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Adolescents resettled to the US from conflict-affected countries in the Middle East and North Africa region face a range of acculturative challenges, including language barriers, that may affect their wellbeing. This qualitative study aims to understand the variety of approaches US schools use to support the education of Arabic-speaking students. Utilizing Ruíz’s influential typology of language orientations, our analysis reveals a range of school approaches aligning most closely with the ‘language-as-problem’ and ‘language-as-resource’ orientations. Participants identified several perceived effects of these orientations on academic achievement and acculturation, and providers highlighted promising directions and potential barriers for bolstered language supports. Findings indicate that Arabic-speaking newcomer students experience persistent language inequity but also locate promising pathways towards reducing these inequities. We discuss structural shifts schools can implement to bolster language as a resource and move towards larger systems change in which heritage language is a right.

Healthcare providers (HCPs) can support women affected by violence, providing a safe way for women to disclose experiences of violence and mitigating violence against women (VAW) through the identification of cases in routine clinical practice. We conducted in-depth interviews and focus group discussions with HCPs in three tertiary facilities in Maharashtra, India, who had participated in training using the World Health Organization curriculum, adapted for the Indian context. n = 21 HCPs participated in in-depth interviews and n = 10 nurses participated in two focus group discussions. The respondents indicated that the training approach and content were acceptable and that the skills learned during the training were feasible to implement. A shift in perspective from viewing VAW as a private issue to understanding it as a health issue facilitated HCPs’ response. The training enabled HCPs to recognize barriers faced by women in disclosing violence and their role in supporting disclosure. HCPs reported barriers to providing care for survivors of violence, including a lack of human resources, the time during regular clinical practice, and a lack of strong referral networks. These data can be utilized to inform other efforts to train HCPs in facilities in this setting and provide evidence for ways to improve health systems’ responses to VAW in low-and middle-income country settings.

This study describes sex trafficking and associations with violence and health among female migrants in the sex industry in Mae Sot, Thailand. The mixed-methods study included a qualitative interview phase ( n = 10), followed by a cross-sectional survey phase ( n = 128). Entry via trafficking (force, fraud, or coercion [FFC], or as minors) was prevalent (76.6%), primarily FFC (73.4%). FFC was associated with inconsistent condom use, inability to refuse clients, poor health, and anxiety. Past-year violence was normative including client sexual violence (66.4%), client coercion for condom nonuse (> 95%), and police extortion (56%). Working conditions enabled violence irrespective of mode of entry. Profound unmet needs exist for safety and access to justice irrespective of trafficking history.

Background Violence against women is a serious public health concern, and is highly prevalent globally, including in India. Health-care providers [HCPs] can play an important role in addressing and reducing negative consequences of violence against women. We implemented a pre-post intervention study of HCP training in three tertiary care facilities in Maharashtra, India. Methods The study used a pre-post intervention design with assessment of HCPs’ (n = 201) knowledge, attitudes, perceived preparedness and practice at three time points: before training, after training and at 6 months follow- up. Results Total median score of knowledge about common signs and symptoms of violence (8.89 vs, 10.00), attitudes towards acceptability of violence (9.05 vs. 10.00), individual (6.74 vs. 10.00) and system level preparedness (6.11 vs. 8.14) improved from pre to post- training. The generalized estimating equation [GEE] model, adjusted for age, sex, site and department, showed an improvement in knowledge, attitudes and preparedness post- training. The change from pre to 6 months follow- up was not significant for attitude. Conclusions This package of interventions, including training of HCPs, improved HCPs’ knowledge, attitudes and practices, yet changes in attitudes and preparedness did not sustain over time. This study indicates feasibility and positive influence of a multi-component intervention to improve HCP readiness to respond to violence against women in a low-resource setting. Future phases of intervention development include adapting this intervention package for primary and secondary health facilities in this context, and future research should assess these interventions using a rigorous experimental design. Finally, these results can be used to advocate for multi-layered, systems-based approaches to strengthening health response to violence against women.

