BackgroundIncreasing women’s status and male involvement are important strategies in reducing preventable maternal morbidity and mortality. While efforts to both empower women and engage men in maternal health care-seeking can work synergistically, in practice they may result in opposing processes and outcomes. This study examines whether a woman’s empowerment status, in sum and across economic, socio-familial, and legal dimensions, is associated with male partner accompaniment to antenatal care (ANC).MethodsWomen’s empowerment was measured based on the sum of nine empowerment items in the 2010–2011 Demographic and Health Surveys in eight sub-Saharan African countries: Burkina Faso (n = 2,490), Burundi (n = 1,042), Malawi (n = 1,353), Mozambique (n = 414), Rwanda (n = 1,211), Senegal (n = 505), Uganda (n = 428) and Zimbabwe (n = 459). In cross-sectional analyses, bivariate and multivariable logistic regressions models were used to examine the odds of male partner accompaniment to ANC between women with above-average versus below-average composite and dimensional empowerment scores.ResultsIn the majority of countries, male accompaniment to ANC was not uncommon. However, findings were mixed. Positive associations in women’s composite empowerment and male involvement were observed in Burkina Faso (OR = 1.27, 95% CI: 1.08, 1.50) and Uganda (OR = 1.53, 95% CI: 1.00-2.35), and in the economic empowerment dimension in Burkina Faso (OR = 1.24, 95% CI: 1.05-1.47). In Malawi, significant negative associations were observed in the odds of male accompaniment to ANC and women’s composite (OR = 0.77, 95% CI: 0.62-0.97) and economic empowerment scores (OR = 0.75, 95% CI: 0.59-0.94). No significant differences were observed in Burundi, Mozambique, Rwanda, Senegal, or Zimbabwe.ConclusionWomen’s empowerment can be positively or negatively associated with male antenatal accompaniment. Male involvement efforts may benefit from empowerment initiatives that promote women’s participation in social and economic spheres, provided that antenatal participation does not undermine women’s preferences or autonomy. The observation of mixed and null findings suggests that additional qualitative and longitudinal research may enhance understanding of women’s empowerment in sub-Saharan African settings.

BackgroundThe objective of this study was to characterize injuries, deaths, and disabilities arising during 11 years of conflict in Baghdad.MethodsUsing satellite imagery and administrative population estimated size for Baghdad, 30 clusters were selected, proportionate to population size estimates. Interviews were conducted during April and May 2014 in 900 households containing 5148 persons. Details about injuries and disabilities occurring from 2003 through May 2014 and resultant disabilities were recorded.FindingsThere were 553 injuries reported by Baghdad residents, 225 of which were intentional, and 328 unintentional. For intentional injuries, the fatality rate was 39.1% and the disability rate 56.0%. Gunshots where the major cause of injury through 2006 when blasts/explosions became the most common cause and remained so through 2014. Among unintentional injuries, the fatality rate was 7.3% and the disability rate 77.1%. The major cause of unintentional injuries was falls (131) which have increased dramatically since 2008, followed by traffic related injuries (81), which have steadily increased. The proportion of injuries ending in disabilities remained fairly constant through the survey period.InterpretationIntentional injuries added substantially to the burden of unintentional injuries for the population. For Baghdad, the phases of the Iraqi conflict are reflected in the patterns of injuries and consequent deaths reported. The scale of injuries during conflict is most certainly under-reported. Difficulties recalling injuries in a survey covering 11 years is a limitation, but it is likely that minor injuries were under-reported more than severe injuries. The in- and out-migration of Baghdad populations likely had effects on the events reported which we could not measure or estimate. Damage to the health infrastructure and the flight of health workers may have contributed to mortality and morbidity. Civilian injuries as well as mortality should be measured during conflicts, though not currently done.

