Evaluation of an integrated intervention to reduce psychological distress and intimate partner violence in refugees: Results from the Nguvu cluster randomized feasibility trial.

INTRODUCTION: The complex relationship between intimate partner violence and psychological distress warrants an integrated intervention approach. In this study we examined the relevance, acceptability, and feasibility of evaluating a multi-sectoral integrated violence- and mental health-focused intervention (Nguvu). METHODS: We enrolled 311 Congolese refugee women from Nyarugusu refugee camp in Tanzania with past-year intimate partner violence and elevated psychological distress in a feasibility cluster randomized trial. Women were recruited from local women's groups that were randomized to the Nguvu intervention or usual care. Participants from women's groups randomized to Nguvu received 8 weekly sessions delivered by lay refugee incentive workers. Psychological distress, intimate partner violence, other wellbeing, and process indicators were assessed at baseline and 9-weeks post-enrollment to evaluate relevance, acceptability, and feasibility of implementing and evaluating Nguvu in refugee contexts. RESULTS: We found that Nguvu was relevant to the needs of refugee women affected by intimate partner violence. We found reductions in some indicators of psychological distress, but did not identify sizeable changes in partner violence over time. Overall, we found that Nguvu was acceptable and feasible. However, challenges to the research protocol included baseline imbalances between study conditions, differential intervention completion related to intimate partner violence histories, differences between Nguvu groups and facilitators, and some indication that Nguvu may be less beneficial for participants with more severe intimate partner violence profiles. CONCLUSIONS: We found evidence supporting the relevance of Nguvu to refugee women affected by partner violence and psychological distress and moderate evidence supporting the acceptability and feasibility of evaluating and implementing this intervention in a complex refugee setting. A definitive cluster randomized trial requires further adaptations for recruitment and eligibility screening, randomization, and retention. TRIAL REGISTRATION: ISRCTN65771265, June 27, 2016.

Intestinal parasitic infections in a population of BaAka Pygmies inhabiting the Congo Basin in the Central African Republic.

INTRODUCTION: Pygmy tribes inhabit tropical environment of Central Africa. After expulsion from their original habitat by the Bantu people, they settled in a local forest ecosystem where they live with very low sanitary standards. Their actual morbidity remains unknown. OBJECTIVE: The aim of the study was to analyze the prevalence of intestinal parasitic infections in BaAka Pygmies inhabiting the Congo Basin in the Central African Republic. MATERIAL AND METHODS: The study was conducted in 2015, and involved a group of 950 Pygmies living inthe Sangha-Mbaere and Lobaye prefectures. Single stool samples were collected from study participants, fixed in 10% formalin, transported from Africa to Europe, and analyzed by light microscopy using 5 different diagnostic methods (direct smear, decantation with distilled water, Fülleborne's flotation, Kato-Miura thick smear, DiaSyS/PARASYS system sedimentation) at the Military Institute of Medicine in Warsaw, Poland. RESULTS: Microscopic examination revealed infections with 14 different species of intestinal nematodes, cestodes, trematodes and protozoa. According to the study findings, 90.5% of BaAka Pygmies were found to be infected with intestinal parasites, and 70.8% had mixed infections. Most of the pathogenic intestinal parasites were nematodes (85.0%), with Asrcaris lumbricoides (29.8%), hookworm (29.4%) and Trichuris trichiura (10.7%) being predominant. CONCLUSIONS: Poor sanitation, limited the high prevalence of intestinal parasitic infections in the community of Pygmies. The negative test results may prove the effectiveness of periodic deworming campaigns chich, implemented by non-governmental organizations, are voluntary with respect to the informed consent principle.

A Multi-Methods Qualitative Study of the Delivery Care Experiences of Congolese Refugees in Uganda.