Women with disabilities are at heightened risk of experiencing intimate partner violence [IPV], although the mechanisms through which disability acts as a risk factor for IPV are not clear.We analyzed cross-sectional data (n = 867) from Wave 3 of the MAISHA longitudinal study, conducted in Mwanza, Tanzania, to i) describe the levels of disability and IPV amongst women, and ii) to assess the association between level and type of disability and IPV experience.IPV was assessed using the WHO Multi-Country study instrument. Levels of disability (none, mild and severe) were categorized based on responses to the Washington Group Short Set questions. We fitted logistic regression models to determine the risk of experiencing each type of IPV according to disability level and type of disability.We found significant associations between mild and severe disability and different types of IPV. For example, in multivariate analyses controlling for socio-demographic variables, women reporting severe disability were significantly more likely to report physical and/or sexual IPV, sexual IPV. controlling behaviors, economic IPV, and severe IPV, whereas for mild disability compared to no disability, physical and/or sexual IPV, sexual IPV, and economic IPV were significantly more likely to be reported. Cognitive disability was a significant correlate of all forms of IPV apart from physical IPV.Our findings that specific types of disability and not others were associated with an elevated risk of IPV exposure indicate the need for nuanced measurement and analysis of the association between disability and IPV.

ObjectiveThe aim of this review is to elucidate the characteristics of school-based mental health and psychosocial support (MHPSS) interventions in humanitarian contexts and the hypothesised mechanisms by which they influence well-being or learning outcomes.MethodsWe conducted a realist review and searched PubMed, Embase, Global Health, CINAHL, PsychInfo, PILOTS and grey literature through January 2022. Eligible studies included children age 6–12 years, were conducted in humanitarian contexts in low-income or middle-income countries, and focused on universal MPHSS prevention in an educational setting, using any study design. Data were extracted and analysed using narrative synthesis and realist analysis techniques to create ‘context–mechanism–outcome’ configurations that were iteratively developed to modify, refine and substantiate programme theories.ResultsTwenty-seven articles, representing 19 studies, were included in the review. We analysed data from 26 articles. Eleven evidenced-informed programme theories were developed at the levels of the child (n=4), teacher (n=3), caregiver (n=2), school environment (n=1) and school managers/administrators (n=1). At the child level, mechanisms related to strengthening coping skills, emotion regulation, interpersonal relationships led to improved psychosocial well-being or learning outcomes. At the teacher level, coping skills and the provision of support to students were linked to psychosocial well-being and learning outcomes. At the caregiver level, strengthening interpersonal bonds trigger improved psychosocial well-being, and at the school environment level, fostering feelings of security was linked to psychosocial well-being and learning outcomes. We did not find any evidence supporting the programme theory at the school managers/administrators level. We found limited evidence of positive impacts of the included interventions to support these programme theories.ConclusionsThese programme theories are a promising start towards ensuring school-based MHPSS interventions in humanitarian contexts better address the well-being and learning needs of children. Future research is needed to support these programme theories and enhance the evidence base.

Background Globally, including in low- and middle-income [LMIC] countries, there is increased attention to and investment in interventions to prevent and respond to violence against women; however, most of these approaches are delivered outside of formal or informal health systems. The World Health Organization published clinical and policy guidelines Responding to intimate partner violence and sexual violence against women in 2013. Further evidence is needed concerning implementation of the Guidelines, including how health care providers perceive training interventions, if the training approach meets their needs and is of relevance to them and how to ensure sustainability of changes in practice due to training. This manuscript describes a study protocol for a mixed methods study of the implementation of the Guidelines and related tools in tertiary hospitals in two districts in Maharashtra, India. Methods The study will employ a mixed-methods study design. A quantitative assessment of health care providers’ and managers’ knowledge, attitudes, and practices will be conducted pre, post, and 6 months after the training. Qualitative methods will include a participatory stakeholders’ meeting to inform the design of the training intervention design, in-depth interviews [IDIs] and focus-group discussions [FGDs] with health care providers and managers 3–6 months after training, and IDIs with women who have disclosed violence to a trained health care provider, approximately 6 months after training. The study will also validate two tools: a readiness assessment of health facilities and a health management information system form in a facility register format which will be used to document cases of violence. Discussion The multiple components of this study will generate data to improve our understanding of how implementation of the Guidelines works, what barriers and facilitators to implementation exist in this context, and how current implementation practices result in changes in terms of health services and providers’ practices of responding to women affected by violence. The results will be useful for governmental and non-governmental and United Nations Agency efforts to improve health systems and services for women affected by violence, as well as for researchers working on health systems responses to violence against women in India and possibly other contexts.

