Perceptions and behaviors of healthcare providers towards rehabilitation support to children with severe malaria-related disability in Ethiopia: A qualitative descriptive study using the Theoretical Domains Framework.

INTRODUCTION: Severe malaria often results in childhood disability. The prevalence of disability related to severe malaria is significant and is estimated to affect up to 53% of severe malaria survivors. In contrast, information is sparse about how healthcare providers in Africa think about or provide rehabilitation support in acute and post-acute phases respectively. Understanding the perceptions and behaviors of healthcare providers treating malaria could help inform malaria-related disability research, policy, and practice, aimed at the providers themselves. This study explored the perceptions and behaviors of healthcare providers towards rehabilitation for children with severe malaria-related disability. The Theoretical Domains Framework was used to describe the findings relative to wider literature on health provider behavior change. METHODS: A qualitative descriptive approach was used to interview thirteen healthcare providers recruited purposively based on their clinical professions, roles, and settings. Data were analyzed using directed content analysis. We decided on the most prominent theoretical domains considering the frequency of specific perceptions and behaviors across the participants, the frequency of perceptions and behaviors in each domain, and evidence of strong perceptions and behaviors. RESULTS: Nine out of fourteen theoretical domains were identified. These domains were: Beliefs about consequences, environmental context and resources, goals, knowledge, skills, optimism, reinforcement, social influences, and social or professional role and identity. Healthcare providers' beliefs about their roles in screening for disability or referring to rehabilitation were less positive. CONCLUSIONS: The findings of this study suggest the need for interventions to support healthcare providers in acute phases (prevention and control of severe malaria) and post-acute phases (disability screening, referral, and rehabilitation care). Recommended interventions should focus on developing clinical guidelines, training clinicians, addressing institutional factors, and modifying external social influences such as socio-cultural factors.

Family and community resilience: a Photovoice study.

BACKGROUND: Adverse childhood experiences (ACEs), in combination with adverse community environments, can result in traumatic stress reactions, increasing a person's risk for chronic physical and mental health conditions. Family resilience refers to the ability of families to withstand and rebound from adversity; it involves coping with disruptions as well as positive growth in the face of sudden or challenging life events, trauma, or adversities. This study aimed to identify factors contributing to family and community resilience from the perspective of families who self-identified as having a history of adversity and being resilient during the COVID-19 pandemic. METHODS: This study used Photovoice, a visual participatory research method which asks participants to take photographs to illustrate their responses to a research question. Participants consisted of a maximum variation sample of families who demonstrated family level resilience in the context of the pair of ACEs during the COVID-19 pandemic. Family members were asked to collect approximately five images or videos that illustrated the facilitators and barriers to well-being for their family in their community. Semi-structured in-depth interviews were conducted using the SHOWeD framework to allow participants to share and elucidate the meaning of their photos. Using thematic analysis, two researchers then independently completed line-by-line coding of interview transcripts before collaborating to develop consensus regarding key themes and interpretations. RESULTS: Nine families were enrolled in the study. We identified five main themes that enhanced family resilience: (1) social support networks; (2) factors fostering children's development; (3) access and connection to nature; (4) having a space of one's own; and (5) access to social services and community resources. CONCLUSIONS: In the context of additional stresses related to the COVID-19 pandemic, resilient behaviours and strategies for families were identified. The creation or development of networks of intra- and inter-community bonds; the promotion of accessible parenting, housing, and other social services; and the conservation and expansion of natural environments may support resilience and health.

Severe malaria-related disability in Ethiopian children from the perspectives of caregivers: an interpretive description study.

