"If I have a cancer, it is not my fault I am a refugee": A qualitative study with expert stakeholders on cancer care management for Syrian refugees in Jordan.

BACKGROUND: Noncommunicable diseases including cancer are widespread amongst the 5.6 million Syrian refugees currently hosted in the Middle East. Given its prevalence as the third leading cause of death in Syria, cancer is likely to be an important health burden among Syrian refugees. Against this background, our aim was to describe the clinical, ethical and policy decision-making experiences of health actors working within the current refugee cancer care system; the impact of refugee cancer care health policies on health care providers and policy makers in this context; and provide suggestions for the way delivery of care should be optimised in a sustained emergency situation. METHODS: From April-July 2016, we conducted in-depth interviews with 12 purposively sampled health officials and health care workers from the Jordanian Ministry of Health, multilateral donors and international non-governmental organisations. Data were analysed using a framework analysis approach to identify systemic, practical and ethical challenges to optimising care for refugees, through author agreement on issues emerging from the data and those linked more directly to areas of questioning. RESULTS: As has been previously reported, central challenges for policy makers and health providers were the lack of quality cancer prevalence data to inform programming and care delivery for this refugee population, and insufficient health resource allocation to support services. In addition, limited access to international funding for the host country, the absence of long-term funding schemes, and barriers to coordination between institutions and frontline clinicians were seen as key barriers. In this context where economic priorities inevitably drive decision-making on public health policy and individual care provision, frontline healthcare workers and policy makers experienced significant moral distress where duties of care and humanitarian values were often impossible to uphold. CONCLUSIONS: Our findings confirm and expand understanding of the challenges involved in resource allocation decisions for cancer care in refugee populations, and highlight these for the particular situation of long term Syrian refugees in Jordan. The insights offered by frontline clinicians and policy makers in this context reveal the unintended personal and moral impact of resource allocation decisions. With many countries facing similar challenges in the provision of cancer care for refugees, the lessons learned from Jordan suggest key areas for policy revision and international investment in developing cancer care policies for refugees internationally.

Prevalence of childhood overweight and obesity and associated factors in Peru / Prevalencia de sobrepeso y obesidad infantiles y de sus factores asociados en el Perú

OBJECTIVE:To determine the prevalence of and factors associated with childhood overweight and obesity among a cohort of children 7-8 years of age in Peru. METHODS: This was a cross-sectional secondary analysis of data from the Young Lives longitudinal study of childhood poverty. The sample was a cohort of 1 737 children 7-8 years of age in 2009. Prevalence of overweight and obesity was assessed using body mass index-forage Z-scores. Logistic regression was used to determine associations with a number of individual, household, and community factors. RESULTS: Prevalences of overweight and obesity were 19.2% and 8.6%, respectively. A prevalence of 32.0% and 23.5% overweight and obesity was found among males and females, respectively. High socioeconomic status, living in Lima, having a mother who was overweight or obese, being male, and being an only child or having only one sibling were associated with being overweight and obese at this age. CONCLUSIONS: This study shows a high prevalence of childhood and maternal overweight and obesity in Peru. In contrast to findings in many high-income countries, the findings in Peru indicate that children from wealthier households were more likely to be overweight or obese than those from poorer households. In addition, there is something particularly obesogenic about the Lima environment that merits further investigation, and several key issues to consider when targeting future interventions and research.

OBJETIVO:Determinar la prevalencia de sobrepeso y obesidad infantiles y de sus factores asociados en una cohorte de niños de 7 y 8 años de edad en el Perú. MÉTODOS: El presente estudio es un análisis secundario, de tipo transversal, de los datos generados por el ensayo longitudinal sobre la pobreza en la niñez conocido por Vidas jóvenes. La muestra se compuso de una cohorte de 1 737 niños que tenían 7 y 8 años de edad en 2009. La prevalencia de sobrepeso y obesidad se evaluó mediante el uso de la puntuación z del índice de masa corporal para la edad. Se llevó a cabo una regresión logística con objeto de detectar posibles asociaciones con diversos factores individuales, domésticos y comunitarios. RESULTADOS: El sobrepeso y la obesidad mostraron prevalencias de 19,2% y 8,6%, respectivamente. Se halló una prevalencia de sobrepeso y obesidad de 32,0% y 23,5% en niños y niñas, respectivamente. Varios factores mostraron una asociación con el sobrepeso y la obesidad a esta edad: pertenecer a un estrato socioeconómico alto; vivir en Lima; tener una madre con sobrepeso u obesidad; ser de sexo masculino; y ser hijo único o tener un solo hermano o hermana. CONCLUSIONES: El presente estudio pone de manifiesto la alta prevalencia de obesidad materna e infantil en el Perú. Los resultados observados en este país, que contrastan con los provenientes de muchos países de ingresos altos, apuntan a una mayor propensión al exceso de peso o a la obesidad entre los niños de hogares más ricos que entre los de hogares más pobres. Además, existe algún factor especialmente obesógeno en el ambiente de Lima que debe investigarse más a fondo, así como varios factores esenciales que deberán tenerse en cuenta a la hora de determinar cómo enfocar las intervenciones e investigaciones en un futuro.