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Conflict and Health

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Open Access 01-12-2018 | Research

Health status of returning refugees, internally displaced persons, and the host community in a post-conflict district in northern Sri Lanka: a cross-sectional survey

Authors: Rachel Burns, Kolitha Wickramage, Anwar Musah, Chesmal Siriwardhana, Francesco Checchi

Published in: Conflict and Health | Issue 1/2018

Abstract

Background

Although the adverse impacts of conflict-driven displacement on health are well-documented, less is known about how health status and associated risk factors differ according to displacement experience. This study quantifies health status and quality of life among returning refugees, internally displaced persons, and the host community in a post-conflict district in Northern Sri Lanka, and explores associated risk factors.

Methods

We analysed data collected through a household survey (n = 570) in Vavuniya district, Sri Lanka. The effect of displacement status and other risk factors on perceived quality of life as estimated from the 36-item Short Form Questionnaire, mental health status from 9-item Patient Health Questionnaire, and self-reported chronic disease status were examined using univariable analyses and multivariable regressions.

Results

We found strong evidence that perceived quality of life was significantly lower for internally displaced persons than for the host community and returning refugees, after adjusting for covariates. Both mental health status and chronic disease status did not vary remarkably among the groups, suggesting that other risk factors might be more important determinants of these outcomes.

Conclusions

Our study provides important insights into the overall health and well-being of the different displaced sub-populations in a post-conflict setting. Findings reinforce existing evidence on the relationship between displacement and health but also highlight gaps in research on the long-term health effects of prolonged displacement. Understanding the heterogeneity of conflict-affected populations has important implications for effective and equitable humanitarian service delivery in a post-conflict setting.

Thomas SL, SDM T. Displacement and health. Vol. 69, British Medical Bulletin; 2004. p. 115–27.

Heudtlass P, Speybroeck N, Guha-Sapir D. Excess mortality in refugees, internally displaced persons and resident populations in complex humanitarian emergencies (1998-2012) - insights from operational data. Confl Health. 2016;10:15. Available from: https://conflictandhealth.biomedcentral.com/articles/10.1186/s13031-016-0082-9.

Toole MJ, Waldman RJ. The public health aspects of complex emergencies and refugee situations. Annu Rev Public Health. 1997;18(1):283–312 Available from: https://doi.org/10.1146/annurev.publhealth.18.1.283.CrossRef

Spiegel PB, Checchi F, Colombo S, Paik E. Health-care needs of people affected by conflict: future trends and changing frameworks. Lancet. 2010;375(9711):341–5.CrossRef

Roberts B, Patel P, Mckeea M. Noncommunicable diseases and post-conflict countries. Bull World Health Organ. 2012;90(1):12.CrossRef

Siriwardhana C, Ali SS, Roberts B, Stewart R. A systematic review of resilience and mental health outcomes of conflict-driven adult forced migrants. Confl Health. 2014;8(1):13 Available from: https://doi.org/10.1186/1752-1505-8-13.CrossRef

Porter M, Haslam N. Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons: a meta-analysis. JAMA. 2005 Aug 3;294(5):602–12 Available from: https://doi.org/10.1001/jama.294.5.602.CrossRef

Siriwardhana C, Wickramage K. Conflict, forced displacement and health in Sri Lanka: a review of the research landscape. Confl Health. 2014;8(22):9. Available from: http://www.conflictandhealth.com/content/8/1/22 CrossRef

Salama P, Spiegel P, Brennan R. No less vulnerable: the internally displaced in humanitarian emergencies. Lancet. 2001;357:1430–1.CrossRef

10.

Wickramage K, Mosca D, Peiris SL, editors. Migration Health Research to advance evidence based policy and practice in Sri Lanka: volume 1. Makati City: International Organization for Migration Migration Health Research Unit; 2017. p. 224. Available from: https://publications.iom.int/books/migration-health-research-advance-evidence-based-policy-and-practice-sri-lanka

11.

UNHCR. Coming Home: Sri Lankan refugees return. 2010. Available from: http://www.unhcr.org/4c657ec69.html [cited 2017 Aug 23]

12.

Siriwardhana C, Adikari A, Jayaweera K, Sumathipala A. Ethical challenges in mental health research among internally displaced people: ethical theory and research implementation. BMC Med Ethics. 2013;14(1):13 Available from: http://www.biomedcentral.com/1472-6939/14/13.CrossRef

13.