Introduction Refugee adolescents living in camps and settlements in low and middle-income countries are a vulnerable population who face protection and psychosocial risks. This study explores prevalence of child labor amongst adolescent refugees from South Sudan in two refugee settlements in Uganda, to understand impacts of child labor on mental health outcomes, and examines the influence of sex on these impacts. Methods Surveys were conducted in Adjumani and Kiryandongo refugee settlements, Uganda, with 470 adolescents between 13 and 17 interviewed between December 2014–February 2015. Univariate finite mixture modeling identified a two-cluster model of child labor. Logistic regression models assessed the association of child labor and mental health. Results A two-cluster solution for child labor activity was determined among the 332 adolescents who self-reported engaging in any child labor (Significant child labor: n = 174, 37%; moderate child labor cluster: n = 158, 34%; no child labor cluster: n = 138, 29%. Odds of depression amongst adolescents exposed to significant vs. no child labor was 4.15 (95% CI: 2.01–8.56), in a model examining interaction of sex and child labor and controlling for socio-demographic variables. For the anxiety outcome, girls exposed to significant vs. no child labor are less likely to report higher levels of anxiety (OR: 0.29, 95% CI: 0.09–0.90). Conclusions Adolescents living in refugee settlements in Uganda report high levels of participation in child labor. Protection of adolescents from the risks involved with child labor in refugee contexts is an important and often over-looked area of child protection in humanitarian settings.

The United Nations Refugee Agency [UNHCR] implements a Framework for Child Protection for refugee children, based on a child protection systems-strengthening approach. Measurement of child protection system strength in humanitarian contexts is nascent, and existing methodologies do not capture the multiple components of the Framework.To develop, pilot and refine a measure of child protection system strength in humanitarian contexts.The Child Protection Index [CPI] was implemented in two humanitarian contexts - Kiziba Camp, Rwanda and Kiryandongo and Adjumani refugee camps, Uganda, at two time points [Time 1 = T1; Time 2 = T2]. Data collection in Kiziba camp was conducted in December 2013 and October/November 2015, and in Kiryandongo and Adjumani in December 2014/February 2015 and June-August 2016. Participants were staff members of international non-governmental organizations (T1: n = 17, T2: n = 29), local non-governmental organizations (T1: n = 3, T2: n = 2), Government bodies (T1: n = 3, T2: n = 3) and United Nations agencies (T1: n = 14, T2: n = 9) who were purposively selected to respond to the items included in the CPI. Selection was made on the basis of identifying individuals with the most knowledge and expertise to address the questions in the CPI.We conducted a qualitative study, conducting key informant interviews based on an interview guide developed to address the items in the CPI, and tailored to the expertise of each key informant. The CPI included scoring, to translate key informants' responses to numerical scores of child protection system strength.The pilot test conducted in Kiziba Camp indicated moderate child protection system strength, with a score of 61/100. At T2, results indicated a change in CPI score of +18.5 to 79.5. At T1, Kiryandongo refugee settlement received a total of 46/100 on the CPI, and at T2, the score improved by 13.5 points. At T1, Adjumani refugee settlement scored a total of 60/100, and at T2, received a total score change of +4.5.Findings from implementation, adaptation, and evaluation of the CPI offer valuable insights about practicality, validity and potential breadth of measurement of child protection system strengthening in humanitarian settings.

IntroductionIn 2013, the WHO published the first global and regional estimates on physical and sexual intimate partner violence (IPV) and non-partner sexual violence (NPSV) based on a systematic review of population-based prevalence studies. In this protocol, we describe a new systematic review for the production of updated estimates for IPV and NPSV for global monitoring of violence against women, including providing the baseline for measuring Sustainable Development Goal to eliminate all forms of violence against women and girls.Methods and analysisThe systematic review will update and extend the previous search for population-based surveys (either nationally or subnationally representative) conducted among women aged 15+ years that measured the prevalence of physical, sexual, psychological and physical and/or sexual IPV, NPSV or sexual violence by any perpetrator up to December 2019. Data will be extracted separately for all age groups, setting (urban/rural), partnership status (currently partnered/ever partnered/all women) and recall period (lifetime prevalence/past 12 months). Studies will be identified from electronic searches of online databases of EMBASE, MEDLINE, Global Health and PsycInfo. A search of national statistics office homepages will be conducted for each country to identify reports on population-based, national or subnational studies that include data on IPV or NPSV published outside academic journals. Two reviewers will be involved in quality assessment and data extraction of the review. The review is planned to be updated on a continuous basis. All findings will undergo a country consultation process.Ethics and disseminationFormal ethical approval is not required, as primary data will not be collected. This systematic review will provide a basis and a follow-up tool for global monitoring of the Sustainable Development Goal Target 5.2 on the elimination of all forms of violence against women and girls.PROSPERO registration numberCRD42017054100.