IntroductionResearch that seeks to better understand vulnerability to earthquakes and risk factors associated with mortality in low resource settings is critical to earthquake preparedness and response efforts. This study aims to characterize mortality and associated risk factors in the 2010 Haitian earthquake.MethodsIn January 2011, a survey of the earthquake affected Haitian population was conducted in metropolitan Port-au-Prince. A stratified 60x20 cluster design (n = 1200 households) was used with 30 clusters sampled in both camp and neighborhood locations. Households were surveyed regarding earthquake impact, current living conditions, and unmet needs.ResultsMortality was estimated at 24 deaths (confidence interval [CI]: 20–28) per 1,000 in the sample population. Using two approaches, extrapolation of the survey mortality rate to the exposed population yielded mortality estimates ranging from a low of 49,033 to a high of 86,555. No significant difference in mortality was observed by sex (p = .786); however, age was significant with adults age 50+ years facing increased mortality risk. Odds of death were not significantly higher in camps, with 27 deaths per 1,000 (CI: 22–34), compared to neighborhoods, where the death rate was 19 per 1,000 (CI: 15–25; p = 0.080). Crowding and residence in a multistory building were also associated with increased risk of death.ConclusionsHaiti earthquake mortality estimates are widely varied, though epidemiologic surveys conducted to date suggest lower levels of mortality than officially reported figures. Strategies to mitigate future mortality burden in future earthquakes should consider improvements to the built environment that are feasible in urban resource-poor settings.

BackgroundYouth in conflict and post-conflict settings are exposed to a variety of potentially-traumatic events that impact their mental health and well-being. The purposes of this study were to examine coping strategies among conflict-affected youth exposed to potentially-traumatic events and the relationship to psychological symptoms and well-being in the Democratic Republic of Congo (DRC).MethodsA total of 434 male and female youth (ages 10–15 years) completed data collection with a trained Congolese interviewer. The survey instrument included measures of exposure to potentially traumatic events, an adapted coping strategies checklist, and measures of psychosocial distress and well-being. Exploratory factor analyses was used to identify coping strategies and Hierarchical regression was used to assess how coping strategies were associated with psychological symptoms including internalizing and externalizing problems and well-being outcomes including prosocial behavior and self-esteem.ResultsExploratory Factor analysis suggested four coping strategies; problem-focused, emotion-focused, avoidance and faith-based strategies. Problem-focused coping strategies were associated with greater internalizing and externalizing problems and lower prosocial behavior in both boys and girls. However, when problem-focused strategies were used with emotion-focused coping strategies, the result was fewer internalizing problems in girls and fewer externalizing problems in boys and girls. Emotion-focused, avoidance and faith based strategies were associated with better self-esteem.ConclusionThese results suggest a complex relationship between coping strategies, psychological symptoms and well-being and contradict evidence that problem-focused strategies benefit mental health while emotion-focused strategies harm mental health, particularly in conflict and post-conflict settings. The results suggest coping flexibility, or use of multiple coping strategies may be particularly useful to improving mental health and well-being. The need for context specific understandings of coping strategies in conflict-affected populations is highlighted by the results of the study.

BackgroundThe environment for medical education in Iraq has been difficult for many years. The 2003 invasion of Iraq accelerated a steady emigration of faculty and graduates. Kidnappings and deaths of doctors became commonplace. To understand current career plans, expectations and perceptions of medical students, three Baghdad medical schools were surveyed.MethodsWritten questionnaires were completed by 418 medical students variously in their 4th, 5th and 6th (final)years of training. We asked about perceptions of the quality of their medical education, the quality of health services in Iraq generally, and about deaths, injuries and migration of faculty, classmates and family.ResultsThe average age of students was 22 years, with 59% women. Most students (90%) were originally from Baghdad. Although there were some positive responses, many students (59%) rated the overall quality of their medical education as fair or poor. Three-fourths of students believed the quality of hospital care in Iraq to be only fair or poor. A majority of students (57%) stated they were thinking frequently or all the time about leaving Iraq after graduation. Reasons given for leaving included the desire for further education, seeking a better lifestyle and fleeing conflict. Leading reasons for staying included the pull of friends and family, familiarity with the health system, and a sense of responsibility to the country. Nearly one in five (18%) students reported the death of a family member attributable to intentional violence, and 15% reported the violent death of a medical school classmate or faculty member since the 2003 invasion. Half the students reported at least one school faculty members had left Iraq because of the war.ConclusionMedical students hold a mediocre view of the quality of their medical education and of Iraq’s health system. Many of their faculty members have left the country. The majority of students may leave Iraq after graduation, afforded the opportunity. This poses a significant problem for staffing an already demoralized and stressed health system. Current circumstances suggest the situation will continue to deteriorate.Electronic supplementary materialThe online version of this article (10.1186/s12909-018-1156-8) contains supplementary material, which is available to authorized users.