Publications

The United States government (USG) is a key global actor in preventing mortality and supporting lifesaving health services among women and children in low- and middle-income countries (LMICs). Since the Foreign Assistance Act of 1961, USG has funded global health programmes targeting specific conditions and strengthening health systems for the delivery of essential services via the United States Agency for International Development (USAID) and other USG agencies. However, directly quantifying and attributing the impact of USG health investments is challenging due to the inability of conducting randomised control trials for such large programmes at scale. In this study, we compared two quasi-experimental impact evaluation approaches to estimate the effects of sustained USG health investments on mortality among women of reproductive age (WRA).

Humanitarian emergencies are postulated to increase rates of early marriage and early childbearing, as drivers of both are heightened or exacerbated in crisis settings. There is a critical need for research that explores the causal mechanisms that motivate family formation, i.e. the process from marriage into childbearing, and how this process is affected by conflict and displacement.

Pregnancy induces physiological decline in maternal immunity. Ebola virus disease (EVD) in pregnancy is associated with obstetrical complications, and vaccination in early pregnancy is recommended, but may not be without risk. We described neonatal survival after spontaneous maternal EVD recovery. This neonate was born to a 25-year-old mother admitted to an Ebola Treatment Unit (ETU) in July, 2020, after 11 days of symptoms. She was vaccinated with rVSV-ZEBOV three days before symptom onset and her real-time polymerase chain of reaction (RT-PCR) results confirmed EVD and malarial infection two days after, but she refused hospitalization. She was treated at home with PO ASAQ, amoxicillin, paracetamol, albendazole, omeprazole, and papaverine. Eleven days later, due to clinical deterioration and onset of vaginal hemorrhage, she finally accepted to be transferred in ETU. She was Parity 2, fetal age at admission was 5 weeks and 3 days. Upon admission, her EVD PCR measured NP 26.3 and GP 32.9. She did not receive monoclonal therapy against Ebola infection due to stock shortage. She received intravenous, artesunate, ceftriaxone, and papaverine. She experienced spontaneous resolution of EVD 18 days after symptom onset and was discharged. At 40 weeks gestation, seven and a half months after EVD recovery, she delivered a healthy female infant, APGAR 10/10/10, weighing 3450 g. Maternal blood, adnexal, and newborn blood samples were RT-PCR negative, and the mother and the baby were discharged after 14 days. At our last follow-up, in June 2023 (2 years, 3 months after delivery), the mother and the baby were in good health.

Humanitarian assistance has saved millions of lives, improved public health outcomes, and strengthened communities in crisis.¹From responding to armed conflicts and natural disasters to advancing disease control and poverty reduction, the humanitarian and development sectors have played an indispensable role in reducing suffering worldwide. However, despite these successes, the existing humanitarian system is not fit for purpose in today's rapidly evolving geopolitical landscape of conflict and displacement.²Reform is essential, but it should be undertaken strategically—rooted in evidence and accountability, and with affected populations at the centre.³ Simply dismantling existing structures without a clear strategy for the future will set back humanitarian assistance for decades, cause catastrophic harm to the most vulnerable, and further destabilise global health security.⁴

Given the many approaches to and definitions of gender responsive monitoring and evaluation (M&E) for health programs and interventions there is a lack of clarity on how to operationalize it including what to measure and how to measure it. We conducted a scoping review to understand what makes M&E gender responsive. We included 31 studies and conducted two rounds of extraction to delineate ways in which gender was integrated into M&E. Twelve articles described the use of theory to guide M&E though most were not related to gender. Twelve articles employed a gender score in data collection, most of which measured Likert scale responses related to gender equity. Even though most studies did not use a specific gender framework, most incorporated gender domains in their analysis. Seven studies used participatory methods in the design and implementation of M&E. Most studies conducted M&E on programs or interventions that were designed to be gender intentional and related to gender issues. Gender responsive M&E intentionally integrates gender into the M&E process, regardless of how gender-intentional the program or intervention is. Gender dimensions can be identified through gender theories, models, scores, and frameworks to inform tool development, data collection, analysis, and stakeholder engagement processes.