IntroductionViolence against women is a serious threat to women’s health and human rights globally. Disability has been associated with increased risk of exposure to different forms of violence, however, there are questions concerning how best to measure this association. Research on understanding the association between violence and disability among women has included incorporating short disability measures into violence against women prevalence surveys. The potential to improve understanding of interconnections between violence and disability by measuring violence within disability-focused research is underexplored. The scoping review described here focuses on three areas of measurement of violence against women and disability: (1) measurement of violence within the context of disability-focused research, (2) measurement in research focused on the intersection of disability and violence and (3) measurement of disability in the context of research focused on violence against women. Specifically, we aim to map definitions, measures and methodologies in these areas, globally.Methods and analysisFor our scoping review, we will conduct searches for quantitative studies of disability-focused research which use measures of violence against women, and measures of disability in research focused on violence against women, in 11 online databases. Two authors will independently review titles and abstracts retrieved through the search strategy. We will search for grey literature, search the websites of National Statistics Offices for all countries to identify any national or subnational disability research and consult with experts for input. Data extraction will be conducted independently by one author and reviewed by another author, and data will be analysed and synthesised using a thematic synthesis approach.Ethics and disseminationEthics approval was not sought as no primary data is being collected. Findings will be disseminated through a publication in a peer-reviewed journal, through coordinated dissemination to researchers, practitioners, data users and generators and through various working groups and networks on violence against women and disability.

BackgroundAccurate and reliable estimates of violence against women statistics form the backbone of monitoring efforts to eliminate these human right violations and public health concerns. Estimating the prevalence of intimate partner violence (IPV) is challenging due to variations in case definition and recall period, surveyed populations, partner definition, level of age disaggregation, and survey representativeness, among others. In this paper, we aim to develop a sound and flexible statistical modeling framework for global, regional, and national IPV statistics.MethodsWe modeled IPV within a Bayesian multilevel modeling framework, accounting for heterogeneity of age groups using age-standardization, and age patterns and time trends using splines functions. Survey comparability is achieved using adjustment factors which are estimated using exact matching and their uncertainty accounted for. Both in-sample and out-of-sample comparisons are used for model validation, including posterior predictive checks. Post-processing of models’ outputs is performed to aggregate estimates at different geographic levels and age groups.ResultsA total of 307 unique studies conducted between 2000-2018, from 154 countries/territories/areas, and totaling nearly 1.8 million unique women responses informed lifetime IPV. Past year IPV had similar number of studies (n=332), countries represented (n=159), and individual responses (n=1.8 million). Roughly half of IPV observations required some adjustments. Posterior predictive checks suggest good model fit to data and out-of-sample comparisons provided reassuring results with small median prediction errors and appropriate coverage of predictions’ intervals.ConclusionsThe proposed modeling framework can pool both national and sub-national surveys, account for heterogeneous age groups and age trends, accommodate different surveyed population, adjust for differences in survey instruments, and efficiently propagate uncertainty to model outputs. By describing this model to reproducible levels of details, the accurate interpretation and responsible use of estimates for global monitoring of violence against women elimination efforts are supported, as part of the Sustainable Development Goals.

Background Violence against women [VAW] is an urgent public health issue and health care providers [HCPs] are in a unique position to respond to such violence within a multi-sectoral health system response. In 2013, the World Health Organization (WHO) published clinical and policy guidelines (henceforth – the Guidelines) for responding to intimate partner violence and sexual violence against women. In this practical implementation report, we describe the adaptation of the Guidelines to train HCPs to respond to violence against women in tertiary health facilities in Maharashtra, India. Methods We describe the strategies employed to adapt and implement the Guidelines, including participatory methods to identify and address HCPs’ motivations and the barriers they face in providing care for women subjected to violence. The adaptation is built on querying health-systems level enablers and obstacles, as well as individual HCPs’ perspectives on content and delivery of training and service delivery. Results The training component of the intervention was delivered in a manner that included creating ownership among health managers who became champions for other health care providers; joint training across cadres to have clear roles, responsibilities and division of labour; and generating critical reflections about how gender power dynamics influence women's experience of violence and their health. The health systems strengthening activities included establishment of standard operating procedures [SOPs] for management of VAW and strengthening referrals to other services. Conclusions In this intervention, standard training delivery was enhanced through participatory, joint and reflexive methods to generate critical reflection about gender, power and its influence on health outcomes. Training was combined with health system readiness activities to create an enabling environment. The lessons learned from this case study can be utilized to scale-up response in other levels of health facilities and states in India, as well as other LMIC contexts. Plain language summary Violence against women affects millions of women globally. Health care providers may be able to support women in various ways, and finding ways to train and support health care providers in low and middle-income countries to provide high-quality care to women affected by violence is an urgent need. The WHO developed Clinical and Policy Guidelines in 2013, which provide guidance on how to improve health systems response to violence against women. We developed and implemented a series of interventions, including training of health care providers and innovations in service delivery, to implement the WHO guidelines for responding to violence against women in 3 tertiary hospitals of Maharashtra, India. The nascent published literature on health systems approaches to addressing violence against women in low and middle-income countries focuses on the impact of these interventions. This practical implementation report focuses on the interventions themselves, describes the processes of developing and adapting the intervention, and thus provides important insights for donors, policy-makers and researchers.

