. Throughout the five-year study period, the highest number of reported sexual assaults occurred in 2004, with a steady decrease in the total number of incidents reported at Panzi Hospital from 2004 through 2008. The highest peak of reported sexual assaults coincided with a known militant attack on the city of Bukavu. A smaller sexual violence peak in April 2004 coincided with a known military clash near Bukavu. Over the five-year period, the number of sexual assaults reportedly perpetrated by armed combatants decreased by 77% (p = 0.086) and the number of assaults reportedly perpetrated by non-specified perpetrators decreased by 92% (p < 0.0001). At the same time, according to the hospital registry, the number of sexual assaults reportedly perpetrated by civilians increased 17-fold (p < 0.0001). This study was limited by its retrospective nature, by the inherent selection bias of studying only survivors presenting to Panzi Hospital, and by the use of a convenience sample within Panzi Hospital. CONCLUSIONS: After years of military rape in South Kivu Province, civilian adoption of sexual violence may be a growing phenomenon. If this is the case, the social mechanisms that prevent sexual violence will have to be rebuilt and sexual violence laws will have to be fully enforced to bring all perpetrators to justice. Proper rehabilitation and reintegration of ex-combatants may also be an important step towards reducing civilian rape in Eastern DRC.

Quantifying the Ripple Effects of Civil War: How Armed Conflict Is Associated with More Severe Violence in the Home.

Both the fields of public health and that of human rights seek to improve human well-being, including through reducing and preventing all forms of violence, to help individuals attain the highest quality of life. In both fields, mathematical methods can help "visibilize" the hidden architecture of violence, bringing new methods to bear to understand the scope and nuance of how violence affects populations. An increasing number of studies have examined how residing in a conflict-affected place may impact one of the most pervasive forms of violence-intimate partner violence (IPV)-during and after conflict. This paper contributes to this effort by examining whether severe forms of IPV are associated with previous experience of political violence in one conflict-affected country: Liberia. Our findings indicate that living in a district with conflict fatalities increased the risk of IPV among women by roughly 60%. Additionally, living in a district with conflict fatalities increased the risk of a past-year injury from IPV by 50%. This analysis brings to light links between two of the most pervasive forms of violence-political violence and violence against women. The findings suggest that women residing in a district that is more highly affected by conflict, not only people experiencing direct trauma during conflict, may be at risk of increased violence long after peace is declared. These findings point to the need for targeted programs that address IPV postconflict.

Measuring gender-based violence risk mitigation in humanitarian settings: results from a comprehensive desk review and systematic mapping.

OBJECTIVES: To systematically document measurement approaches used in the monitoring and evaluation of gender-based violence (GBV) risk mitigation activities, categorise the types of available literature produced by sector, identify existing tools and measures and identify knowledge gaps within the humanitarian sector. DESIGN: Systematic mapping and in-depth review. DATA SOURCES: Pubmed, Global Health, PsychInfo, ReliefWeb, OpenGrey (grey literature), Google Scholar, Web of Science (Social Science Index)Eligibility criteria: a structured search strategy was systematically applied to 17 databases as well as registers, websites and other resources to identify materials published between 1 January 2005 and 15 May 2019. DATA EXTRACTION AND SYNTHESIS: Those resources that met the inclusion criteria underwent a comprehensive full-text review. A detailed matrix was developed and key data from each resource were extracted to allow for the assessment of patterns in thematic areas. RESULTS: A total of 2108 documents were screened. Overall, 145 documents and 112 tools were reviewed, representing 10 different humanitarian sectors. While numerous resources exist, many lack sufficient information on how to monitor outputs or outcomes of GBV risk mitigation activities. There is also limited guidance on how to integrate the measurement of GBV risk mitigation into existing monitoring and evaluation frameworks. Those reports that aimed to measure GBV risk mitigation activities mostly employed qualitative methods and few measured the impact of a GBV risk mitigation with robust research designs. CONCLUSIONS: Recent efforts to adapt humanitarian response to COVID-19 have highlighted new and existing challenges for GBV risk mitigation. There is a significant gap in the evidence base around the effectiveness of GBV risk mitigation across all sectors. Understanding and strengthening measurement approaches in GBV risk mitigation remains a critical task for humanitarian response.

Gender-Based Violence Risk Mitigation by Non-GBV Specialists Prior to and during COVID-19: A Global Survey of Knowledge, Attitudes and Practices of Humanitarian Practitioners.