PURPOSE: This study explored severe malaria-related disability in children from the perspectives of their caregivers. MATERIALS AND METHODS: The interpretive description qualitative approach was employed. The participants were selected using the purposive sampling technique considering the child's history of severe malaria, age (0-10 years), and location (urban/rural). Data were collected through face-to-face interviews with sixteen caregivers. Reflexive thematic data analysis was utilized. Through prolonged engagement, reflective journaling, an audit trail, and co-authors' review, trustworthiness was enhanced. RESULTS: The study generated five themes from the interviews: mitigators of disability, contributors of disability, impact on body function, impact on activities and participation, and uncertainties about future well-being. The findings revealed previously unstudied social components of disability and environmental factors. Furthermore, the research uncovered health-related quality of life aspects that are out of the scope of the current comprehensive disability framework. CONCLUSIONS: The study contributes to a deeper understanding of severe malaria-related disability in children from the biopsychosocial perspective. The findings could help policymakers, researchers, and clinicians who want to design rehabilitation interventions for the affected children or examine the components of disability on a large scale using quantitative methods.IMPLICATIONS FOR REHABILITATIONVarious contextual factors interacted with severe malaria and influenced functioning either as facilitators or barriers, implying disability related to malaria can be prevented or created.The long-term impacts of severe malaria are not limited to functioning and disability but also affect the health-related quality of life of children who survive severe malaria.Rehabilitation professionals should consider applying comprehensive functioning and disability frameworks such as the ICF when designing (or applying) screening tools, planning interventions, and evaluating the outcomes of intervention for children with severe malaria-related disability.Rehabilitation interventions for children with severe malaria-related disability should consider patient- or caregiver-reported outcomes (components of disability).

Impacts of the COVID-19 pandemic on life and learning experiences of indigenous and non-Indigenous university and college students in Ontario, Canada: a qualitative study.

BACKGROUND: The years people spend attending university or college are often filled with transition and life change. Younger students often move into their adult identity by working through challenges and encountering new social experiences. These transitions and stresses have been impacted significantly by the COVID-19 pandemic, which has led to dramatic change in the post-secondary experience, particularly in the pandemic's early months when colleges and universities were closed to in person teaching. The goal of this study was to identify how COVID-19 has specifically impacted the postsecondary student population in Kingston, Ontario, Canada. METHODS: The Cost of COVID is a mixed methods study exploring the social and emotional impacts of the COVID-19 pandemic, with a focus on families, youth, and urban Indigenous People. The present analysis was completed using a subset of qualitative data including Spryng.io micronarrative stories from students in college and university, as well as in-depth interviews from service providers providing services to students. A double-coded phenomenological approach was used to collect and analyze data to explore and identify themes expressed by postsecondary students and service providers who worked with postsecondary students. RESULTS: Twenty-six micronarratives and seven in-depth interviews were identified that were specifically relevant to the post-secondary student experience. From this data, five prominent themes arose. Impacts of the COVID-19 pandemic on the use of technology was important to the post secondary experience. The pandemic has substantial educational impact on students, in what they chose to learn, how it was taught, and experiences to which they were exposed. Health and wellbeing, physical, psychological and emotional, were impacted. Significant impacts were felt on family, community, and connectedness aspects. Finally, the pandemic had important financial impacts on students which affected their learning and their experience of the pandemic. Impacts did differ for Indigenous students, with many of the traditional cultural supports and benefits of spaces of higher education no longer being available. CONCLUSION: Our study highlights important impacts of the pandemic on students of higher education that may have significant individual and societal implications going forward. Both postsecondary institutions and society at large need to attend to these impacts, in order to preserve the wellbeing of graduates, the Canadian labor market, and to ensure that the pandemic does not further exacerbate existing inequalities in post-secondary education in Canada.

Severe malaria-related disability in African children: a scoping review.