We describe human rights violations against migrant workers at the Thailand–Myanmar border, and evaluate differences by gender and industry. This mixed methods study pairs key informant interviews ( n = 40) with a cross-sectional quantitative survey of migrant workers from Myanmar ( n = 589) recruited via respondent-driven sampling. Key informants described significant hazards during migration, including deception, theft, and physical and sexual abuse, the latter primarily for women. Quantitative results confirmed prevalent mistreatment and abuse, with significant gender differences, most notably women’s disproportionate burden of sexual abuse. Current evidence on the nature of experiences, and significant differences by gender, can position prevention and response programming.

Refugee adolescents face increased vulnerability to child protection risks including abuse, neglect, violence, and exploitation. The aim of this qualitative study was to examine the nature of violence against adolescents in Kiziba Camp, Rwanda, using an ecological framework to analyze the factors that influence protection risks and abuse disclosure across multiple system levels. In order to understand these issues more comprehensively, a transgenerational inquiry sought perceptions from both adolescents and their caregivers. In April 2016, as part of a larger, comprehensive study on adolescent protection, 19 focus group discussions were conducted with a total of 70 adolescents and 68 caregivers from the Democratic Republic of Congo. A qualitative content analysis identified three salient themes. First, structural protection risks exist for adolescents in Kiziba Camp, with economic insecurity and resource constraints resulting in specific risks such as overcrowded housing and adolescents traveling for firewood collection. Second, intergenerational conflict between caregivers and adolescents was perceived to negatively influence abuse disclosure. Lastly, protection mechanisms and reporting pathways were underutilized as caregivers and adolescents expressed concern over the shame, embarrassment, and social rejection that characterized formal disclosure in Kiziba, often rooted in restrictive and inequitable gender norms. These findings suggest that efforts at child protection should be multi-faceted and address structural aspects of risk; household levels of communication and trust; and societal norms that deter abuse reporting. The study also underscores the need for further research on risk and protective factors in camp settings to better tailor interventions aiming to reduce violence against children.

Ugandan households play a central role in child care and protection, and household-level practices influence the ways in which children are protected from adversities. This study was designed to identify community perceptions of protective and harmful parenting practices in three districts in Uganda. It employed free-listing interviews to determine priorities and practices deemed to be important in providing care and protection to children. Findings suggest that parenting practices can be grouped into seven basic themes, which are: Investing in children's future, Protection, Care, Enterprising, Relationship with neighbors, Intimate partner relationship, and Child Rearing. Investing in children's future, including educating children, was cited most often as a hallmark of positive parenting; while failure to care for children was most often cited as a hallmark of negative parenting. Concrete behaviors, such as walking a daughter to school; sewing a son's torn pants before going to church; and structuring study time at home were identified as concrete actions Ugandan parents undertake daily to promote their children's well-being. Conversely, specific contextual aspects of neglect and abuse were identified as central components of negative parenting, including lack of investment in children's education and not serving as a good role model. Building on community strengths is recommended as a principal means of enhancing household resilience and reducing childhood risk.