Available evidence indicates that the COVID-19 pandemic and response measures may lead to increased risk of gender-based violence (GBV), including in humanitarian contexts. This study examined the knowledge, attitudes, and practices of humanitarian practitioners related to GBV risk mitigation approaches during COVID-19 in order to refine current guidance and inform future materials. A global, online cross-sectional survey of humanitarian practitioners was conducted between November 2020 and April 2021. We calculated descriptive statistics and used Chi-square or Fisher's exact tests to compare knowledge, attitudes, and practices among GBV specialists and non-specialists. Of 170 respondents, 58% were female and 44% were GBV specialists. Almost all (95%) of the respondents agreed or strongly agreed that they have a role to play in GBV risk mitigation. Compared to GBV specialists, a higher proportion of non-specialists reported little to no knowledge on GBV risk mitigation global guidance (38% vs. 7%, p < 0.001) and on how to respond to a disclosure of GBV (18% vs. 3%, p < 0.001). Respondents reported several barriers to integrating GBV risk mitigation into their work during COVID-19, including insufficient funding, capacity, knowledge, and guidance. Efforts to mainstream GBV risk mitigation actions should continue and intensify, leveraging the lessons and experiences generated thus far.

From political to personal violence: Links between conflict and non-partner physical violence in post-conflict Liberia.

War and interpersonal violence together account for a large burden on global health. Yet very few studies look at the relationship between these types of aggression. Non-partner physical violence (NPPV) is an often-understudied form of gender-based violence (GBV). This analysis draws on two datasets from one conflict-affected country, Liberia, to evaluate the impact of conflict on NPPV post-conflict. The Armed Conflict Location and Event Dataset (ACLED) measures the intensity of the conflict in Liberia from 1999-2003, while the Demographic and Heath Survey (DHS) data measure women's experiences with violence four years post-conflict. Almost half of women surveyed (45%) indicated that they experienced any kind of NPPV, highlighting the widespread nature of this issue. A multilevel modelling approach was used to account for the nesting of individuals within districts. Women living in districts that experienced conflict events in four or five years were almost three times as likely (aOR 2.93, p < .001) to experience past-year NPPV compared to individuals living in no conflict districts. Findings from this study suggest women residing in a conflict event-affected district may be at heightened risk of increased violence even years after peace is declared.

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.

Altered energetics and parasitism in juvenile northern pike (Esox lucius) inhabiting metal-mining contaminated lakes.

The objective of this study was to evaluate possible factors that could be contributing to altered bioenergetics of juvenile northern pike (Esox lucius) living in lakes receiving effluent from the Key Lake uranium mill in northern Saskatchewan, Canada. Although glycogen and triglycerides stores in liver and muscle were significantly greater in pike from exposure lakes compared to the reference, triglycerides stores of aquatic insects and spottail shiners that are prey items of juvenile pike showed no overall differences among lakes. Measures of parasitism, on the other hand, were negatively correlated with pike bioenergetics thereby reflecting a possible energetic cost of parasitism on reference lake fishes. The degree of infection, as measured by the abundance and biomass of intestinal parasites and the abundance of monogeneans on pike gills, was greatest in reference fishes and intermediate in low-exposure pike, whereas high-exposure fishes harbored no parasites.

From the battlefield to the bedroom: a multilevel analysis of the links between political conflict and intimate partner violence in Liberia.

OBJECTIVES: Assess the link between levels of armed conflict and postconflict intimate partner violence (IPV) experienced by women in Liberia. METHODS: Armed Conflict Location and Event Data Project data were used to measure conflict-related fatalities in districts in Liberia during the country's civil war from 1999 to 2003. These data were linked to individual-level data from the 2007 Demographic and Health Survey, including past-year IPV. Multilevel logistic models accounting for the clustering of women within districts evaluated the relationship of conflict fatalities with postconflict past-year IPV. Additional conflict measures, including conflict events and cumulative years of conflict, were assessed. RESULTS: After adjusting for individual-level characteristics correlated with IPV, residence in a conflict fatality-affected district was associated with a 50% increase in risk of IPV (adjusted OR (aOR): 1.55, 95% CI 1.26 to 1.92). Women living in a district that experienced 4-5 cumulative years of conflict were also more likely to experience IPV (aOR 1.88, 95% CI 1.29 to 2.75). CONCLUSION: Residing in a conflict-affected district even 5 years after conflict was associated with postconflict IPV. POLICY IMPLICATIONS: Recognising and preventing postconflict IPV violence is important to support long-term recovery in postconflict settings.