Ebola-HIV and malaria co-infection is one of the rare clinical situations that remains complex to manage even in the context of unlimited resources. In pregnancy, each of these infections can compromise maternal and fetal outcomes. The synergy of their effects on maternal immunity are often fatal, and survival is an exception, especially in a context of limited resources, such as in Ebola Treatment Units (ETUs).

Syria's health-care system has undergone profound upheaval over the past decade, shaped by conflict, fragmentation, and now, a tenuous political transition. The acute conflict phase (2011–15) devastated health infrastructure, with systematic attacks on medical facilities and the mass exodus of health-care workers.¹ This phase was followed by a protracted phase (2015–23) in which parallel governance structures resulted in a fractured and inconsistent health-care landscape.² Now, with the fall of the Assad regime and the emergence of a transitional government, Syria faces a daunting challenge: reconstructing a unified, resilient health-care system from these disparate remnants.

On 20 January 2025, the day of his second inauguration as president, Donald Trump signed an executive order rescinding the Biden era policy that restricted Immigration and Customs Enforcement (ICE) operations at “sensitive” locations, including schools, churches, and healthcare facilities.12 The negative impact has been immediate. Patients are fearful, public health is under threat, and providers are braced for ethical challenges.

There is a dearth of evidence on the scale, scope and quality of midwifery education programs in conflict-affected settings. This study sought to assess the extent to which midwifery pre-service education programs meet national and global standards, and to explore how conflict affects pre-service midwifery education in Yobe State Nigeria and the Benadir and Galgaduud regions of Somalia.

This longitudinal experimental study aimed to profile audiometric hearing loss, explore the feasibility and efficacy of low-cost hearing devices, and examine their social and emotional impact on participants in South Sudan, a low-resource humanitarian setting.

Cholera outbreaks are surging worldwide. Growing research supports case-area targeted interventions (CATIs), whereby teams provide a package of interventions to case and neighboring households, as an effective strategy in cholera outbreak control, particularly in humanitarian settings. While research exists on individual CATI interventions, research gaps exist on outcomes of integrated interventions during CATI responses.

Midwives play an important role in maternal and newborn care, yet are in short supply globally. The shortage in midwives is particularly acute in sub-Saharan African countries, many of which are conflict-affected. Midwives face many challenges that impact their workforce participation and retention, and these challenges are often compounded in conflict settings. Somalia ranks among the countries with the highest maternal mortality rate, with an estimated shortage of 20,000 midwives compared to the WHO recommended standard. Yet, limited research has explored the lived experience of midwives in conflict. This qualitative study seeks to explore the experiences, plans, and aspirations of midwifery students and recent graduates from nine midwifery schools in Somalia and to understand how the safety and security situation impacts their educational experience and willingness to join the profession.

More than 650 million women alive today were married as children. Relative to efforts to prevent child marriage, efforts to support child brides have received much less attention. This review set out to map and describe interventions that support child brides. We performed a scoping review using seven electronic databases coupled with a grey literature search in January 2022. Data were extracted using a piloted extraction tool and findings were reported in narrative synthesis. A total of 34 projects were included in our review. Most projects focused on improving sexual and reproductive health (SRH) knowledge and behaviours among child brides, which was often achieved through a combination of SRH education, counselling and information provision, along with linkages to SRH services. Some interventions were health facility-based and aimed at improving responsiveness of health service providers to the needs of child brides. Very few described economic interventions as one component of a broader health intervention, and only three interventions focused on improving girls' educational outcomes. We also note the paucity of media-based interventions, despite their popularity among adolescents. Over time, interventions addressing the needs of child brides have increased, but the preponderance of evidence has focused on SRH interventions, with interventions that couple education with adolescent-friendly health services demonstrating promise. Interventions addressing other areas of health and social wellbeing of this group, such as mental health, sexual health, and economic independence, have been overlooked in comparison. The review highlights the need for additional empirical evidence on what works to support child brides.