The majority of the existing evidence-base on violence against women focuses on women of reproductive age (15–49), and globally there is sparse evidence concerning patterns of and types of violence against women aged 50 and older. Improved understanding of differing patterns and dynamics of violence older women experienced is needed to ensure appropriate policy or programmatic responses. To address these gaps in the evidence, we conducted a systematic review of qualitative literature on violence against older women, including any form of violence against women, rather than adopting a specific theoretical framework on what types of violence or perpetrators should be included from the outset, and focusing specifically on qualitative studies, to explore the nature and dynamics of violence against older women from the perspective of women. Following pre-planned searches of 11 electronic databases, two authors screened all identified titles, abstracts and relevant full texts for inclusion in the review. We extracted data from 52 manuscripts identified for inclusion, and conducted quality assessment and thematic synthesis from the key findings of the included studies. Results indicated that the vast majority of included studies were conducted in high-income contexts, and did not contain adequate information on study setting and context. Thematic synthesis identified several central themes, including the intersection between ageing and perceptions of, experiences of and response to violence; the centrality of social and gender norms in shaping older women’s experiences of violence; the cumulative physical and mental health impact of exposure to lifelong violence, and that specific barriers exist for older women accessing community supports and health services to address violence victimization. Our findings indicated that violence against older women is prevalent and has significant impacts on physical and mental well-being of older women. Implications for policy and programmatic response, as well as future research directions, are highlighted.

Background: Violence against children (VAC) in Uganda is recognized as an urgent dilemma; however, most research has been quantitatively oriented and has seldom involved children in the research process. Objective: We discuss what we learned about child participation in the research process as a means of informing ethical praxis in future child- and youth-led research initiatives. As an overarching aim of this paper, we utilize our engagement with YPAR as a springboard to reflect on methodological best practices for VAC research that involve children themselves as part of a movement to democratize the research process. Participants and Setting: The study includes street-connected children (40), sexually exploited children (19) and domestic workers (34) in Kampala. Methods: The YPAR team led participant observation, 52 semi-structured life history interviews, 31 auto-photographic exercises, and 4 focus groups. All data collection, analysis and dissemination activities were led by the YPAR team including four Ugandan street-connected youth between the ages of 16–25 and two Ugandan university-trained youth researchers. Results: The results are framed as a methodological reflection regarding the complexities and transformative potential of including children as researchers in the framework of YPAR. Conclusions: We urge scholars to create spaces for sustainable YPAR movements, both in academic and policy arenas, and to design participatory initiatives that prioritize knowledge produced by and for the improvement of children’s lives globally. We encourage challenging traditional, extractive research practices through participatory approaches that carve out spaces for child participation in research.

Improved understanding of refugees’ perceptions of provision of humanitarian support in these contexts is important to improve design and delivery of humanitarian assistance. Refugee adolescents displaced to low and middle-income countries face a range of adversities. Globally, refugee situations are increasingly characterized by multiple waves of displacement; phase of displacement likely influences risk factors for adolescent refugees. However, evidence is sparse concerning perceptions of the impact of these factors on health and well-being of adolescent refugees. We conducted a qualitative study in November 2016, using focus group discussions [FGDs] with caregivers and adolescent refugees (n = 325: 183 adolescents and 142 caregivers). The study was conducted in two refugee settlements in Uganda (Kiryandongo and Adjumani), which were experiencing a major influx of new refugees from South Sudan. We sought to explore one potential influence on adolescent well-being – the impact of the new influx of refugees from South Sudan on protection risks and well-being of adolescents already settled in Uganda. Themes that emerged indicate that caregivers and adolescents perceived the influx as directly impacting access to basic needs, which had direct and indirect impacts on adolescent psychosocial well-being, for example, educational attainment was impacted due to adolescent hunger while attending school. Lack of food security was described as associated with caregiver use of violence against adolescents, due to stress related to deterioration of household well-being. The immediate basic needs of newly arrived refugees – which are often urgent and life-threatening – may eclipse the on-going needs of previously settled refugees in a context of multiple waves of displacement and continuous conflict. Policy implications of findings in this study include the need to understand conflict and divisions within refugee populations and provide support for community-based protection mechanisms to ensure that changes in humanitarian support do not adversely impact adolescent protection needs.

