Relief International

Introduction: Identifying health facility damage following disasters is crucial, but ground-based evaluations require substantial time and labor. Remote-sensing artificial intelligence (AI) models trained on satellite imagery can estimate building damage, and could be used to generate rapid health facility damage reports. There is little published methodology for generating these estimates, testing real-world accuracy, or exploring error sources. This study presents a novel method of overlaying model damage outputs with health facility location data to generate health facility damage estimates following the February 2023 earthquake in Turkey. Two models were compared for agreement, accuracy, and errors. Methods: Building-level damage estimates were obtained for Model A (Microsoft neural network model) and Model B (Google AI model), and overlaid with health facility location data to identify facilities with significant damage. Model agreement, sensitivity, and specificity for damage detection were calculated. A descriptive review of common error sources based on selected satellite imagery was conducted. A spatially aggregated damage estimation, based on a proportion of buildings damaged in a 0.125 km 2 area, was also generated and assessed for each model. Results: Twenty-five hospitals, 13 dialysis facilities, and 454 pharmacies were evaluated across three cities. Estimated damage was higher for Model A (10.4%) than for Model B (4.3%). Cohen’s kappa was 0.32, indicating fair agreement. Sensitivity was low for both models at 42.9%, while specificity was high (A: 93.6%, B: 96.8%). Agreement and sensitivity were best for hospitals. Common errors included inaccurate building identification and underestimation of damage for destroyed buildings. Spatially aggregated damage estimates yielded higher sensitivity (A:71.4%, B:57.1%) and agreement (Cohen’s kappa 0.38). Conclusion: Leveraging remote-sensing models for health facility damage assessment is feasible, but currently lacks the sensitivity to replace ground evaluations. Improving building identification, damage detection for destroyed buildings, and spatially aggregating results may improve the performance and utility of these models for use in disaster response settings.

Longing for touch (LFT) refers to a discrepancy between touch wish and touch frequency. The aim of this thesis was to investigate the implications of LFT for general wellbeing and the perception of touch in adults. First, the prevalence of LFT during and after the COVID-19 pandemic was measured. Results showed that the prevalence remained high (78.2-80%), even in the absence of social distancing regulations. Second, the potential causes of LFT were explored. Physical distance (e.g., living further away from your family and friends) was more often identified as a cause of LFT than internal barriers (e.g., being afraid of being rejected). Third, the relation between LFT and quality of life (QoL) was assessed during the pandemic. LFT was found to be negatively associated with physical, psychological and social QoL. This further highlights the importance of touch for general wellbeing. Fourth, two novel physiological (the post-auricular reflex) and cognitive (the implicit association task) measures were used to investigate the relation between LFT and the pleasantness perception of touch in non-clinical adults. This association was also studied in clinical outpatients and women with interpersonal trauma. LFT was positively associated with the perception of images and videos of touch, suggesting that the appeal these visual stimuli increases when someone longs to be touched. However, LFT was not found to be associated with the perception of actual physical touch. Taken together, this thesis provides novel insights into the potential causes and consequences of LFT in adults. Further research is needed to better understand the mixed perceptual results, and to determine how the development of LFT could be prevented.

Background: This paper examines the dynamics of internal displacement in Sudan following the outbreak of conflict in April 2023, arguing that displacement has evolved from a temporary humanitarian emergency into a structural condition embedded in the country’s political economy of violence and institutional collapse. Methods: Drawing on field testimonies, secondary reporting, and contextual analysis, the study develops the Cycle of Debilitation, a framework that explains how vulnerability accumulates across four interconnected phases of displacement: forced departure, perilous transit, fragile temporary adaptation, and attempted return. Results: The findings show that displacement is not a singular event but a recursive process in which each phase generates losses - material, institutional, psychosocial, and social - that deepen exposure to risk in subsequent phases. The analysis highlights the deliberate and disproportionate violence that triggered mass flight from Khartoum; the insecurity, predation, and deprivation that characterised transit routes; the precarious coping strategies and erosion of resilience in receiving areas; and the dangers, impossibilities, and repeated failures of attempted return. Conclusion: Together, these processes illuminate the systemic nature of Sudan’s displacement crisis and the mechanisms through which it is reproduced. While this paper focuses on the dynamics and internal logic of displacement, it does not address the broader impacts on livelihoods, education, health, or governance, nor does it examine policy implications or recommendations. These dimensions require separate, dedicated analysis.

