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Article ; Online: A Systematic Review of Vaccination Guidance for Humanitarian Responses

Lauren E. Allison / Mervat Alhaffar / Francesco Checchi / Nada Abdelmagid / Barni Nor / Majdi M. Sabahelzain / Page M. Light / Neha S. Singh

Vaccines, Vol 11, Iss 12, p

2023 Volume 1743

Abstract: Delivering vaccines in humanitarian response requires rigourous and continuous analysis of evidence. This systematic review mapped the normative landscape of vaccination guidance on vaccine-preventable diseases in crisis-affected settings. Guidance ... ...

Abstract	Delivering vaccines in humanitarian response requires rigourous and continuous analysis of evidence. This systematic review mapped the normative landscape of vaccination guidance on vaccine-preventable diseases in crisis-affected settings. Guidance published between 2000 and 2022 was searched for, in English and French, on websites of humanitarian actors, Google, and Bing. Peer-reviewed database searches were performed in Global Health and Embase. Reference lists of all included documents were screened. We disseminated an online survey to professionals working in vaccination delivery in humanitarian contexts. There was a total of 48 eligible guidance documents, including technical guidance ( n = 17), descriptive guidance ( n = 16), operational guidance ( n = 11), evidence reviews ( n = 3), and ethical guidance ( n = 1). Most were World Health Organization documents ( n = 21) targeting children under 5 years of age. Critical appraisal revealed insufficient inclusion of affected populations and limited rigour in guideline development. We found limited information on vaccines including, yellow fever, cholera, meningococcal, hepatitis A, and varicella, as well as human papilloma virus (HPV). There is a plethora of vaccination guidance for vaccine-preventable diseases in humanitarian contexts. However, gaps remain in the critical and systematic inclusion of evidence, inclusion of the concept of “zero-dose” children and affected populations, ethical guidance, and specific recommendations for HPV and non-universally recommended vaccines, which must be addressed.
Keywords	vaccination ; guidance ; humanitarian ; vaccine-preventable diseases ; zero dose children ; crises ; Medicine ; R
Subject code	170
Language	English
Publishing date	2023-11-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Design and implementation of a web-based, respondent-driven sampling solution

Catherine R. McGowan / Promise Ekoriko / Mervat Alhaffar / Sarah Cassidy-Seyoum / Steven Whitbread / Phil Rogers / Lucy Bell / Francesco Checchi

BMC Medical Informatics and Decision Making, Vol 23, Iss 1, Pp 1-

2023 Volume 9

Abstract: Abstract Background Respondent-driven sampling (RDS) refers both to a chain-referral sampling method and an analytical model for analysing sampled data. Web-based respondent-driven sampling (webRDS) uses internet-based recruitment coupled with an ... ...

Abstract	Abstract Background Respondent-driven sampling (RDS) refers both to a chain-referral sampling method and an analytical model for analysing sampled data. Web-based respondent-driven sampling (webRDS) uses internet-based recruitment coupled with an electronic survey to carry out RDS studies; there is currently no commercially available webRDS solution. We designed and developed a webRDS solution to support a research study aimed at estimating conflict-attributable mortality in Yemen. Our webRDS solution is composed of an existing survey platform (i.e. ODK) and a bespoke RDS system. The RDS system is designed to administer and manage an RDS survey cascade and includes: (1) an application programming interface, (2) a study participant client, and (3) an administrator interface. We report here on the design of the webRDS solution and its implementation. Results We consulted members of the Yemeni diaspora throughout the development of the solution. Technical obstacles were largely the result of: WhatsApp’s policies on bulk messaging and automated messaging behaviour, the inherent constraints of SMS messaging, and SMS filtering behaviour. Language support was straight-forward yet time consuming. Survey uptake was lower than expected. Factors which may have impacted uptake include: our use of consumable survey links, low interest amongst the diaspora population, lack of material incentives, and the length and subject matter of the survey itself. The SMS/WhatsApp messaging integration was relatively complex and limited the information we could send potential participants. Conclusion Despite lower-than expected survey uptake we believe our webRDS solution provides efficient and flexible means to survey a globally diverse population.
Keywords	Respondent-driven sampling ; Mortality estimation ; webRDS ; Hard-to-reach populations ; Chain-referral ; Yemen ; Computer applications to medicine. Medical informatics ; R858-859.7
Subject code	310
Language	English
Publishing date	2023-07-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: "They cannot afford to feed their children and the advice is to stay home. How‥?"