PURPOSE: Disability is a consequence of severe malaria for a significant proportion of African children. This scoping review aims to describe the impact of severe malaria on African children according to current literature using an international biopsychical classification and framework of disability and functioning. MATERIALS AND METHODS: MEDLINE, EMBASE, Global Health, and CINHAL databases were searched for original research conducted on African children aged 0-18 using terms related to severe malaria and components of disability. Independent and dependent variables were extracted and classified using the World Health Organization's International Classification of Functioning, Disability, and Health-Children and Youth version (ICF-CY) using standardized coding methods. RESULTS: Seventy-two percent of the measured variables in the 34 included studies were coded as "body functions," (i.e., impairments), such as mental, neuromusculoskeletal, movement, and sensory functions, and 23.3% of variables were coded as "activities and participation" (i.e., activity limitations/participation restrictions), such as difficulties with general tasks and demands, communication, mobility, interpersonal interactions, and relationships. "Environment" variables such as family support, health access, education, or societal attitudes were not found in the included studies. CONCLUSIONS: Existing peer-reviewed quantitative research of severe malaria-related disability is focused on neurological sequelae, with less research about activity limitations and participation restrictions.

Promoting the use of a comprehensive biopsychosocial disability framework and classification system for severe malaria will provide a framework that other researchers, policymakers, and rehabilitation professionals can consider when looking at the best ways to support outcomes for children with severe malaria.Using a framework of the ICF-CY, we have highlighted the need for better research into child functioning outcomes in severe malaria research, especially within the domain of child participation.Policymakers should be encouraged to support better holistic evaluation, support, and rehabilitation of children who have had severe malaria.

Directed content analysis: A life course approach to understanding the impacts of the COVID-19 pandemic with implications for public health and social service policy.

BACKGROUND: The COVID-19 pandemic has had broad impacts on individuals, families and communities which will continue to require multidimensional responses from service providers, program developers, and policy makers. OBJECTIVES: The purpose of this study was to use Life Course theory to understand and imagine public health and policy responses to the multiple and varied impacts of the COVID-19 pandemic on different groups. METHODS: "The Cost of COVID-19" was a research study carried out in Kingston, Frontenac, Lennox and Addington counties in South Eastern Ontario, Canada, between June and December 2020. Data included 210 micronarrative stories collected from community members, and 31 in-depth interviews with health and social service providers. Data were analyzed using directed content analysis to explore the fit between data and the constructs of Life Course theory. RESULTS: Social pathways were significantly disrupted by changes to education and employment, as well as changes to roles which further altered anticipated pathways. Transitions were by and large missed, creating a sense of loss. While some respondents articulated positive turning points, most of the turning points reported were negative, including fundamental changes to relationships, family structure, education, and employment with lifelong implications. Participants' trajectories varied based on principles including when they occurred in their lifespan, the amount of agency they felt or did not feel over circumstances, where they lived (rural versus urban), what else was going on in their lives at the time the pandemic struck, how their lives were connected with others, as well as how the pandemic impacted the lives of those dear to them. An additional principle, that of Culture, was felt to be missing from the Life Course theory as currently outlined. CONCLUSIONS: A Life Course analysis may improve our understanding of the multidimensional long-term impacts of the COVID-19 pandemic and associated public health countermeasures. This analysis could help us to anticipate services that will require development, training, and funding to support the recovery of those who have been particularly affected. Resources needed will include education, mental health and job creation supports, as well as programs that support the development of individual and community agency.

Development of a novel continuous measure of adolescent mental health inspired by the dual-factor model.

Background: According to the Dual-factor Model, mental health is comprised of two related constructs: subjective well-being and psychopathology. Combining these constructs can provide a more accurate and comprehensive assessment of adolescent mental health than considering either on its own. The model suggests the need to group mental health into four distinct categories, which does not recognize its potential continuum and adds statistical complexity. In this study, we developed a continuous measure inspired by, and as a complement to, the Dual-factor Model. Our goal was to demonstrate a novel approach to developing a valid measure for use in public health research that captures varying mental health states more accurately than traditional approaches and has advantages over the categorical version. Methods: Self-report data are from the 2014 Canadian Health Behavior in School-aged Children study (n = 21,993). Subjective well-being was measured by combining indicators of life satisfaction, positive affect, and negative affect. Internalized and externalized symptoms scales were combined to measure psychopathology. The continuous dual-factor measure was created by subtracting standardized psychopathology scores from standardized subjective well-being scores. Construct validity was assessed using multivariable linear regression by examining associations between factors known to be associated with adolescent mental health status (demographic characteristics, social and academic functioning, and specific indicators of mental health) and average mental health scores. Results: The average age was 14.0 (SD = 1.41) years. The continuous mental health score ranged from 5 to 67 [Mean (SD): 50.1 (9.8)], with higher scores indicating better overall mental health. The nature and direction of the associations examined supported construct validity. Being from a more affluent family, and having more supportive relationships with family, peers, teachers, and classmates was associated with greater mental health (Cohen's d: 0.65 to 1.63). Higher average marks were also associated with better mental health. Average mental health scores were much lower if students reported feeling hopeless or rated their health as fair or poor. Conclusion: A continuous measure of mental health based on the Dual-factor Model appears to be a comprehensive and valid measure with applications for research aimed at increasing our understanding of adolescent mental health.