OBJECTIVE: Rural-to-urban migration within low- and middle-income countries (LMICs), and migration from one LMIC to another, are prevalent forms of international migration. Migration may be associated with adverse mental health outcomes. The aim of the current study is to systematically review the literature on migration and mental health between and within LMICs. METHODS: This systematic review of PubMed, PsycINFO, Embase, Web of Science, and PILOTS, identified 2,818 total records published between 1991 and 2016, with 139 of these assessed for eligibility. Two authors reviewed full text to assess if they met inclusion criteria, extracted data, and applied a quality assessment to all included studies. RESULTS: The search identified 37 articles that met the inclusion criteria, based on 28 separate studies. All studies apart from one were cross-sectional studies, and studies utilized a range of sampling methods. In all, 19 of these studies were conducted in China. Studies addressed a range of mental health outcomes, and variation in prevalence was reported. Research questions addressed determinants of mental health outcomes, including analysis of risk and protective factors, such as social, cultural, and economic determinants; migrationrelated risk factors; and substance use. CONCLUSIONS: Limitations in study design and methodological rigor of studies indicate a limited evidence base concerning migration and mental health in LMICs. Expansion of research to different regions, utilization of adapted and validated measurement instruments, and longitudinal research could significantly strengthen the evidence base.

Background Adolescents displaced by conflict face a number of risks, and access to education has potential to have multiple protective aspects in humanitarian settings. Yet, the impact of violence experienced at school by adolescents in humanitarian contexts is poorly understood, especially in terms of impacts on educational outcomes. # Methods A household survey of adolescents in a refugee camp in Rwanda (n=274) and in two refugee settlements in Uganda (n=763) was conducted. Multiple logistic regression models were used to assess the influence of violence experienced at school on school attendance, feelings of fear and feelings of safety at school. # Results In multiple logistic regression models, adjusting for socio-demographic variables, exposure to school violence was significantly associated with feelings of safety at school (adjusted odds ratio (AOR)=2.29, 95% confidence interval (CI)=1.20-4.38) and days of school missed (AOR=3.28, 95% CI=1.54-7.01) in Rwanda. In Uganda, exposure to violence was significantly associated with all outcomes: school fear (AOR=2.26, 95% CI=1.48-3.44), school safety (AOR=1.90, 95% CI=1.23-2.92) and school attendance (AOR=2.39, 95% CI=1.52-3.74). Gender-stratified analyses indicated that in both contexts exposure to school violence is significantly associated with school attendance, school fear, and school safety for girls, but the association is weaker amongst boys (with experience of violence significantly associated with school attendance for boys in Uganda, but not for other outcomes and not in Rwanda). # Conclusions This study presents some initial and novel findings on the relationships between violence experienced at school and educational outcomes amongst adolescents displaced by conflict.

BackgroundLittle is known about violence against children in refugee camps and settlements, and the evidence-base concerning mental health outcomes of youth in refugee settings in low and middle-income countries is similarly small. Evidence is needed to understand patterns of violence against children in refugee camps, and associations with adverse mental health outcomes.MethodsSurveys were conducted with adolescent refugees (aged 13–17) in two refugee contexts – Kiziba Camp, Rwanda (n= 129) (refugees from Democratic Republic of Congo) and Adjumani and Kiryandongo refugee settlements, Uganda (n= 471) (refugees from South Sudan). Latent Class Analysis was utilized to identify classes of violence exposure (including exposure to witnessing household violence, verbal abuse, physical violence and sexual violence). Logistic regressions explored the association between latent class of violence exposure and symptoms of depression and anxiety.ResultsIn Rwanda, a two-class solution was identified, with Class 1 (n= 33) representing high levels of exposure to violence and Class 2 (n= 96) representing low levels of exposure. In Uganda, a three-class solution was identified: Class 1 (high violence;n= 53), Class 2 (low violence,n= 100) and Class 3 (no violence,n= 317). Logistic regression analyses indicated that latent violence class was associated with increased odds of high anxiety symptoms in Rwanda (AOR 3.56, 95% CI 1.16–0.95), and highv. no violence class was associated with depression (AOR 3.97, 95% CI 1.07–7.61) and anxiety symptoms (AOR 2.04, 95% CI 1.05–3.96) in Uganda.ConclusionsThe present results support the existing evidence-base concerning the association between violence and adverse mental health outcomes, while identifying differences in patterns and associations between refugee youth in two different contexts.