INTRODUCTION: Uganda hosts over 1.4 million refugees and is regarded as one of the world's most hospitable places for displaced populations. However, reports suggest that comprehensive sexual and reproductive health (SRH) services remain inadequate. We aimed to explore the SRH experiences of Congolese refugees living in Uganda and ways that services could be improved. We focus this article on delivery care-related results. METHODS: In 2017, we assessed Congolese women's SRH, including pregnancy and delivery care, needs in the Nakivale Refugee Settlement and Kampala. We conducted a review of published literature and institutional records, 11 key informant interviews, four focus group discussions with married and unmarried Congolese women, and 21 in-person in-depth interviews with Congolese women refugees. We analyzed these data for content and themes using inductive and deductive techniques. In the final analytic phase, we integrated findings from each study component to identify concordant and discordant results. RESULTS: Our findings indicate that Congolese refugees experience significant challenges accessing delivery care in both camp and urban settings. The availability of trained healthcare staff is limited, health facilities and medication supplies are inadequate, and referral systems are deficient. Refugee women report that corruption, discrimination, language barriers, and lack of privacy characterize their delivery experiences. CONCLUSION: Efforts to increase trained healthcare staff, improve supply-chain management, and maintain infrastructure and equipment are imperative. Ensuring compliance with anti-bribery and anti-corruption policies and supporting respectful maternity care is also important. Creating approaches to overcome language barriers is crucial to minimizing miscommunication and building patient-provider trust.

Novel hepatitis B virus subgenotype A8 and quasi-subgenotype D12 in African-Belgian chronic carriers.

BACKGROUND: Hepatitis B virus (HBV) is a public health threatening virus and is classified into more than eight genotypes and more than forty subgenotypes. OBJECTIVES: To characterize and propose novel strains assigned as A8 and D12. METHODS: Four out of 133 HBV complete genome sequences, isolated from Belgian chronic carriers with African origin were phylogenetically analyzed. RESULTS: Phylogenetic analyses of HBV genotypes A and D strains exhibited separate clusters supported by significant bootstrap values. The two genotype A strains isolated from Congolese patients, and two genotype D strains isolated from Ghanaian carriers clustered separately from the other known subgenotypes A (A1-A6 and quasi-subgenotypes) and subgenotypes D (D1-D11). The mean inter-subgenotypic nucleotide divergence over the full-length genome sequence between the novel strains (A8 and D12) and A1-A7 and D1-D11 subgenotypes was higher than 4%. CONCLUSIONS: Phylogenetic analysis of the full-length HBV genome sequences revealed a novel subgenotype and quasi-subgenotype based on the nucleotide divergence and identification of novel amino acids motifs in different ORFs. We identified two strains of the novel subgenotype A8 and two strains of the novel quasi-subgenotype D12. Notably, the analysis demonstrated that the subgenotype A8 strains are a basal lineage that diverged before the other African subgenotypes A.

"In Africa, There Was No Family Planning. Every Year You Just Give Birth": Family Planning Knowledge, Attitudes, and Practices Among Somali and Congolese Refugee Women After Resettlement to the United States.

It is crucial for refugee service providers to understand the family planning knowledge, attitudes, and practices of refugee women following third country resettlement. Using an ethnographic approach rooted in Reproductive Justice, we conducted six focus groups that included 66 resettled Somali and Congolese women in a western United States (US) metropolitan area. We analyzed data using modified grounded theory. Three themes emerged within the family planning domain: (a) concepts of family, (b) fertility management, and (c) unintended pregnancy. We contextualized these themes within existing frameworks for refugee cultural transition under the analytic paradigms of "pronatalism and stable versus evolving family structure" and "active versus passive engagement with family planning." Provision of just and equitable family planning care to resettled refugee women requires understanding cultural relativism, social determinants of health, and how lived experiences influence family planning conceptualization. We suggest a counseling approach and provider practice recommendations based on our study findings.

Epigenetic aging in children from a small-scale farming society in The Congo Basin: Associations with child growth and family conflict.