Sexual and reproductive health and rights of "last mile" adolescents: a scoping review.

Globally, significant progress has been made in the realm of adolescent sexual and reproductive health. We conceptualised "last mile" adolescents as having two or more of the following factors of identity: refugee, Indigenous, 2SLGBTQIA+, out of school, rurally or remotely located, slum dwelling, incarcerated or previously incarcerated, HIV/AIDS infected, and living with a disability. We conducted a scoping review with an aim to synthesise evidence and identify research gaps in the literature pertaining to the sexual and reproductive health and rights (SRHR) of last mile adolescents. We conducted searches in three databases (Embase, Global Health, and Medline). Fifty-four publications met our inclusion criteria. Our results revealed that the state of evidence on the SRHR of last mile adolescents is poor. Very few studies used qualitative and mixed-method inquiry. The number of studies carried out in North America, Europe, and Oceania were limited. We found insufficient disaggregated data with respect to SRHR-related knowledge, behaviour, and access to services. Adopting an intersectional lens is critical to uncover the multiplicative effects of last mile adolescents' factors of identity on their SRHR. National data systems should be strengthened to enable the collection of quality disaggregated data which can play a vital role in identifying SRHR inequities affecting last mile adolescents. Research priorities should be realigned to generate data globally on the SRHR of last mile adolescents whose lives are marked by intersecting vulnerabilities.

Food worry and mental health outcomes during the COVID-19 pandemic.

BACKGROUND: There is limited and inconsistent literature examining the relationship between food worry and mental health in the context of the COVID-19 pandemic. This study examined the association between food worry and mental health among community dwelling Canadian adults during the COVID-19 pandemic. METHODS: Adults age 16 years and older completed an anonymous online questionnaire between April 1, 2020 and November 30 2020. Measures of pre-pandemic and current food worry, depression (PHQ-2), anxiety (GAD-2), and sociodemographic variables were included. Multivariable logistic regression models were used to determine the association between food worry and symptoms of depression and anxiety. RESULTS: In total, 1605 participants were included in analyses. Worry about affording food was reported by 320 (14.78%) participants. In models adjusting for sociodemographic covariates, compared with people without food worry, participants who had food worry were 2.07 times more likely to report anxiety symptoms (aOR 2.07, 95% CI: 1.43 - 2.98, p < .001) and were 1.9 times more likely to report depressive symptoms (aOR 1.89, 95% CI: 1.39-2.57, p < .0001). Lower income, lower education, and pre-existing mental health conditions were significant predictors of symptoms of depression. Female gender, younger age, lower education, lower income, and pre-existing mental health condition were significant predictors of anxiety symptoms. CONCLUSION: Our study highlights the relationship between food worry and poor mental health. Policy supports such as improved income supports, clinical implications such as screening for food worry in primary care, referral to emergency food programs and support with meal planning may help mitigate mental health symptoms during the current pandemic, during future societal recovery from this pandemic and during future pandemics.

A Scoping Review of Climate Change, Climate-Related Disasters, and Mental Disorders among Children in Low- and Middle-Income Countries.