Kirkbya K, Galappaththy GNL, Kurinczuk JJ, Rajapakse S, Deepika Fernando S. Knowledge, attitudes and practices relevant to malaria elimination amongst resettled populations in a post-conflict district of northern Sri Lanka. Trans R Soc Trop Med Hyg. 2013;107(2):110–8.CrossRef

14.

Nagai M, Abraham S, Okamoto M, Kita E, Aoyama A. Reconstruction of health service systems in the post-conflict Northern Province in Sri Lanka. Health Policy. 2007;83(1):84–93.CrossRef

15.

Siriwardhana C, Adikari A, Pannala G, Siribaddana S, Abas M, Sumathipala A, et al. Prolonged internal displacement and common mental disorders in Sri Lanka: the COMRAID study. PLoS One. 2013;8(5):e64742.CrossRef

16.

Ware JE, Gandek B. Overview of the SF-36 health survey and the international quality of life assessment (IQOLA) project. J Clin Epidemiol. 1998;51(11):903–12.CrossRef

17.

John E, Ware J, Kosiniski M, Dewey JE. How to score version 2 of the SF-36 health survey. Quality Metric Incorporated: Lincoln, RI; 2000.

18.

Cardozo BL, Talley L, Burton A, Crawford C. Karenni refugees living in Thai-Burmese border camps: traumatic experiences, mental health outcomes, and social functioning. Soc Sci Med. 2004;58:2637–44.CrossRef

19.

Daher AM, Ibrahim HS, Daher TM, Anbori AK. Health related quality of life among Iraqi immigrants settled in Malaysia. BMC Public Health. 2011;11:407 Available from: https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-11-407.

20.

Lansakara N, Wickramasinghe AR, Seneviratne HR. Feeling the blues of infertility in a south Asian context: psychological well-being and associated factors among Sri Lankan women with primary infertility. Women Health. 2011;51(4):383–99 Available from: https://doi.org/10.1080/03630242.2011.574790.CrossRef

21.

Gunawardena NS, de Alwis Seneviratne R, Athauda T. Functional outcomes of unilateral lower limb amputee soldiers in two districts of Sri Lanka. Mil Med. 2006;171(4):283.CrossRef

22.

Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. Gen Intern Med. 2001;16:606–13.CrossRef

23.

Senarath U, Wickramage K, Peiris SL. Prevalence of depression and its associated factors among patients attending primary care settings in the post-conflict Northern Province in Sri Lanka: a cross-sectional study. BMC Psychiatry. 2014;14:85 Available from: https://bmcpsychiatry.biomedcentral.com/articles/10.1186/1471-244X-14-85.

24.

Victora CG, Huttly SR, Fuchs SC, Olinto MT. The role of conceptual frameworks in epidemiological analysis: a hierarchical approach. Int J Epidemiol. 1997;26(1):224–7.CrossRef

25.

Dahab M, Charalambous S, Karstaedt AS, Fielding KL, Hamilton R, La Grange L, et al. Contrasting predictors of poor antiretroviral therapy outcomes in two south African HIV programmes: a cohort study. BMC Public Health. 2010;10(1):430 Available from: https://doi.org/10.1186/1471-2458-10-430.CrossRef

26.

Cardozo BL, Bilukha OO, Crawford CAG, Shaikh I, Wolfe MI, Gerber ML, et al. Mental health, social functioning, and disability in postwar Afghanistan. JAMA. 2004;292(5):575–84.CrossRef

27.

Makhashvili N, Javakhishvili J, Pinchuk I, Roberts B. Mental health conditions and co-morbidities among internally displaced populations (IDPs) in Ukraine. Eur Psychiatry. 2017;41:S245.CrossRef

28.

Somasundaram D. Collective trauma in Sri Lanka. Intl J Ment Heal Psychosoc Work Couns Areas Armed Confl. 2003;1(1):1–11.

29.

Husain F, Anderson M, Lopes Cardozo B, Becknell K, Blanton C, Araki D, et al. Prevalence of war-related mental health conditions and association with displacement status in postwar Jaffna District, Sri Lanka. JAMA. 2011;306(5):522–31 Available from: http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2011.1052.CrossRef

30.