Developmental environments influence individuals' long-term health trajectories, and there is increasing emphasis on understanding the biological pathways through which this occurs. Epigenetic aging evaluates DNA methylation at a suite of distinct CpG sites in the genome, and epigenetic age acceleration (EAA) is linked to heightened chronic morbidity and mortality risks in adults. Consequently, EAA provides insights on trajectories of biological aging, which early life experiences may help shape. However, few studies have measured correlates of children's epigenetic aging, especially outside of the U.S. and Europe. In particular, little is known about how children's growth and development relate to EAA in ecologies in which energetic and pathogenic stressors are commonplace. We studied EAA from dried blood spots among Bondongo children (n = 54) residing in a small-scale, fisher-farmer society in a remote region of the Republic of the Congo. Here, infectious disease burdens and their resultant energy demands are high. Children who were heavier for height or taller for age, respectively, exhibited greater EAA, including intrinsic EAA, which is considered to measure EAA internal to cells. Furthermore, we found that children in families with more conflict between parents had greater intrinsic EAA. These results suggest that in contexts in which limited energy must be allocated to competing demands, more investment in growth may coincide with greater EAA, which parallels findings in European children who do not face similar energetic constraints. Our findings also indicate that associations between adverse family environments and greater intrinsic EAA were nonetheless observable but only after adjustment for covariates relevant to the energetically and immunologically demanding nature of the local ecology.

Assessing the availability and accessibility of emergency contraceptive pills in Uganda: A multi-methods study with Congolese refugees.

OBJECTIVES: We aimed to document the availability and explore the accessibility of emergency contraceptive pills for Congolese refugees living in both camp and urban settings in Uganda. METHODS: In 2017, we conducted a multi-methods assessment in both the Nakivale Refugee Settlement and Uganda's capital of Kampala. Our study included a review of the published literature and institutional reports and statistics, 11 key informant interviews, 4 focus group discussions (FGDs) with married (N = 16) and unmarried (N = 20) Congolese women, and 21 in-person in-depth interviews with refugee women. We analyzed these data for content and themes using deductive and inductive techniques and triangulated our findings. RESULTS: Our findings show that the availability of emergency contraception in the Nakivale Refugee Settlement is inconsistent and theft of product by health center personnel is a significant problem. Congolese women living in Kampala reported that the cost of emergency contraceptive pills is prohibitive. Most of our refugee participants living in both settings lacked accurate knowledge about post-coital contraception and several reported using a range of other drugs to prevent pregnancy after sex. CONCLUSION: Emergency contraception has long been incorporated into the standards of care for sexual and reproductive health in humanitarian settings. However, results from our study indicate that Congolese women face a range of challenges accessing emergency contraception in Uganda. Strengthening supply chain management, examining and addressing the dynamics underlying product theft, and increasing awareness of effective post-coital methods are priorities for expanding reliable access. IMPLICATIONS: Inconsistent availability and lack of accessibility of emergency contraception has significant implications for refugee and displaced populations. Supporting efforts to ensure that humanitarian stakeholders in Uganda are adhering to global standards of care is critical.

[Coming from Afar and Rediscovering Oneself: Group Intervention for Immigrant and Refugee Women Having Experienced Violence]. / Venir de loin et se retrouver : intervention de groupe pour femmes immigrantes et réfugiées ayant vécu la violence.