Children, particularly those living in low- and middle-income countries (LMICs), are highly vulnerable to climate change and its impacts. Our main objective was to conduct a scoping literature review to determine how exposure to climate change and climate-related disasters influences the presence of mental disorders among children in LMICs. We also aimed to identify gaps in this area of scholarship. We included studies of children in LMICs that had a climate change or climate-related disaster exposure and mental disorder outcome. Twenty-three studies were included in the final synthesis. Fourteen studies were conducted in China, three in India, two each in Pakistan and the Philippines, and one each in Namibia and Dominica. All studies assessed the association between a climate-related disaster exposure and a mental disorder outcome, while none explored broader climate change-related exposures. Post-traumatic stress disorder (n = 21 studies) and depression (n = 8 studies) were the most common mental disorder outcomes. There was considerable between-study heterogeneity in terms of sample size, follow-up length, and outcome measurement. Overall, the literature in this area was sparse. Additional high-quality research is required to better understand the impacts of climate-related disasters and climate change on mental disorders within this population to ultimately inform future policies and interventions.

Spirituality, Community Belonging, and Mental Health Outcomes of Indigenous Peoples during the COVID-19 Pandemic.

We aimed to assess the association between community belonging, spirituality, and mental health outcomes among Indigenous Peoples during the COVID-19 pandemic. This cross-sectional observational study used online survey distribution and targeted outreach to the local Indigenous community to collect a convenience sample between 23 April 2020 and 20 November 2020. The surveys included demographic information, self-reported symptoms of depression (PHQ-2) and anxiety (GAD-2), and measures of the sense of community belonging and the importance of spirituality. Multivariate logistic regression was used to model the association between the sense of community belonging and spirituality, and symptoms of anxiety and depression. Of the 263 self-identified Indigenous people who participated, 246 participants had complete outcome data, including 99 (40%) who reported symptoms of depression and 110 (45%) who reported symptoms of anxiety. Compared to Indigenous participants with a strong sense of community belonging, those with weak community belonging had 2.42 (95% CI: 1.12-5.24)-times greater odds of reporting symptoms of anxiety, and 4.40 (95% CI: 1.95-9.89)-times greater odds of reporting symptoms of depression. While spirituality was not associated with anxiety or depression in the adjusted models, 76% of Indigenous participants agreed that spirituality was important to them pre-pandemic, and 56% agreed that it had become more important since the pandemic began. Community belonging was associated with positive mental health outcomes. Indigenous-led cultural programs that foster community belonging may promote the mental health of Indigenous Peoples.

Associations between the self-reported happy home lives and health of Canadian school-aged children: An exploratory analysis with stratification by level of relative family wealth.

BACKGROUND: Connections between home life, level of family wealth, happiness and health are strong, yet these relationships are complex and for Canadian adolescents not well studied. The objective of this investigation was to explore associations between aspects of health and self-reported happy home life among Canadian adolescents aged 10-16 years and to determine if level of self-reported relative family wealth modified associations. MATERIAL AND METHODS: This was a secondary analysis of Canadian data from the 2018 Health Behaviour in School-aged Children (HBSC) study (n=21,745). Theory drove the selection of 26 health-related HBSC variables. Bivariate analyses and calculation of adjusted odds ratios, considering level of self-reported relative family wealth in a stratified analysis, were undertaken. RESULTS: Overall, proximal, micro-level factors were most strongly associated with reports of a happy home life, with distal, macro-level factors less strongly associated. Differences existed between the health and home-life associations for adolescents of different levels of self-reported relative family wealth indicating effect modification. Family support and levels of adolescent self-reported overall health and mental health were common factors that were strongly associated with reporting a happy home life. CONCLUSION: We believe happy home lives are central and critical for thriving youth and families. This was an exploratory analysis. Many of the factors and relationships in this study are potentially modifiable and represent important possible areas of future focus for adolescent and family health improvement.

Investigating the role of climate-related disasters in the relationship between food insecurity and mental health for youth aged 15-24 in 142 countries.