Background Family-level predictors, including caregiver depression, are considered important influences on adolescent mental health. Adolescent depression and anxiety in refugee settings is known to be a significant public health concern, yet there is very limited literature from humanitarian settings focusing on the relationship between caregiver mental health and adolescent mental health. In the context of a larger study on child protection outcomes in refugee settings, researchers explored the relationship between caregiver depression and adolescent mental health in two refugee settlements, Kiryandongo and Adjumani, in Uganda. Methods Adolescents between 13 and 17 and their caregivers participated in a household survey, which included measures of adolescent anxiety and depression, and caregiver depression. Analysis was conducted using multiple logistic regression models, and results were reported for the full sample and for each site separately. Results In Kiryandongo, a one-unit increase in a caregiver’s depression score tripled the odds that the adolescent would have high levels of anxiety symptoms (AOR: 3.0, 95% CI: 1.4, 6.1), while in Adjumani, caregiver depression did not remain significant in the final model. Caregiver depression, gender and exposure to violence were all associated with higher symptoms of adolescent depression in both sites and the full sample, for example, a one unit increase in caregiver depression more than tripled the odds of higher levels of symptoms of adolescent depression (AOR: 3.6, 95% CI: 2.0, 6.2). Caregiver depression is a consistently significantly associated with adverse mental health outcomes for adolescents in this study. Conclusions Adolescent well-being is significantly affected by caregiver mental health in this refugee context. Child protection interventions in humanitarian contexts do not adequately address the influence of caregivers’ mental health, and there are opportunities to integrate child protection programming with prevention and treatment of caregivers’ mental health symptoms. Electronic supplementary material The online version of this article (10.1186/s12888-017-1566-x) contains supplementary material, which is available to authorized users.

IntroductionThere is sparse evidence globally concerning patterns of and types of violence against women aged 50 and older. Improved understanding of older women’s experiences of violence, including types of violence, perpetrators and health impacts, is needed to address evident gaps in the literature, address requirements for monitoring and reporting on global sustainable development goal indicators, and inform policy and programming for preventing and responding to violence against older women. The aim of the systematic review is to identify, evaluate and synthesise qualitative studies from all countries, exploring violence against women aged 50 and above, identifying types and patterns of violence, perpetrators of violence and impacts of violence on various health outcomes for older women.Methods and analysisA systematic search for qualitative studies of violence against older women will be conducted in the following databases: PubMed, PsycINFO, Embase, CINAHL, PILOTS, ERIC, Social Work Abstracts, International Bibliography of the Social Sciences, Social Services Abstracts, ProQuest Criminal Justice and Dissertations and Theses Global. Studies will be focused on violence against older women (aged 50 and above), using qualitative methodology, exploring women’s experiences of any type of violence perpetrated by any type of perpetrator. Two authors will independently review titles and abstracts retrieved through the search strategy. Data extraction will be conducted independently by one author and quality assessment will be conducted by two authors, using an adapted version of the Critical Appraisal Skills Programme scale. Data will be analysed and synthesised using a thematic synthesis approach.Ethics and disseminationEthics approvals are not required as primary data are not being collected. Findings will be disseminated through a publication in a peer-reviewed journal and used to inform development of a module to measure violence against older women, for use in specialised violence against women surveys.PROSPERO registration numberCRD42019119467

Migrant workers in low-resource settings may experience multiple types of workplace and security-related stressors. This study explores the relationship between these stressors and adverse mental health outcomes, through a study of migrant workers from Myanmar, working in agriculture, factory, and sex industries in and around Mae Sot, Thailand. Respondent-driven sampling was used to recruit a total sample of 589 male and female migrants. Trained data collectors administered a survey, which included measures of workplace and security-related stressors, and depression and anxiety symptoms. Multivariate regression models were conducted separately for depression and anxiety symptoms. For male agricultural workers, security stressors (β = 1.9, p = .001) are associated with an increase in depression symptoms and coercive working conditions are associated with an increase in anxiety symptoms (β = .8, p = .000). For female agricultural workers, daily hassles and stressors were associated with both depression (β = 1.5, p = .000) and anxiety (β = .5, p = .027), and barriers to exit (β = 3.0, p = .005) and security stressors (β = .9, p = .010) were significantly associated with increased depression symptoms. In the factory subsample, sexual assault and abuse (depression: β = 2.7, p = .009; anxiety: β = 2.8, p = .002) and daily hassles and stressors (depression: β = .7, p = .007; anxiety: β = .7, p = .001) were both significantly associated with increased depression and anxiety symptoms for males. Other categories of stressors similarly showed different associations with mental health outcomes between occupational groups, and between male and female migrant workers. The differing influences of stressors on mental health between the three occupational groups, and between males and females, indicate the need for targeted and tailored approaches to reduce specific stressors and improve services to address mental health needs. Prevention and response need to recognize the differences in working conditions, vulnerabilities, and needs between occupational groups, and between male and female migrant workers.