Mervat Alhaffar / Hala Mkhallalati / Omar Alrashid Alhiraki / Manar Marzouk / Ahmad Khanshour / Yazan Douedari / Natasha Howard

PLoS ONE, Vol 17, Iss 11, p e

A qualitative study of community experiences of COVID-19 response efforts across Syria.

2022 Volume 0277215

Abstract: Introduction COVID-19 highlighted the importance of meaningful engagement between communities and health authorities. This is particularly challenging in conflict-affected countries such as Syria, where social protection and food security needs can ... ...

Abstract	Introduction COVID-19 highlighted the importance of meaningful engagement between communities and health authorities. This is particularly challenging in conflict-affected countries such as Syria, where social protection and food security needs can hinder adherence to non-pharmaceutical interventions (NPIs) and vaccine uptake. This study explored community perspectives of COVID-19 and health authority responses across the three main areas of control in Syria, i.e. Syrian government-controlled areas (GCA), autonomous administration-controlled areas (AACA), and opposition-controlled areas (OCA). Methods We conducted a qualitative study, interviewing 22 purposively-sampled Syrians accessing health services in AACA, GCA, or OCA in 2021 to provide approximately equal representation by governance area and gender. We analysed data thematically using deductive and inductive coding. Findings Interviewees in all areas described how their fears of COVID-19 and willingness to adhere to NPIs decreased as their local COVID-19 epidemics progressed and NPIs disrupted access to household essentials such as work and food. Community-level responses were minimal and ad hoc, so most people focused on personal or household protective efforts and many mentioned relying on their faith for comfort. Misinformation and vaccine hesitancy were common in all areas, linked to lack of transparency from and mistrust of local health authorities and information sources. Conclusions The COVID-19 pandemic has increased health actors' need to engage with communities to control disease spread, yet most NPIs implemented in Syria were inappropriate and adherence decreased as the pandemic progressed. This was exemplified by lockdowns and requirements to self-isolate, despite precarious reliance on daily wages, no subsidies for lost income, individual self-reliance, and mistrust/weak communication between communities and health authorities. We found minimal community engagement efforts, consisting entirely of informing with no efforts to consult, ...
Keywords	Medicine ; R ; Science ; Q
Subject code	360
Language	English
Publishing date	2022-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: The Governance of Childhood Vaccination Services in Crisis Settings

Nada Abdelmagid / Rosamund J. Southgate / Mervat Alhaffar / Matab Ahmed / Hind Bani / Sandra Mounier-Jack / Maysoon Dahab / Francesco Checchi / Majdi M. Sabahelzain / Barni Nor / Bhargavi Rao / Neha S. Singh

Vaccines, Vol 11, Iss 12, p

A Scoping Review

2023 Volume 1853

Abstract: The persistence of inadequate vaccination in crisis-affected settings raises concerns about decision making regarding vaccine selection, timing, location, and recipients. This review aims to describe the key features of childhood vaccination intervention ...

Abstract	The persistence of inadequate vaccination in crisis-affected settings raises concerns about decision making regarding vaccine selection, timing, location, and recipients. This review aims to describe the key features of childhood vaccination intervention design and planning in crisis-affected settings and investigate how the governance of childhood vaccination is defined, understood, and practised. We performed a scoping review of 193 peer-reviewed articles and grey literature on vaccination governance and service design and planning. We focused on 41 crises between 2010 and 2021. Following screening and data extraction, our analysis involved descriptive statistics and applying the governance analysis framework to code text excerpts, employing deductive and inductive approaches. Most documents related to active outbreaks in conflict-affected settings and to the mass delivery of polio, cholera, and measles vaccines. Information on vaccination modalities, target populations, vaccine sources, and funding was limited. We found various interpretations of governance, often implying hierarchical authority and regulation. Analysis of governance arrangements suggests a multi-actor yet fragmented governance structure, with inequitable actor participation, ineffective actor collaboration, and a lack of a shared strategic vision due to competing priorities and accountabilities. Better documentation of vaccination efforts during emergencies, including vaccination decision making, governance, and planning, is needed. We recommend empirical research within decision-making spaces.
Keywords	vaccination ; governance ; humanitarian ; scoping review ; Medicine ; R
Language	English
Publishing date	2023-12-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Lessons from humanitarian clusters to strengthen health system responses to mass displacement in low and middle-income countries

Anna Durrance-Bagale / Omar Mukhtar Salman / Maryam Omar / Mervat Alhaffar / Muhammad Ferdaus / Sanjida Newaz / Sneha Krishnan / Natasha Howard

Journal of Migration and Health, Vol 1, Iss , Pp 100028- (2020)

A scoping review

2020

Abstract: The humanitarian cluster approach was established in 2005 but clarity on how lessons from humanitarian clusters can inform and strengthen health system responses to mass displacement in low and middle-income countries (LMIC) is lacking. We conducted a ... ...