In 2020, COVID-19 modeling studies predicted rapid epidemic growth and quickly overwhelmed health systems in humanitarian and fragile settings due to preexisting vulnerabilities and limited resources. Despite the growing evidence from Bangladesh, no study has examined the epidemiology of COVID-19 in out-of-camp settings in Cox’s Bazar during the first year of the pandemic (March 2020-March 2021). This paper aims to fill this gap.

Female genital mutilation (FGM), defined as any procedure altering or removing external female genitalia without medical justification, is a serious human rights violation affecting women, particularly across several African and Middle Eastern countries, where it also poses a significant public health challenge.¹ The consequences of FGM are extensive, impacting both mental and reproductive health and contributing to complications like hypertensive disorders during pregnancy, such as eclampsia.¹

Introduction: Yemen has one of the highest rates of child marriage in the Middle East and North Africa region and is home to one of the world's worst humanitarian crises. How the conflict and resulting displacement have impacted family formation patterns is not entirely clear. In this study, we investigate the impact of displacement on child marriage and early childbearing by comparing time-to-first-marriage and time-to-first-birth among displaced and non-displaced girls.

On Sept 13, 2024, WHO announced the prequalification of the first mpox vaccine, MVA-BN.¹ WHO's Strategic Advisory Group of Experts (SAGE) on Immunization recommended this vaccine for people at high risk of mpox exposure in the current outbreak, stating that “this vaccine may be used ‘off-label’ in infants, children and adolescents, and in pregnant and immunocompromised people”. ¹ Missing from these recommendations are breastfeeding mothers. In 2022, WHO had stated that the MVA-BN vaccine could be used in breastfeeding women.² However, WHO's new 2024 guidance, which replaced the 2022 recommendations, simply states, “MVA-BN safety and efficacy has not been evaluated in breastfeeding women. Data are not available to assess…the safety of MVA-BN in breastfed infants.”³

MVA-BN contains a weakened, non-replicating virus that cannot cause mpox. Currently, some countries recommend its use in people who are breastfeeding,⁴ whereas others prefer not to make this recommendation.⁵ This contradiction has, understandably, led to confusion among health-care workers.

There has been tremendous progress in building and promoting evidence-based practice around parenting programming in low- and middle-income countries. However, there remains a dearth of evidence specifically examining gender transformative programming designed to address gender-based violence in humanitarian settings. To inform this gap, we examine how existing gender transformative programmatic material addresses the unique circumstances of parenting in humanitarian settings. Incorporating lessons from the field, we inform considerations of how to adapt future content to address gender-based violence in humanitarian settings. We reviewed two gender transformative programs in humanitarian settings: Safe at Home and Sibling Support for Adolescent Girls in Emergencies. Four thematic recommendations emerged for gender-transformative parenting programming in humanitarian settings to address gender-based violence, specifically intimate partner violence and violence against children. These recommendations include: 1) Recognize the diversity of families in humanitarian settings, 2) Prioritize participatory approaches from the start, 3) Set realistic parameters and goals for the specific humanitarian context, and 4) Ensure pathways to scale and sustainability within the initial program design. We advocate for broader application of these principals to support gender-transformative parenting programming that is tailored to address gender-based violence in humanitarian settings and that will continue to build the respective evidence base.

This study investigates the association between forced displacement and the experience of menstrual shame, highlighting age and current displacement as influential factors of menstrual wellbeing amidst humanitarian crises.

Violence and threats against health facilities and workers, both in peacetime and during armed conflict, and the criminalisation of medical care, such as abortion care, limit access to health services and result in worse health outcomes for millions of people around the world.^1,2 Combatants', governments', and the international community's abdication of responsibility to protect health workers and facilities subjects physicians, nurses, and other health personnel to verbal and physical attack and leads to needless patient deaths. As leaders of medical and nursing organisations and researchers in the field, we share the conviction that attacks against health personnel anywhere should be a matter of concern for health professionals everywhere.