Six rapid assessments of alcohol and other substance use in populations displaced by conflict.
Six rapid assessments of alcohol and other substance use in populations displaced by conflict.
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DOI：
10.1186/1752-1505-5-1
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发表时间：
2011-02-11
影响因子：
3.6
通讯作者：
van Ommeren, Mark
中科院分区：
文献类型：
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作者：
Ezard, Nadine;Oppenheimer, Edna;van Ommeren, Mark
背景：因冲突而流离失所的人口中的药物使用是公共卫生的一个被忽视的领域。据记录，一系列流离失所者使用酒精、阿拉伯茶、苯二氮卓类、鸦片剂和其他药物，对健康和社会产生了广泛影响。不断变化的议程，在人道主义反应，包括精神卫生和慢性病的突出地位的增加，迄今未能转化为有意义的干预措施substance use.METHODS：研究进行了从2006年至2008年在六个不同的设置长期流离失所，三个在非洲（肯尼亚，利比里亚，乌干达北方）和三个在亚洲（伊朗，巴基斯坦和泰国）。我们采用了以干预为导向的定性快速评估和反应方法，这些方法是根据20年来在非流离失所人口中的经验改编的。数据的主要来源是与具有文化代表性的人进行的个人和小组访谈。（非概率）社区成员和服务提供者的样本。与会者认为，在肯尼亚、利比里亚、乌干达和泰国广泛使用酒精，特别是手工生产的酒精，以及在伊朗和巴基斯坦广泛使用鸦片制剂，与一系列健康、社会和保护问题有关，包括疾病、伤害（有意和无意）、基于性别的暴力、艾滋病毒和其他性传播感染和血液传播病毒的危险行为，以及对家庭经济的有害影响。流离失所的经历，包括财产被剥夺、生计受到限制、绝望和未来不确定，可能使社区特别容易受到药物使用及其影响的影响，而不断变化的社会规范和网络（包括周围人口）可能导致改变-而且可能更加有害-使用模式。有限的服务，包括医疗服务，并排除在相关的东道国人口programmes，可能会加剧有害的后果。结论：六项研究表明，在流离失所人口进行快速评估的可行性和价值。这些研究的成果之一是制定了难民署/世卫组织关于快速评估受冲突影响人口使用酒精和其他药物情况的实地指南。在收集基于人口的流行病学数据方面需要做更多的工作，在提供有效的干预措施方面需要更多的经验。这些调查结果的介绍应有助于提高认识，改善反应，并围绕这一重要但被忽视的领域进行更有力的辩论。
BACKGROUND: Substance 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.METHODS: Studies 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.RESULTS: Widespread 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.CONCLUSIONS: The 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.