Abstract	The humanitarian cluster approach was established in 2005 but clarity on how lessons from humanitarian clusters can inform and strengthen health system responses to mass displacement in low and middle-income countries (LMIC) is lacking. We conducted a scoping review to examine the extent and nature of existing research and identify relevant lessons.We used Arksey and O'Malley's scoping framework with Levac's 2010 revisions and Khalil's 2016 refinements, focussing on identifying lessons from discrete humanitarian clusters that could strengthen health system responses to mass population displacement. We summarised thematically by cluster.Of 186 sources included, 56% were peer-reviewed research articles. Most related to health (37%), protection (18%), or nutrition (13%) clusters. Key lessons for health system responses included the necessity of empowering women; ensuring communities are engaged in decision-making processes (e.g. planning and construction of camps and housing) to strengthen trust and bonds between and within communities; and involving potential end-users in technological innovations development (e.g. geographical information systems) to ensure relevance and applicability.Our review provided evidence that non-health clusters can contribute to improving health outcomes using focussed interventions for implementation by government or humanitarian partners to inform LMIC health system responses to mass displacement.
Keywords	Mass displacement ; Humanitarian cluster ; Health systems ; Public aspects of medicine ; RA1-1270 ; Colonies and colonization. Emigration and immigration. International migration ; JV1-9480
Subject code	306 ; 360
Language	English
Publishing date	2020-01-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Whose voices should shape global health education? Curriculum codesign and codelivery by people with direct expertise and lived experience

Aula Abbara / Maryam Omar / Mervat Alhaffar / Victoria Pilkington / Melanie Leis / Amelia Kataria Golestaneh / Mariam Sbaiti / Mike J Streule / Hala Mkhallalati / Lillian Liu

BMJ Global Health, Vol 6, Iss

2021 Volume 9

Keywords	Medicine (General) ; R5-920 ; Infectious and parasitic diseases ; RC109-216
Language	English
Publishing date	2021-09-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Excess mortality during the COVID-19 pandemic

Francesco Checchi / Emilie S Koum Besson / Andy Norris / Abdulla S Bin Ghouth / Terri Freemantle / Mervat Alhaffar / Yolanda Vazquez / Chris Reeve / Patrick J Curran

BMJ Global Health, Vol 6, Iss

a geospatial and statistical analysis in Aden governorate, Yemen

2021 Volume 3

Abstract: Background The burden of COVID-19 in low-income and conflict-affected countries remains unclear, largely reflecting low testing rates. In parts of Yemen, reports indicated a peak in hospital admissions and burials during May–June 2020. To estimate excess ...

Abstract	Background The burden of COVID-19 in low-income and conflict-affected countries remains unclear, largely reflecting low testing rates. In parts of Yemen, reports indicated a peak in hospital admissions and burials during May–June 2020. To estimate excess mortality during the epidemic period, we quantified activity across all identifiable cemeteries within Aden governorate (population approximately 1 million) by analysing very high-resolution satellite imagery and compared estimates to Civil Registry office records.Methods After identifying active cemeteries through remote and ground information, we applied geospatial analysis techniques to manually identify new grave plots and measure changes in burial surface area over a period from July 2016 to September 2020. After imputing missing grave counts using surface area data, we used alternative approaches, including simple interpolation and a generalised additive mixed growth model, to predict both actual and counterfactual (no epidemic) burial rates by cemetery and across the governorate during the most likely period of COVID-19 excess mortality (from 1 April 2020) and thereby compute excess burials. We also analysed death notifications to the Civil Registry office over the same period.Results We collected 78 observations from 11 cemeteries. In all but one, a peak in daily burial rates was evident from April to July 2020. Interpolation and mixed model methods estimated ≈1500 excess burials up to 6 July, and 2120 up to 19 September, corresponding to a peak weekly increase of 230% from the counterfactual. Satellite imagery estimates were generally lower than Civil Registry data, which indicated a peak 1823 deaths in May alone. However, both sources suggested the epidemic had waned by September 2020.Discussion To our knowledge, this is the first instance of satellite imagery being used for population mortality estimation. Findings suggest a substantial, under-ascertained impact of COVID-19 in this urban Yemeni governorate and are broadly in line with previous ...
Keywords	Medicine (General) ; R5-920 ; Infectious and parasitic diseases ; RC109-216
Subject code	310
Language	English
Publishing date	2021-03-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: “Ten years of war! You expect people to fear a ‘germ’?”