Objectives This paper has a clinical perspective and presents an innovative intervention that could be offered in different institutions and practice environments. The object here is a group intervention addressed specifically to immigrant and refugee women having experienced different forms of violence. The consequences of being exposed to intentional and dehumanizing violence, paired with the challenges associated with migration and forced exile, can fragilize the individuals and challenge their capacity to adapt. Even though psychological and psychosocial support in the years following their arrival could be beneficial, immigrants and refugees rarely use institutional services, and experts point out that the services are not tailored to them. In that respect stems the importance of promoting the development of more meaningful interventions for immigrants and refugees, in accordance with the principle of equity and equality of chances to have access to appropriate services, but also to better equip the specialists by giving them access to safe and culturally sensitive interventions. Following that perspective, a group intervention for immigrants and refugees having experienced violence was created in 2010 with the collaboration of researchers from l'IUPLSSS and social workers from CIUSSS de l'Estrie-Chus. Method Firstly, this article aims to present this group intervention. Innovative features of the proposed program will be highlighted, followed by an overview of the clinical and empirical supports that recommend the use of groups and art to intervene with immigrants and refugees. A more detailed description of the intervention will follow, describing the objectives of the intervention as well as the intervention framework, including some necessary components to assure the therapeutic reach of the groups and the establishment of a safe space. Secondly, the article presents a brief summary of the preliminary results of a current study aiming to evaluate the impacts of the intervention. During this study, qualitative and quantitative data was collected from 3 groups (n = 17) and analyzed with content analysis and non-parametric analyses to measure the changes between pre and post intervention. Results The results of the qualitative and quantitative analyses show that women report positive changes at the end of the group, namely in regard to post-traumatic stress symptoms and different dimensions of their well-being. Conclusion To conclude, the advantages and limits of this intervention will be discussed, but also its relevance for the practice environments. Even if it isn't the only answer for the intervention in a post-violence context, it consists of a good option for providing adapted services to the reality and needs of immigrants and refugees.

Barriers and Facilitators to Food Security among Adult Burundian and Congolese Refugee Females Resettled in the US.

Sub-Saharan African refugees in the US have reported food security rates seven times below the national average. Dietary acculturation issues may be a contributing factor. Criterion-specific sample (n = 18) was recruited using network then snowball sampling methods. Semi-structured interviews were facilitated with the aid of a culturally and linguistically appropriate interpreter. An iterative, two cycle coding analytic process was completed within NVivo 11 by two coders who sought inter-rater reliability. Codes were organized into hierarchical maps and coding matrices for direct content analysis, and pattern and theme detection. Saturation was achieved and validated with an additional two interviews. Participants were primarily Burundian (67% vs. 33% Congolese), married (72%), held no high school degree (72%), unemployed (56%) and reported limited English proficiency (72%). Barriers and facilitators to food security across all levels of the Socio-Ecological Model (SEM) were noted. Emerging themes included difficulty with language, cooking, and shopping; transportation; social network support; orientation services; reliance on nutrition assistance programs; limited culturally relevant food and land access; and program policy miscomprehension. The complex relationship between dietary acculturation barriers and facilitators at various SEM levels demonstrates the need for a multi-level intervention to improve food security among refugees.

Narrativas femininas e saúde mental: a saída da República Democrática do Congo e o refúgio no Rio de Janeiro / Female narratives and mental health: the departure from Democratic Republic of Congo and the refuge in Rio de Janeiro

O objetivo central desta dissertação é refletir sobre o processo de refúgio e a relação deste com a saúde mental de mulheres naturais da República Democrática do Congo (RDC), residentes no Rio de Janeiro. Essa dissertação foi realizada a partir de um estudo qualitativo, de abordagem etnográfica, composto por observação participante e entrevistas, realizado em uma instituição de acolhimento a esta população - a Caritas RJ. A partir das falas dessas mulheres, este trabalho traz ponderações sobre como o Brasil que, até o momento, detém uma legislação favorável à questão do refúgio (lei 9.474 de 1997), na realidade, não apresenta providências de acordo com o que se comprometeu e contribui para a manutenção de vulnerabilidades. Ao analisar as trajetórias das mulheres negras, congolesas, refugiadas em território nacional, me apoio nos conceitos de precarização da vida e sofrimento social, para associar os contextos de violência persistentes e suas interferências em quadros mentais. Neste sentido, foi possível notar a ampla capacidade de resiliência apresentada por elas e sua relação com a religião e a cultura. Entre os adoecimentos, foi observado maior presença de quadros de natureza somatoforme, ansiosa e depressiva (Transtornos Mentais Comuns - TMC). Diante deste contexto, as propostas da Saúde Mental Global (SMG), com tratamentos baseados em evidências e particularizados entre diferentes culturas, podem beneficiar esse grupo