Context-dependent interactions and the regulation of species richness in freshwater fish.

Species richness is regulated by a complex network of scale-dependent processes. This complexity can obscure the influence of limiting species interactions, making it difficult to determine if abiotic or biotic drivers are more predominant regulators of richness. Using integrative modeling of freshwater fish richness from 721 lakes along an 11o latitudinal gradient, we find negative interactions to be a relatively minor independent predictor of species richness in lakes despite the widespread presence of predators. Instead, interaction effects, when detectable among major functional groups and 231 species pairs, were strong, often positive, but contextually dependent on environment. These results are consistent with the idea that negative interactions internally structure lake communities but do not consistently 'scale-up' to regulate richness independently of the environment. The importance of environment for interaction outcomes and its role in the regulation of species richness highlights the potential sensitivity of fish communities to the environmental changes affecting lakes globally.

Morphological, developmental and ecological evidence for a progenetic life cycle in Neochasmus (Digenea).

Seven species of fishes, Catostomus commersonii (Lacépède), Etheostoma nigrum Rafinesque, Micropterus dolomieu Lacépède, Notemigonus crysoleucas (Mitchill), Notropis hudsonius (Clinton), Perca flavescens (Mitchill), and Percina caprodes (Rafinesque) from the St. Lawrence River, Quebec, Canada, were found infected with progenetic specimens of Neochasmus spp. in the orbits and/or the body musculature. Worms displayed varying degrees of maturation. Eggs occupied the entirety of the worm in late stages of development and persisted as distinct clusters in situ after worm death. Populations of parasites were studied monthly in E. nigrum from one site between May and October in order to follow parasite recruitment, development and maturation. Recruitment of parasites was observed in young-of-the-year fish primarily in July and continued through October. Worms matured rapidly, displaying egg production within a month. Later developmental stages, in which eggs occupied most of the worm, and clusters of eggs became abundant by September. Infections in overwintered fish collected in May consisted mainly of worms in early stages of egg production and of clusters of eggs. When hatched artificially, eggs from the clusters released viable miracidia, indicating that they survive beyond the lifespan of the adult worm. It is suggested that progenesis is a fixed characteristic of the life cycle of these species, that egg dispersal requires the death of the host and that it is facilitated by predation. All prior records of Neochasmus spp. are examined, leading us to conclude that the role of the putative definitive host (primarily basses) has been reduced to that of a dispersal agent. Current hypotheses concerning the evolution and maintenance of progenesis are considered, but it is concluded that they do not apply to this host-parasite system.

Abducted children and youth in Lord's Resistance Army in Northeastern Democratic Republic of the Congo (DRC): mechanisms of indoctrination and control.

BACKGROUND: Globally, an estimated 300,000 children under the age of 18 participate in combat situations; those in armed groups in particular suffer prolonged exposure to psychological and physical abuse. The Lord's Resistance Army (LRA) is a rebel movement known for its widespread conscription of children; yet little is known about this process once the group moved beyond northern Uganda. In this paper, we describe the processes related to abduction and indoctrination of youth by the LRA in northeastern Democratic Republic of the Congo ( DRC). METHODS: In-depth interviews were conducted with formerly abducted children, their family members, community leaders, and service providers (total n = 34) in four communities in LRA-affected areas of northeastern DRC. Inductive coding of transcripts was undertaken to identify salient themes. RESULTS: Informants articulated a range of practices by the LRA to exert high levels of control over new recruits, including strict social isolation from recent abductees; control of communication; promoting new identity formation; and compelling children to act out strictly defined gendered roles. Witchcraft and secrecy are used to intimidate recruits and to magnify perception of the group's power. These methods promote de-identification with one's civilian and family life; and eventually the assimilation of a new language and identity. CONCLUSION: Indoctrination of newly abducted children into the LRA occurs via a complex system of control. This study provides one of the first detailed explorations of social and psychological mechanisms through which this is achieved, and focuses particularly on the gendered differences in the indoctrination process. Results support past findings that the LRA is a strategic and well-organized organization in its approach to enlisting child soldiers. Understanding some of the ways in which the LRA controls its recruits and the psychological impact of indoctrination enables reintegration programs to more effectively address these issues and serve the complex needs of formerly abducted children.