BackgroundSubstance use among populations displaced by conflict is a neglected area of public health. Alcohol, khat, benzodiazepine, opiate, and other substance use have been documented among a range of displaced populations, with wide-reaching health and social impacts. Changing agendas in humanitarian response-including increased prominence of mental health and chronic illness-have so far failed to be translated into meaningful interventions for substance use.MethodsStudies were conducted from 2006 to 2008 in six different settings of protracted displacement, three in Africa (Kenya, Liberia, northern Uganda) and three in Asia (Iran, Pakistan, and Thailand). We used intervention-oriented qualitative Rapid Assessment and Response methods, adapted from two decades of experience among non-displaced populations. The main sources of data were individual and group interviews conducted with a culturally representative (non-probabilistic) sample of community members and service providers.ResultsWidespread use of alcohol, particularly artisanally-produced alcohol, in Kenya, Liberia, Uganda, and Thailand, and opiates in Iran and Pakistan was believed by participants to be linked to a range of health, social and protection problems, including illness, injury (intentional and unintentional), gender-based violence, risky behaviour for HIV and other sexually transmitted infection and blood-borne virus transmission, as well as detrimental effects to household economy. Displacement experiences, including dispossession, livelihood restriction, hopelessness and uncertain future may make communities particularly vulnerable to substance use and its impact, and changing social norms and networks (including the surrounding population) may result in changed - and potentially more harmful-patterns of use. Limited access to services, including health services, and exclusion from relevant host population programmes, may exacerbate the harmful consequences.ConclusionsThe six studies show the feasibility and value of conducting rapid assessments in displaced populations. One outcome of these studies is the development of a UNHCR/WHO field guide on rapid assessment of alcohol and other substance use among conflict-affected populations. More work is required on gathering population-based epidemiological data, and much more experience is required on delivering effective interventions. Presentation of these findings should contribute to increased awareness, improved response, and more vigorous debate around this important but neglected area.

Health workers (HWs) play a pivotal role in preventative programmes being implemented to combat the steady increase in the prevalence of HIV infection and AIDS in Nigeria. We report on a questionnaire survey conducted in October, 1993 among 111 doctors, 92 nurses and 53 non-health workers at the University of Ilorin Teaching Hospital, Ilorin, Nigeria. The aim was to assess their knowledge of AIDS (for all groups) and the attitude of the HWs only towards the care of patients with AIDS (PWAs). Although important gaps in knowledge were found in all groups, doctors performed significantly better than non-health workers on 22 out of 23 knowledge items, and more than nurses on 8 of such items. Nurses scored significantly higher than non-health workers on 18 of the knowledge items and more than doctors on one knowledge item. About one in three nurses would hesitate to nurse a PWA, while half would not participate in birth delivery. Also, about a quarter of doctors would hesitate to treat a PWA while one in three would not carry out surgery despite adequate precautions. The findings compare favourably with those reported from other countries. However, they still indicate the need for a comprehensive AIDS education package to improve the knowledge base and allay fears for all groups and to prepare HWs for the important task of caring for PWAs.

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In low-income countries, clinicians must seek strategies to improve treatment adherence that are non-resource intensive and easily integrated into existing treatment structures. We conducted a prospective observational cohort study to investigate the relationship of family engagement in treatment during hospitalisation with post-discharge appointment and medication adherence in 81 patients from a Nigerian psychiatric hospital. After controlling for gender, diagnosis, mental state at discharge, and marital status, family involvement was significantly associated with appointment (P=0.047) but not medication adherence (P=0.590). Studies are needed to determine whether interventions based on engaging families in treatment can improve post-discharge adherence in this setting.

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