Roberts B, Browne J. A systematic review of factors influencing the psychological health of conflict-affected populations in low- and middle-income countries. Glob Public Health. 2011;6(8):814–29 Available from: https://doi.org/10.1080/17441692.2010.511625.CrossRef

31.

Siriwardhana C, Adikari A, Pannala G, Roberts B, Siribaddana S, Abas M, et al. Changes in mental disorder prevalence among conflict-affected populations: a prospective study in Sri Lanka (COMRAID-R). BMC Psychiatry. 2015;15:41.CrossRef

32.

Somasundaram D. Collective trauma in northern Sri Lanka: a qualitative psychosocial-ecological study. Int J Ment Health Syst. 2007;1(1):5 Available from: https://ijmhs.biomedcentral.com/articles/10.1186/1752-4458-1-5.CrossRef

33.

Johnson SA. The cost of war on public health: an exploratory method for understanding the impact of conflict on public health in Sri Lanka. PLoS One. 2017;12(1):e0166674.CrossRef

34.

Karunapema P, Abeykoon P. Chapter 3: Sri Lankan country case study. In Yiengprugsawan V, Healy J, Kendig H. Health system responses to population ageing and noncommunicable diseases in Asia. Manila: World Health Organization, Regional Office for the Western Pacific, 2016. Available from: http://apps.who.int/iris/bitstream/handle/10665/252738/apo-ccs-ageing5b.pdf?sequence=1.

35.

UNICEF. Sri Lanka Statistics. . Available from: https://www.unicef.org/infobycountry/sri_lanka_statistics.html. [cited 2017 Sep 1].

36.

World Health Organization. Global status report on noncommunicable diseases 2010. 2010. Available from: http://whqlibdoc.who.int/publications/2011/9789240686458_eng.pdf.

37.

Weaver H, Roberts B. Drinking and displacement: a systematic review of the influence of forced displacement on harmful alcohol use. Subst Use Misuse. 2010;45(13):2340–55.CrossRef

38.

Roberts B, Ocaka KF, Browne J, Oyok T, Sondorp E. Alcohol disorder amongst forcibly displaced persons in northern Uganda. Addict Behav. 2011;36(8):870–3.CrossRef

39.

Roberts B, Damundu EY, Lomoro O, Sondorp E. The influence of demographic characteristics, living conditions, and trauma exposure on the overall health of a conflict-affected population in southern Sudan. BMC Public Health. 2010;10(1):518.CrossRef

40.

Roberts B, Ocaka KF, Browne J, Oyok T, Sondorp E. Factors associated with the health status of internally displaced persons in northern Uganda. J Epidemiol Community Heal. 2009;63(3):227–32.CrossRef

41.

Araya M, Chotai J, Komproe IH, de Jong JTVM. Effect of trauma on quality of life as mediated by mental distress and moderated by coping and social support among postconflict displaced Ethiopians. Qual Life Res. 2007;16(6):915–27.CrossRef

42.

Blome C, Augustin M. Measuring change in quality of life: bias in prospective and retrospective evaluation. Elsevier; 2015. p. 110–5.

43.

Katulanda P, Constantine GR, Mahesh JG, Sheriff R, Seneviratne RDA, Wijeratne S, et al. Prevalence and projections of diabetes and pre-diabetes in adults in Sri Lanka—Sri Lanka diabetes, cardiovascular study (SLDCS). Diabet Med. 2008;25(9):1062–9.CrossRef

44.

Siriwardhana C, Adikari A, Jayaweera K, Abeyrathna B, Sumathipala A. Integrating mental health into primary care for post-conflict populations: a pilot study. Int J Ment Health Syst. 2016;27(10):12. Available from: https://ijmhs.biomedcentral.com/articles/10.1186/s13033-016-0046-x.

Title: Health status of returning refugees, internally displaced persons, and the host community in a post-conflict district in northern Sri Lanka: a cross-sectional survey
Authors: Rachel Burns
Kolitha Wickramage
Anwar Musah
Chesmal Siriwardhana
Francesco Checchi
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: Conflict and Health / Issue 1/2018
Electronic ISSN: 1752-1505
DOI: https://doi.org/10.1186/s13031-018-0176-7

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Health status of returning refugees, internally displaced persons, and the host community in a post-conflict district in northern Sri Lanka: a cross-sectional survey

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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