Background: Carpal Tunnel Syndrome (CTS) is the most common entrapment neuropathy, strongly linked to repetitive hand use and sustained non-neutral wrist postures. With the rise of digital technology, mobile gaming has emerged as a potential risk factor for CTS, particularly among young adults who engage in prolonged smartphone use. Despite increasing concern, limited evidence exists from Pakistan examining CTS specifically among mobile gamers. Objective: To determine the prevalence of CTS among mobile gamers in Pakistan and to assess its association with mobile gaming habits and symptom severity. Methods: An analytical cross-sectional study was conducted from August 2020 to January 2021 across six cities in Pakistan. A total of 500 participants aged 15–40 years were recruited using convenience sampling, including 394 gamers and 106 non-gamers. CTS was assessed using Phalen’s test, and wrist disability was measured with the Patient-Rated Wrist and Hand Evaluation (PRWHE) questionnaire. Data were analyzed in SPSS 21 using chi-square tests, correlation analysis, and odds ratios. Results: CTS prevalence was 47.5% among gamers compared to 17.9% among non-gamers, yielding an odds ratio of 4.28 (95% CI: 2.48–7.36, p<0.001). Symptom severity was predominantly mild to moderate in gamers, while non-gamers mostly reported minimal symptoms. City-wise prevalence ranged from 31.8% in Gilgit to 57.0% in Islamabad. Conclusion: Mobile gaming is strongly associated with CTS and greater wrist disability among young adults in Pakistan. Preventive strategies, ergonomic education, and early screening are essential to mitigate long-term disability.

This study evaluates the impact of endogenous land restoration techniques, particularly on certain fundamental soil properties, namely bulk density, volumetric moisture, and texture. The urban commune of Tagazar in Niger, which served as the experimental field for the study, is located in the heart of the Sahel and is highly exposed to land degradation. The methodological approach used is quasi-experimental, based on a counterfactual model, by comparing plots treated with sylvopastoral bunds and forest half-moons on the one hand, and untreated control plots on the other, located on glacis and plateau sites. A significant improvement in the physical properties of the soil was observed following the treatment of the sites with these techniques. Indeed, bulk density decreased by an average of 0.23 g/cm³ on glacis and 0.22 g/cm³ on plateaus, indicating improved porosity and soil structure. At the same time, volumetric moisture increased by 6.4% and 5.1%, respectively, in the two environments, reflecting better soil water retention capacity. These effects are statistically significant (p < 0.05). As for the soil textural analysis, it shows a clear improvement in soil structure in areas rehabilitated with half-moons and bunds, with a reduction in sand content and an enrichment in silt and clay, especially at depth (10–30 cm). These results thus confirm the effectiveness of these land and water restoration and conservation techniques through the improvement of the soil’s hydrophysical function. They are particularly valuable for strengthening the resilience of Sahelian agroecosystems due to their simplicity, low cost, and adaptability to the local agroecological context.

Abstract Introduction The World Health Organization in 2012 introduced the test, treat and track (T3) policy to standardize the process of malaria management in endemic settings. All malaria suspected conditions are expected to be confirmed by test and treatment initiated with recommended artemisinin-based combination therapy (ACTs) and treatment outcomes monitored over the course of the illness. This study evaluated the adherence to the T3 policy in selected health facilities within three malaria epidemiological zones in Ghana. Methods This crossectional study was conducted in November 2019 involving thirty health facilities comprising one district hospital, one Health Centre and 3 Community Health and Planning Services (CHPS) randomly selected from six districts in the 3 malaria epidemiological zones. In addition, Clients exit interviews were conducted from each facility. Frequency charts highlighted facility characteristics. Factors associated with the test, treat and track defined outcomes were assessed using chi square and multivariable logistic regression models at 5% level of significance and 95% confidence interval. Data were classified according to facility and clients’ perspectives. Results Overall, 590 patients and 30 health facility managers were interviewed from 30 facilities in 6 districts across the three zones. CHPS compounds formed 18 (60.0%) of facilities assessed. Twenty-nine out of 30 health facilities had Rapid Diagnostic Test (RDT) kits and antimalarials. In all, adherence to the T3 policy was 31.9%, whiles 30% of facility managers in the North and Middle zones indicated inadequate training on the T3 policy. The study showed that 90% and 98% of patients were tested and treated respectively for malaria. However only 35% (range 22% − 44%) of patients were tracked according to the T3 policy across all zones. Health facilities in the southern zone of Ghana had almost three-fold increased odds of adhering to the T3 policy compared to the middle zone [aOR = 2.87 (1.7, 4.8): p < 0.001]. Males were more likely not to return to the health facility for review [aOR = 0.6 (0.3, 0.9): p = 0.018]. Conclusion Testing and treating for malaria were high among health facilities in the three epidemiological zones. However, tracking of patients was very low across the zones. Adherence from clients’ perspective was low especially for males, who were more likely to default on health facility return for review, even though facility prescribers informed participants on the need to return for review. The hurdle for one to adhere to the policy was to return to facility for review. Recommendations The National Maria Elimination Program (NMEP) should ensure periodic trainings of health facility staff especially those within the Northern and Middle zones of Ghana and strengthen monitoring and supervision of health facilities to enhance adherence to the T3 policy. The NMEP could also intensify Client sensitization programs especially targeting male clients to help understand the need to return to health facilities for review in line with the T3 policy. There is also the need for implementation research to explore strategies to improve the tracking component of the policy at the client and health facilities levels within the T3 policy framework.

