Prevalence and risk factors for child labour and violence against children in Egypt using Bayesian geospatial modelling with multiple imputation.

BACKGROUND: The incidence of child labour, especially across developing nations, is of global concern. The use of children in employment in developing economies constitutes a major threat to the societies, and concerted efforts are made by the relevant stakeholders towards addressing some of the factors and issues responsible. Significant risk factors include socio-demographic and economic factors such as poverty, neglect, lack of adequate care, exposure of children to various grades of violence, parental education status, gender, place of residence, household size, residence type or size, wealth index, parental survivorship and household size. Egypt is the largest country in Africa by population. Although UNCIF 2017 reported that the worst forms of child labour in Egypt are concentrated in domestic work, forced begging and commercial sexual exploitation, the situation has received little attention. There are still very few studies initiated specifically to look at child labour in domestic service in Egypt and those that exist have been limited in the scope of their methodology. Geographical coverage and research for child labour in Egypt is also limited, as are accurate statistics and data. There was, therefore, a strong case for looking again at the domestic child labour phenomenon in Egypt, especially after the Demographic Health Survey (DHS) released the first data about child labour in Egypt in 2014. This study builds on the few findings of earlier work, and broadens coverage by including advanced methods and geographical effects of this problem. OBJECTIVES: This study focuses on identifying socio-demographic, economic and geospatial factors associated with child labour participation. METHODS: We used the 2014 Egypt Demographic and Health Survey (EDHS) from the Ministry of Health and Population in Egypt, with the record of 20,560 never-married children aged 5-17 years engaging in economic activities, in and out of their home. The data focused on demographic and socio-economic characteristics of household members. Multivariate Bayesian geo-additive models were employed to examine the demographical and socio-economic factors for children working less than 16 hrs; between 16 and less 45 hrs; and over 45 hrs weekly. RESULTS: The results showed that at least 31.6% of the children in the age group from 5-10 were working, 68.5% of children aged 11-17 years were engaged in child labour for a wage, and 44.7% of the children in the age group from 5-10 were engaged in hazardous work. From the multivariate Bayesian geo-additive models, female children (with male children as reference category) working at least 16 hrs (OR: 1.3; with 95% CI: 1.2-1.5) were more likely to be engaged in child labour than girls working 16 to 45 hrs (OR: 1; 95% CI: 0.3-1.5). Children born to women without formal education, in non-hazardous jobs, irrespective of the hours spent at work, were more likely to be involved in child labour (52.9%, 56.8%, 62.4%) compared to children of mothers with some level of education. Finally, children who have experienced psychological aggression and physical punishment are more likely to be used as child labour than those without such experience across the job types and hours spent. North-eastern Egypt has a higher likelihood of child labour than most other regions, while children who live in the Delta are more engaged in hazardous work. CONCLUSION: This study revealed a significant influence of socio-demographic and economic factors on child labour and violence against children in Egypt. Poverty, neglect, lack of adequate care and exposure of children to various grades of violence are major drivers of child labour across the country. The spatial effect suggests the need to give more attention to some areas that have high rates of child labour, such as the Nile Delta, Upper Egypt, and North-eastern Egypt.

Hearing the voices of older adult patients: processes and findings to inform health services research.