Food insecurity (FI) represents a major global health challenge. Because climate-related disasters are a determinant of both FI and poor mental health, we investigated whether the severity of these disasters intensifies the relationship between FI and youth mental health. Data on FI and mental health came from the Gallup World Poll, a nationally representative survey of individuals in 142 countries, which included 28,292 youth aged 15-24. Data on climate-related disasters came from the International Disaster Database, a country-level record of disasters. Multilevel negative binomial regression was used to calculate relative risk (RR) of poor mental health. Youth with moderate or severe FI were significantly more likely to report poor mental health experiences compared to those with none/mild FI (moderate: RR 1.37, 95% confidence interval (CI) 1.32-1.41; severe: 1.60, 95% CI 1.54-1.66). We also observed a weak yet significant interaction effect (p<0.0001), which suggested that the country-level relationship between FI and poor mental health is slightly stronger at greater disaster severity. While further research is needed to improve our understanding of these complex relationships, these findings suggest that mental health should be considered when undertaking national climate change actions and that additional FI-related supports may work to improve youth mental health.

Financial stress during COVID-19: implications for parenting behaviour and child well-being.

BACKGROUND: Family financial stress and parenting behaviours are each associated with child behaviours. We sought to explore the association between parent financial stress and child socioemotional and behavioural difficulties during the COVID-19 pandemic and examine parenting behaviour, including overreactive and lax parenting approaches, as a potential mediator to this relationship. METHODS: Cross-sectional sample of parent and child data pairings in Ontario, Canada between April and November of 2020. Linear models were used to describe the relationships between financial worry, child Strengths and Difficulties Questionnaire (SDQ) total difficulties and parenting behaviours measured by the Parenting Scale 8-item (PS-8), which includes measures of both overreactive and lax parenting tendencies. Formal mediation testing was performed to assess the potential mediating role of parenting behaviour. RESULTS: 528 parent and child pairs were enrolled from largely European ancestry (78%), female (93%) and varied household income levels. Analysis revealed increased financial worry during the COVID-19 pandemic was significantly associated with increased child SDQ total difficulties scores (ß=0.23, SE=0.10, p=0.03). This relationship was mediated by reported parenting behaviour, independent of parent education, household income, parent age, parent sex, parent anxiety and child sex (total effect: ß=0.69, p=0.02, average causal mediation effects: ß=0.50, p=0.02, average direct effects: ß=0.19, p=0.08). CONCLUSION: Financial stress during the COVID-19 pandemic was associated with poorer child social and emotional well-being. Parenting behaviours measured by the PS-8 significantly mediated these effects. This work supports the importance of policies aimed to alleviate family financial stresses and highlights the potential impact such policies have on child well-being.

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.

"I Don't Know Where I Have to Knock for Support": A Mixed-Methods Study on Perceptions and Experiences of Single Mothers Raising Children in the Democratic Republic of Congo.

Introduction and Objectives: It is well-documented that single mothers in sub-Saharan Africa face unique psychosocial challenges which can lead to child health and developmental disadvantages, often impacting life trajectories for both the mother and child. Years of instability, conflict, and widespread poor governance within the Democratic Republic of Congo (DRC) have resulted in magnified challenges for parents, making it more difficult to provide supportive and effective parenting. To address gaps in knowledge regarding the specific challenges experienced and adaptations made among single mothers raising children in contexts of adversity, the present study aimed to investigate the phenomenon of single mother parenting in the DRC. Methods: Cognitive Edge SenseMaker, a mixed-method data collection tool, was used to collect self-interpreted narratives among parents in eastern DRC. Quantitative SenseMaker data were uploaded into Tableau, a data organization and analysis tool, to visualize differences in response patterns between single mother (n = 263) and two-parent family study participants (n = 182). Single mother micronarratives (n = 251) were then coded line-by-line and analyzed thematically. Qualitative themes identified in the single mother micronarratives were used to facilitate a deeper and more nuanced understanding of key quantitative SenseMaker findings. Findings and Conclusions: Our study found that single mothers experienced immense challenges raising children in the DRC, including financial-, health- and parenting-related hardships. Single mothers described negative emotions and higher levels of household adversity while providing for their children in situations of extreme poverty compared to two-parent family respondents. Self-reliance was exhibited among most single mothers in an attempt to overcome challenges, primarily financial barriers, and to prioritize the health and well-being of their children. However, many children still lacked access to sufficient food, education, and healthcare. Limited governmental and social security support for single mothers was identified as contributing to heightened challenges and the self-reliance observed among single mothers. Findings emphasize that additional research and attention should be directed towards identifying the specific needs of, and available resources for, single mothers in different localities in an effort to inform policies and programs that best support families.