Yazan Douedari / Mervat Alhaffar / Muhammed Al-Twaish / Hala Mkhallalati / Raheb Alwany / Nafeesah Bte Mohamed Ibrahim / Ayshath Zaseela / Nour Horanieh / Aula Abbara / Natasha Howard

Journal of Migration and Health, Vol 1, Iss , Pp 100021- (2020)

A qualitative study of initial perceptions and responses to the COVID-19 pandemic among displaced communities in opposition-controlled northwest Syria

2020

Abstract: Background: Response to the COVID-19 pandemic has challenged even robust healthcare systems in high-income countries. Syria, a country experiencing protracted conflict, has the largest internally-displaced population globally with most displaced ... ...

Abstract	Background: Response to the COVID-19 pandemic has challenged even robust healthcare systems in high-income countries. Syria, a country experiencing protracted conflict, has the largest internally-displaced population globally with most displaced settlements in opposition-controlled areas governed by local and international NGOs. This study aimed to explore community perspectives on challenges and potential solutions to reduce COVID-19 transmission among displaced communities in opposition-controlled Northwest Syria. Methods: We used a qualitative study design, conducting 20 interviews with displaced Syrians in opposition-controlled camps in Northwest Syria between April-May 2020 and ensuring over half our interviewees were women. We analysed data thematically. Results: Participants described already difficult camp conditions that would be detrimental to an effective COVID-19 response, including household crowding, inadequate sewerage and waste management, insufficient and poor-quality water, and lack of cleaning supplies. Participants most frequently mentioned internet as their COVID-19 information source, followed by NGO awareness campaigns. Men had access to more accurate and comprehensive COVID-19 information than women did. Isolating (shielding) high-risk people within households did not appear feasible, but participants suggested ‘house-swapping’ approaches might work. While most participants had sufficient knowledge about COVID-19, they lacked practical tools to prevent transmission. Conclusion: This study is the first to explore perspectives and lived experiences of internally-displaced Syrians in the weeks prior to the COVID-19 epidemic in Northwest Syria. The challenging living conditions of internally-displaced people in Syria are further threatened by the spread of COVID-19. Tailored control measures are urgently needed to reduce COVID-19 transmission in camps.
Keywords	Displacement ; Conflict ; Lived experience ; COVID-19 ; Syria ; Public aspects of medicine ; RA1-1270 ; Colonies and colonization. Emigration and immigration. International migration ; JV1-9480
Subject code	950
Language	English
Publishing date	2020-01-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Leveraging community mortality indicators to infer COVID-19 mortality and transmission dynamics in Damascus, Syria

Oliver J. Watson / Mervat Alhaffar / Zaki Mehchy / Charles Whittaker / Zack Akil / Nicholas F. Brazeau / Gina Cuomo-Dannenburg / Arran Hamlet / Hayley A. Thompson / Marc Baguelin / Richard G. FitzJohn / Edward Knock / John A. Lees / Lilith K. Whittles / Thomas Mellan / Peter Winskill / Imperial College COVID-19 Response Team / Natasha Howard / Hannah Clapham /

Francesco Checchi / Neil Ferguson / Azra Ghani / Emma Beals / Patrick Walker

Nature Communications, Vol 12, Iss 1, Pp 1-

2021 Volume 10

Abstract: Reported COVID-19 mortality rates have been relatively low in Syria, but there has been concern about overwhelmed health systems. Here, the authors use community mortality indicators and estimate that <3% of COVID-19 deaths in Damascus were reported as ... ...

Abstract	Reported COVID-19 mortality rates have been relatively low in Syria, but there has been concern about overwhelmed health systems. Here, the authors use community mortality indicators and estimate that <3% of COVID-19 deaths in Damascus were reported as of 2 September 2020.
Keywords	Science ; Q
Language	English
Publishing date	2021-04-01T00:00:00Z
Publisher	Nature Portfolio
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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