The main goal of this dissertation is to reflect on the refugee process and the relationship between it and the mental health of women from the Democratic Republic of Congo (DRC) residing at Rio de Janeiro. This is a qualitative study with an ethnographic approach composed of participant observation and interviews, performed at a host institution for this population - Caritas RJ. Based on the statements of these women, this work brings forward considerations about how Brazil, which until now has legislation favorable to the issue of refuge (Law 9.474 of 1997), in fact, does not present provisions according to what it has committed and contributes to the maintenance of vulnerabilities. In analyzing the trajectories of black Congolese women refugees in the national territory, I use as a theoretical base the concepts of precariousness of life and social suffering in order to associate persistent contexts of violence and their interference in mental conditions. In this sense, it was possible to note the wide capacity of resilience presented by them and their relation to religion and culture. Among the diseases, there was a greater presence of somatoform, anxious and depressive conditions (Common Mental Disorders - CMD). Given this context, Global Mental Health (MCH) proposals with evidence-based and individualized treatments among different cultures may benefit this group

Unresolved Splenomegaly in Recently Resettled Congolese Refugees - Multiple States, 2015-2018.

In 2014, panel physicians from the International Organization for Migration (IOM), who conduct Department of State-required predeparture examinations for U.S.-bound refugees at resettlement sites in Uganda, noticed an unusually high number of Congolese refugees with enlarged spleens, or splenomegaly. Many conditions can cause splenomegaly, such as various infections, liver disease, and cancer. Splenomegaly can result in hematologic disturbances and abdominal pain and can increase the risk for splenic rupture from blunt trauma, resulting in life-threatening internal bleeding. On CDC's advice, panel physicians implemented an enhanced surveillance and treatment protocol that included screening for malaria (through thick and thin smears and rapid diagnostic testing), schistosomiasis, and several other conditions; treatment of any condition identified as potentially associated with splenomegaly; and empiric treatment for the most likely etiologies, including malaria and schistosomiasis. CDC recommended further treatment for malaria with primaquine after arrival, after glucose-6-phosphate dehydrogenase testing, to target liver-stage parasites. Despite this recommended treatment protocol, 35 of 64 patients with available follow-up records had splenomegaly that persisted beyond 6 months after resettlement. Among 85 patients who were diagnosed with splenomegaly through abdominal palpation or ultrasound at any point after resettlement, 53 had some hematologic abnormality (leukopenia, anemia, or thrombocytopenia), 16 had evidence of current or recent malaria infection, and eight had evidence of schistosomiasis. Even though primaquine was provided to a minority of patients in this cohort, it should be provided to all eligible patients with persistent splenomegaly, and repeated antischistosomal therapy should be provided to patients with evidence of current or recent schistosomiasis. Given substantial evidence of familial clustering of cases, family members of patients with known splenomegaly should be proactively screened for this condition.

Evaluation of the efficacy of a South African psychosocial model for the rehabilitation of torture survivors.