Climate change, climate-related disasters and mental disorder in low- and middle-income countries: a scoping review.

INTRODUCTION: Climate change and climate-related disasters adversely affect mental health. Low- and middle-income countries (LMICs) are particularly vulnerable to the impacts of climate change and climate-related disasters and often lack adequate mental healthcare infrastructure. We used the scoping review methodology to determine how exposure to climate change and climate-related disasters influences the presence of mental disorders among those living in LMICs. We also aimed to recognise existing gaps in this area of literature. METHODS: This review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews checklist. To identify relevant studies, we searched five electronic databases (MEDLINE, EMBASE, Global Health, APA PsycInfo and Sociological Abstracts) from 1 January 2007 to 31 December 2019. We also searched the grey literature. Included studies had an adult-focused LMIC population, a climate change or climate-related disaster exposure and a mental disorder outcome. Relevant study information was extracted and synthesised. RESULTS: Fifty-eight studies were identified, most of which (n=48) employed a cross-sectional design. The most commonly studied exposure-outcome combinations were flood-related post-traumatic stress disorder (PTSD) (n=28), flood-related depression (n=15) and storm-related PTSD (n=13). The majority of studies identified a positive exposure-outcome association. However, few studies included a baseline or comparator (ie, unexposed) group, thereby limiting our understanding of the magnitude or nature of this association. There was also great heterogeneity in this literature, making studies difficult to pool or compare. Several research gaps were identified including the lack of longitudinal studies and non-uniformity of geographic coverage. CONCLUSION: To our knowledge, this was the first scoping review to investigate the relationship between climate change and climate-related disaster exposures and mental disorder outcomes in LMICs. Our findings support the need for further research, but also highlight that mental health should be a priority within LMIC climate change policy considerations.

Development of a dual-factor measure of adolescent mental health: an analysis of cross-sectional data from the 2014 Canadian Health Behaviour in School-aged Children (HBSC) study.

INTRODUCTION: Studies of adolescent mental health require valid measures that are supported by evidence-based theories. An established theory is the dual-factor model, which argues that mental health status is only fully understood by incorporating information on both subjective well-being and psychopathology. OBJECTIVES: To develop a novel measure of adolescent mental health based on the dual-factor model and test its construct validity. DESIGN: Cross-sectional analysis of national health survey data. SETTING AND PARTICIPANTS: Nationally weighted sample of 21 993 grade 6-10 students; average age: 14.0 (SD 1.4) years from the 2014 Canadian Health Behaviour in School-aged Children study. MEASURES: Self-report indicators of subjective well-being (life satisfaction, positive and negative affect), and psychopathology (psychological symptoms and overt risk-taking behaviour) were incorporated into the dual-factor measure. Characteristics of adolescents families, specific mental health indicators and measures of academic and social functioning were used in the assessment of construct validity. RESULTS: Proportions of students categorised to the four mental health groups indicated by the dual-factor measure were 67.6% 'mentally healthy', 17.5% 'symptomatic yet content', 5.5% 'asymptomatic yet discontent' and 9.4% 'mentally unhealthy'. Being mentally healthy was associated with the highest functioning (greater social support and academic functioning) and being mentally unhealthy was associated with the worst. A one-unit increase (ranges=0-10) in peer support (OR 1.19; 95% CI 1.15 to 1.22), family support (OR 1.32; 95% CI 1.28 to 1.36), student support (OR 1.20; 95% CI 1.17 to 1.24) and average school marks (OR 1.18; 95% CI 1.10 to 1.27) increased the odds of being symptomatic yet content versus mentally unhealthy. Mentally healthy youth were the most likely to live with both parents (77% vs ≤65%) and report their family as well-off (62% vs ≤53%). CONCLUSIONS: We developed a novel, construct valid dual-factor measure of adolescent mental health. This potentially provides a nuanced and comprehensive approach to the assessment of adolescent mental health that is direly needed.