PLAIN ENGLISH SUMMARY: Whilst Patient and Public Involvement and Engagement (PPIE) are widely regarded as critical to developing clinical research, there is a perception that older adults may not be able to contribute and there is less emphasis on gaining a wide range of opinions before developing research questions or projects; for example an organisational change. This PPIE initiative used three PPIE processes including existing panels and wider networking to access older adults in the community who had used the hospital services and been discharged. Older adults expressed a range of views about their experience of discharge planning and this provided an important perspective on patients' research priorities associated with their personal independence. Efforts were taken to ensure representative views across a cross section of the population. As a result of this initial PPIE, a permanent, co-ordinated 'elders' panel has been established to ensure a representation of older adult views for research, service development and evaluation. This panel has permanent, fully supported members who provide reflection and feedback on any projects and programmes relating to older people's services in the City. ABSTRACT: Background Clinical academic research and service improvement is planned using Patient and Public Involvement and Engagement (PPIE) but older PPIE participants are consulted less often due to the perception that they are vulnerable or hard to engage. Objectives To consult frail older adults about a recently adopted service, discharge to assess (D2A), and to prioritise services improvements and research topics associated with the design and delivery of discharge from hospital. To use successive PPIE processes to enable a permanent PPIE panel to be established. Participants Following guidance from an established hospital PPI panel 27 older adult participants were recruited. Participants from Black, Asian and Minority Ethnic (BAME) communities, affluent and non-affluent areas and varied social circumstances were included. Methods Focus groups and individual interviews were conducted in participants own homes or nearby social venues. Results Priorities for discharge included remaining independent despite often feeling lonely at home; to remain in hospital if needed; and for services to ensure effective communication with families. The main research priority identified was facilitating independence, whilst establishing a permanent PPIE panel involving older adults was viewed favourably. Conclusions Taking a structured approach to PPIE enabled varied older peoples' voices to express their priorities and concerns into early discharge from hospital, as well as enabling the development of health services research into hospital discharge planning and management. Older people as participants identified research priorities after reflecting on their experiences. Listening and reflection enabled researchers to develop a new "Community PPIE Elders Panel" to create an enduring PPIE infrastructure for frail older housebound people to engage in research design, development and dissemination.

Evaluation of a mental health liaison team. Part 2: the themes and their effect on practice.

Hospitals and emergency departments (EDs) are caring for increasing numbers of patients who present with underlying mental health issues. Managing these patients can be challenging for clinical staff who often lack the specialist knowledge and skills required to provide appropriate care. This article, part two of two on the evaluation of a newly formed mental health liaison team (MHLT) working in a general hospital, focuses on the perceptions and experiences of the MHLT participants, and explores three sub-themes derived from the interview data. The article considers the effect of these themes on practice, and the relationship between MHLT members and staff in EDs and the wider hospital.

Evaluation of a mental health liaison team. Part 1: background and literature review.

Hospitals and emergency departments (EDs) are caring for increasing numbers of patients who present with underlying mental health issues. Management of these patients can be challenging for clinical staff who often lack the specialist knowledge and skills required to provide appropriate care. In April 2015, a mental health liaison service was introduced in Rotherham Hospital as part of a two-year pilot scheme. The aim was to provide assessment and treatment of adults with mental health problems admitted to the hospital. An evaluation of the new service was undertaken to assess the effects of the service. This article, part one of two, reviews the literature, as well as outlining the background to, and method of, evaluation. Part two, which will be published in December, examines the themes revealed by analysis of the service participants' responses.

Stress and type 2 diabetes: a review of how stress contributes to the development of type 2 diabetes.

Current policy and research around type 2 diabetes (T2D) interventions largely invoke a behavioral model. We suggest that activation of the physiologic stress response (PSR) from chronic exposure to stressors, low socioeconomic status (SES), severe mental health problems, or aggressive behavior increases the risk of T2D. This article is a comprehensive review of the literature on the link between T2D and psychosocial factors focusing on prospective studies of the risk for developing diabetes. The review found an increased risk for T2D in people: exposed to stressful working conditions or traumatic events; with depression; with personality traits or mental health problems that put them in conflict with others; of low SES, either currently or in childhood; and in racial/ethnic minority populations, independent of current SES. This review suggests that T2D prevention research would be more effective if (a) the PSR to psychosocial factors (especially social disparities) was recognized and (b) intervention programs evaluated reduction in social disparities as part of a comprehensive approach.

Engaging minorities in researching sensitive health topics by using a participatory approach.