To address the consequences of past torture experiences as well as current traumas and daily stressors, the Centre for the Study of Violence and Reconciliation (CSVR) developed a contextually appropriate psychosocial framework for the rehabilitation of individuals who have been affected by torture. METHOD: To test the efficacy of this framework, a quasiexperimental study was conducted with torture survivor clients of the CSVR who met the 1985 United Nations Convention Against Torture (UNCAT) definition. A comparison group of clients (n=38) was initially included on a waiting list and thereafter received treatment, whilst the treatment group of clients (n=44) entered straight into treatment. RESULTS: Baseline t-test comparisons conducted on 13 outcome indicators revealed significantly better initial psychological health and functioning of clients in the treatment group than those in the comparison group, with moderately large differences on PTSD, trauma and anxiety, and strong difference in depression scores. Three-month follow-up comparisons using the conservative Wilcoxon test revealed significantly greater improvement on the functioning and anxiety indicators of the treatment group relative to the waiting-list comparison group (odds ratios = 2.49 and 2.61 respectively). After a further three months, when treatment was based on the CSVR framework for both groups, fewer than half the respondents remained in the study (n=20 in the treatment group; n=16 in the comparison group), and the Wilcoxon repeated measures test results on changes since baseline were counter-intuitive: for these remaining clients, there were now more significant outcome improvements for the comparison group than for the treatment group. However, the relative odds ratios for the groups were not significant for these indicators. Furthermore, the clients who dropped out from the treatment group had shown overall improvement in their psychological health and functioning in the initial three months of the study, whereas those who dropped out from the comparison group had shown improvements on fewer indicators. Thus, the research findings on the efficacy of the framework are inconclusive. DISCUSSION: We suggest that this inconclusiveness can be explained by the severe challenges and ethical complexities of psychosocial research on vulnerable groups. The study highlights the serious problem of attrition of participants in the treatment programme which affected the overall study, and which may explain findings that at first appear counter-intuitive.

Challenges of Combining Perspectives.

BACKGROUND: Asylum seekers have increased risk of suicide and suicidal behavior, with differences related to origin, gender, and age. There are barriers to communication in clinical encounters between asylum seekers and clinicians. There is insufficient knowledge about how communication in the clinical encounter affects the suicide risk in female asylum seekers. AIMS: To explore the documented communication between female asylum-seeking suicide attempters and clinicians and how it affects treatment. METHOD: The medical records of 18 asylum-seeking women who had attempted suicide were analyzed with content analysis. RESULTS: Communication between patients and clinicians was affected by: the unbearable realities of the women; difficulties for clinicians in decoding languages of distress, and understanding trauma and subjective meanings of suicide; challenges of combining patients' and clinicians' perspectives; and a sense of shared powerlessness. LIMITATIONS: The medical records did not give direct access to the patient's experience, only to the patient as documented by the clinician. CONCLUSION: The results suggest that clinicians working with asylum seekers who have attempted suicide need to develop an understanding of social and cultural factors and of trauma issues. A question for further study is how an enhanced integration of context and subjectivity in psychiatric practice would equip clinicians for the specific challenges encountered.

How Narratives of Fear Shape Girls' Participation in Community Life in Two Conflict-Affected Populations.

Numerous social factors shape girls' lives in conflict-affected settings, affecting their vulnerability to gender-based violence (GBV). Qualitative research methods were used to examine spaces of perceived safety and risk for girls living in two conflict-affected populations: camps in Ethiopia hosting primarily South Sudanese and Sudanese refugees and communities in eastern Democratic Republic of Congo. Three major themes emerged: (a) challenges around caregiver-child communication regarding development, sex, and sexual violence; (b) a typology of safe/risky spaces; and (c) the influence of male-dominated spaces on experiences and fear of GBV. The findings have implications for programs focused on reducing adolescent girls' vulnerability to violence within conflict-affected contexts.

"Going to the Gym Is Not Congolese's Culture": Examining Attitudes Toward Physical Activity and Risk for Type 2 Diabetes Among Congolese Immigrants.

Purpose The purpose of this study was to explore perceptions and attitudes around physical activity among immigrants from the Democratic Republic of Congo and examine the influence of Congolese cultural beliefs on physical activity practice. Methods In-depth interviews were conducted and augmented by photo-elicitation among 20 Congolese immigrants, distributed equally by gender, aged 35 years or older. The PEN-3 model was used as the cultural conceptual framework. Results Using both the Relationships and Expectations dimension (Perceptions, Enablers, and Nurturers) and Cultural Empowerment dimension (Positive, Existential, and Negative) of the PEN-3 model, emergent themes were categorized around knowing the benefits of being physically active (perceptions), doctor encouragement to be more physically active (enablers), and the habit and local tradition of consuming beer after a soccer match (nurturers). Other emergent themes included Congolese loves to dance (positive), going to the gym is not Congolese culture (existential), and the challenge of increased physical activity (negative). Conclusions Congolese have their intrinsic cultural perceptions and attitudes around types of physical activity. The study disclosed a much more pronounced willingness to dance (as a potential source of increased physical activity) than to go to a gym. As such, if one wants to advocate a regimen of increased physical activity to offset the risk for type 2 diabetes, dance is an alternative to consider among some immigrants.