"I don't know if we'll ever live in harmony": a mixed-methods exploration of the unmet needs of Syrian adolescent girls in protracted displacement in Lebanon.

BACKGROUND: The current crisis in Syria has led to unprecedented displacement, with neighbouring Lebanon now hosting more than 1.5 million conflict-affected migrants from Syria. In many situations of displacement, adolescent girls are a vulnerable sub-group. This study explores and describes the self-reported unmet needs of Syrian adolescent girls who migrated to Lebanon between 2011 and 2016. METHODS: This mixed-methods study focusing on the unmet needs of adolescent girls was part of a larger research project on child marriage among Syrian migrants in Lebanon. Participants were recruited using purposive sampling in three field locations in Lebanon by locally trained research assistants. One hundred eighty-eight Syrian adolescent girls chose to tell qualitative stories about their own experiences. Using handheld tablets and an application called "Sensemaker" stories were audio-recorded and later transcribed. Participants were asked to then self-interpret their stories by answering specific quantitative survey-type questions. Demographic information was also collected. NVivo was used to undertake deductive coding of the qualitative data using Maslow's Hierarchy of Needs as an analytic frame. RESULTS: Among the 188 self-reported stories from adolescent girls, more than half mentioned some form of unmet need. These needs ranged across the five levels of Maslow's Hierarchy from physiological, safety, belonging, esteem and self-actualization. Nearly two thirds of girls mentioned more than one unmet need and the girls' expressed needs varied by marital status and time since migration. Unmet esteem needs were expressed in 22% of married, and 72% of unmarried girls. Belongingness needs were expressed by 13% of girls who migrated in the last 1-3 years and 31% of those who migrated in the previous 4-5 years. CONCLUSION: Many needs of displaced Syrian adolescent girls remain unmet in this situation of now protracted displacement. Girls most commonly expressed needs for love and belonging followed closely by needs for safety and basic resources. The level and type of unmet need differed by marital status and time since displacement. Unmet needs have been associated elsewhere with physical illness, life dissatisfaction, post-traumatic stress, depression, anxiety and even death. These results can inform integrated interventions and services specifically targeting adolescent girls and their families in the protracted migration situation now facing Lebanon.

Father Presence, Father Engagement, and Specific Health and Developmental Outcomes of Mongolian Pre-School Children.

This study explored father involvement as a social determinant of child health within the context of macro-environmental changes in Mongolia. Using data for children aged 3-4 from UNICEF's Multiple Indicator Cluster Surveys, this cross-sectional analysis examined the association between father presence and engagement with child health and educational outcomes. Multivariate regression modeling was employed to identify associations between father presence, engagement, and child outcomes including fever, respiratory illness, diarrhea and preschool attendance. In unadjusted analyses, father engagement was associated with higher odds of preschool attendance (Odds Ratio (OR) = 1.12; 95% Confidence Interval (CI) 1.04-1.20) but not with child illness (OR = 1.04; 95% CI 0.95-1.14). Father engagement was no longer associated with preschool attendance after controlling for potentially confounding variables (ORadj = 0.95; 95% CI 0.88-1.03). Unadjusted and adjusted analyses showed that father presence was not associated with acute illness or preschool attendance. Results also suggest that a larger proportion of children were engaged in activities by their mother compared to their father or other adults. Data indicate that father presence and engagement were not associated with child illness or preschool attendance. Factors such as maternal education, household wealth, and region of residence are stronger predictors of preschool attendance and should continue to be considered for promoting child health and development in Mongolia.