Kenya one of the African countries has pledged to reduce neonatal death as per the 2030 World Health Organization target. Providing high-quality newborn care is critical in minimizing neonatal mortality. This study aimed to determine the factors that influence the quality of newborn care in Kenya. Secondary data from 11,863 participants of the 2022 Kenya Demographic and Health Survey (KDHS) were analyzed. The participants were chosen using two-stage stratified sampling. The quality of newborn care was operationalized as receiving all components of newborn care after childbirth, as reported by the mother. Using SPSS (version 29), univariate and multivariable logistic regression analyses were used to analyse the data. In this study, 32.7% (95% confidence interval [CI]: 31.0%-34.5%) of the mothers reported that their newborns had received all components of quality neonatal care after childbirth. Mothers who spent an average of one hour accessing the health facilities compared with those who spent less than half an hour were 1.33 (95%CI: 1.01-1.75) times more likely to report that their newborns had received quality newborn care. Mothers who gave birth in a non-government organization health facility were 30.37 (95%CI: 2.69-343.20) times more likely to report that their newborns had received quality newborn care compared with those who delivered from a faith-based organization. On the contrary, in terms of regions, mothers who lived in Nyanza, Eastern, and Rift Valley provinces compared with those who lived in the coastal regions were 0.53 (95%CI: 0.34-0.82), 0.61 (95%CI: 0.39-0.94), and 0.62 (95%CI: 0.41-0.93) times less likely to report that their newborns had received quality newborn care, respectively. Mothers who subscribed to other religions or faith (0.28 (95%CI: 0.10-0.76) compared with those from the Christian faith, were less likely to report that their newborns had received quality newborn care. Finally, mothers who gave birth through cesarean section were 0.44 (95%CI: 0.32-0.61) times less likely to report that their newborns had received quality newborn care than mothers who gave birth through spontaneous vaginal delivery. The study indicates that about a third of the neonates received quality newborn care and that facility-related and parental social factors were associated with receiving quality newborn care. Stakeholders need to pay more attention to newborn babies whose mothers come from certain regions of Kenya where the quality of newborn care was found to be low, minority religious faith denominations, and those who delivered by ceasearen section. Stakeholders also should focus on strengthening collaborations with NGO health facilities and achieving universal health coverage to improve the quality of newborn care provided in health facilities.

The feature article explores the journey of foster care in India from 2010 to 2024 as an analysis and commentary on the substantive changes between the foster care 2016 model guidelines and the newly released foster care 2024 guidelines. The article highlights the historical context of foster care in India, acknowledging the efforts of pioneers over the past decades. It discusses the challenges of scaling up foster care nationwide, emphasising the need for proper support systems and cultural sensitivity. Reflecting on the journey since 2016, the article acknowledges the slow progress and instances of corruption in foster care implementation. It underscores the importance of trained oversight and social work expertise in ensuring the well-being of children in foster care. Looking ahead to 2024, with the release of new foster care guidelines, the article suggests a shift towards a child-centred approach and emphasises the need for robust monitoring and evaluation mechanisms. In summary, the article advocates for a comprehensive approach to foster care implementation in India, encompassing cultural sensitivity, capacity building, community engagement, legal framework alignment, child-centred practices and effective monitoring and evaluation.

BackgroundIn Viet Nam, tuberculosis (TB) represents a devastating life-event with an exorbitant price tag, partly due to lost income from daily directly observed therapy in public sector care. Thus, persons with TB may seek care in the private sector for its flexibility, convenience, and privacy. Our study aimed to measure income changes, costs and catastrophic cost incurrence among TB-affected households in the public and private sector.MethodsBetween October 2020 and March 2022, we conducted 110 longitudinal patient cost interviews, among 50 patients privately treated for TB and 60 TB patients treated by the National TB Program (NTP) in Ha Noi, Hai Phong and Ho Chi Minh City, Viet Nam. Using a local adaptation of the WHO TB patient cost survey tool, participants were interviewed during the intensive phase, continuation phase and post-treatment. We compared income levels, direct and indirect treatment costs, catastrophic costs using Wilcoxon rank-sum and chi-squared tests and associated risk factors between the two cohorts using multivariate regression.ResultsThe pre-treatment median monthly household income was significantly higher in the private sector versus NTP cohort (USD 868 vs USD 578; P = 0.010). However, private sector treatment was also significantly costlier (USD 2075 vs USD 1313; P = 0.005), driven by direct medical costs which were 4.6 times higher than costs reported by NTP participants (USD 754 vs USD 164; P < 0.001). This resulted in no significant difference in catastrophic costs between the two cohorts (Private: 55% vs NTP: 52%; P = 0.675). Factors associated with catastrophic cost included being a single-person household [adjusted odds ratio (aOR = 13.71; 95% confidence interval (CI): 1.36–138.14; P = 0.026], unemployment during treatment (aOR = 10.86; 95% CI: 2.64–44.60; P < 0.001) and experiencing TB-related stigma (aOR = 37.90; 95% CI: 1.72–831.73; P = 0.021).ConclusionsPersons with TB in Viet Nam face similarly high risk of catastrophic costs whether treated in the public or private sector. Patient costs could be reduced through expanded insurance reimbursement to minimize direct medical costs in the private sector, use of remote monitoring and multi-week/month dosing strategies to avert economic costs in the public sector and greater access to social protection mechanism in general.