Universality Without Uniformity: A Culturally Inclusive Approach to Sensitive Responsiveness in Infant Caregiving.

Do caregivers in non-Western communities adapt their behaviors to the needs of infants? This question reflects one of the most long-standing debates on the universality versus culture-specificity of caregiver-infant interactions in general and sensitive responsiveness to infants in particular. In this article, an integration of both points of view is presented, based on the theoretical origins of the sensitive responsiveness construct combined with the ethnographic literature on caregivers and infants in different parts of the world. This integration advocates universality without uniformity, and calls for multidisciplinary collaborations to investigate the complexities and nuances of caregiver-infant interactions in different cultures. Salient issues are illustrated with observations of infants (ages 7-31 months) in Mali, the Republic of Congo, and the Philippines.

Learning from UJAMBO: Perspectives on Gynecologic Care in African Immigrant and Refugee Women in Boston, Massachusetts.

African-born immigrant women, and particularly refugees and asylum seekers, are at risk for reproductive health disparities but inadequately use relevant gynecologic services. We sought to elucidate perspectives on gynecologic care in a population of Congolese and Somali immigrants. We conducted a secondary qualitative analysis of focus group data using a grounded theory approach and the Integrated Behavioral Model as our theoretical framework. Thirty one women participated in six focus groups. Participant beliefs included the states of pregnancy and/or pain as triggers for care, preferences included having female providers and those with familiarity with female genital cutting. Barriers included stigma, lack of partner support, and lack of resources to access care. Experiential attitudes, normative beliefs, and environmental constraints significantly mediated care preferences for/barriers to gynecologic health service utilization in this population. Centering of patient perspectives to adapt delivery of gynecologic care to immigrants and refugees may improve utilization and reduce disparities.

Absence of Loa loa Microfilaremia among Newly Arrived Congolese Refugees in Texas.

The Centers for Disease Control and Prevention recommends that refugees at risk of Loa loa infection be tested for microfilaria before treatment with ivermectin. We report observational results of this approach in African refugees in Texas. Daytime blood smears were performed for microfilaria on at-risk African refugees who arrived in Texas from July 1, 2014 through December 30, 2016. Clinics were asked if there were any adverse events reported among those who received ivermectin. Of the 422 persons screened, 346 (82%) were born in L. loa-endemic countries, with 332 (96%) of these being born in the Democratic Republic of Congo. No smears detected microfilaria, and all received presumptive ivermectin with no reports of significant adverse events. In this investigation, the prevalence of significant microfilarial load in sub-Saharan African refugees appeared to be low, and ivermectin treatment was safe and well tolerated.

"My heart is in his hands": The lived spiritual experiences of Congolese refugee women survivors of sexual violence.

The Democratic Republic of Congo (DRC) has experienced widespread violence, including sexual violence. Sexual violence toward women includes rape, genital mutilation, and sexual slavery. Many Congolese have sought to escape such conditions as refugees in the USA. In the present study, we examined lived spiritual experiences of nine Congolese refugee women survivors of sexual violence. Overall, this study provides new insights into participants' experiences of spirituality in the aftermath of sexual trauma and in living as a refugees. Consensual qualitative research (CQR) methods were used to analyze participants' responses to a semistructured interview protocol. Participants endorsed faith that God was in control, reliance on prayer, gratitude toward God, and difficulty practicing their faith in the USA relative to Africa. Results indicated that religion/spirituality is an integral part of the women's lives and that it appears to facilitate coping. Clinical and community mental health implications are discussed.