AIM: To report the use of a community participatory approach (PA) in a project investigating tuberculosis (TB) in UK Somali migrants. BACKGROUND: It is crucial to address health inequalities and persistent health problems, particularly in groups who are often excluded or seem hard to reach. TB is an illness stigmatised in the Somali population, making it a difficult topic for research. In this study, a community PA was used to investigate TB and members of the Somali community were recruited as co-researchers. DATA SOURCES: Four community researchers (CRs), eight focus groups (n=48), interviews with members of the community (n=24), people with TB and ex-TB patients (n=14), and healthcare practitioners (n=18). REVIEW METHODS: This is an informative paper. Discussion The paper describes the approach used in the recruitment of community researchers and how engaging early with community leaders using oral communication made it possible to research TB in the Somali community. CONCLUSION: The PA led to capacity building, trust and a longer sustainable partnership with members of the Somali community. The success of the approach in the study suggests that there are valuable lessons for those researching similar topics with minority groups. IMPLICATIONS FOR PRACTICE/RESEARCH: Involving people in health research topics with a stigma is possible. This paper highlights how this could be achieved using a community PA and the recruitment of community members as co-researchers. However, the PA is time-consuming and will depend on the skills of academic researchers in knowing and engaging with the community.

Experiences of the diagnosis and management of tuberculosis: a focused ethnography of Somali patients and healthcare professionals in the UK.

AIM: To explore experiences of the diagnosis and management of tuberculosis from the perspective of Somali patients and healthcare professionals involved in their care. BACKGROUND: The Somali population has the third highest incidence of tuberculosis occurring in persons born outside the UK. Tuberculosis is a disease with sociocultural as well as physical consequences. Nurses should understand how the disease is experienced by people from different ethnic backgrounds to implement strategies for prevention and management of tuberculosis. DESIGN: A focused ethnography. METHOD: Individual interviews with 14 Somali patients and 18 healthcare professionals with experience of providing care to Somalis were undertaken in 2008-2009. Interviews explored the patient experience from onset of symptoms to completion of treatment. Data were analysed using Framework approach. FINDINGS: Despite presenting in primary care early, patients experienced diagnostic delays due to low clinical suspicion of tuberculosis among general practitioners. Although patients reported felt and enacted stigma, it did not adversely affect concordance with treatment. Patients were reticent about sharing their diagnosis among wider networks due to perceived stigma. Psychological support from families and specialist nurses was valued highly. Healthcare professionals perceived that stigmatization of tuberculosis was diminishing among Somalis leading to improved management of tuberculosis. Patients and healthcare professionals raised concerns about the longer term physical and psychosocial implications of tuberculosis once treatment was completed. CONCLUSION: Nurses have a role in promoting early presentation, timely diagnosis, and treatment adherence through supporting Somali patients and raising awareness of the disease among primary care practitioners.

The meaning and consequences of tuberculosis among Somali people in the United Kingdom.

AIM: To ascertain the socio-cultural meaning and consequences of tuberculosis among people of Somali origin living in the UK. BACKGROUND: In countries where treatment has not been readily available, tuberculosis has become highly stigmatized. Research in Somalia has documented the stigma and social isolation associated with tuberculosis which acts as a powerful deterrent to sufferers acknowledging their illness. The Somali community in the UK is diverse and dynamic: little is known about how tuberculosis is understood, or how stigma is articulated and experienced post-migration. DESIGN: A focused ethnography was undertaken. METHOD: A total of 48 individual interviews were undertaken in 2008-2009 with community leaders, Somali community members and tuberculosis patients to explore the social meaning of tuberculosis and perceived consequences of the disease. Eight focus groups were undertaken involving 56 participants. Vignettes concerning tuberculosis were used to prompt discussion of community norms and socio-cultural constructions of tuberculosis. Data were analysed using the 'Framework' approach. FINDINGS: Most participants were familiar with tuberculosis, its characteristics and treatment. However, many participants held misconceptions about how the disease spread and its prognosis. Tuberculosis was perceived as a stigmatizing disease. Somalis with tuberculosis were considered likely to experience felt and enacted stigma with fear of discrimination in the form of social isolation influencing the extent to which people with tuberculosis disclosed their condition. CONCLUSION: Nurses should understand the socio-cultural meaning and consequences of tuberculosis for Somalis to educate the community through public health initiatives and support patients and their families.