Concern Worldwide

Food and nutrition security is critical for economic development due to the role of nutrition in healthy growth and human capital development. Slum residents, already grossly affected by chronic poverty, are highly vulnerable to different forms of shocks, including those arising from political instability. This study describes the food security situation among slum residents in Nairobi, with specific focus on vulnerability associated with the 2007/2008 postelection crisis in Kenya. The study from which the data is drawn was nested within the Nairobi Urban Health and Demographic Surveillance System (NUHDSS), which follows about 70,000 individuals from close to 30,000 households in two slums in Nairobi, Kenya. The study triangulates data from qualitative and quantitative sources. It uses qualitative data from 10 focus group discussions with community members and 12 key-informant interviews with community opinion leaders conducted in November 2010, and quantitative data involving about 3,000 households randomly sampled from the NUHDSS database in three rounds of data collection between March 2011 and January 2012. Food security was defined using the Household Food Insecurity Access Scale (HFIAS) criteria. The study found high prevalence of food insecurity; 85% of the households were food insecure, with 50% being severely food insecure. Factors associated with food security include level of income, source of livelihood, household size, dependence ratio; illness, perceived insecurity and slum of residence. The qualitative narratives highlighted household vulnerability to food insecurity as commonplace but critical during times of crisis. Respondents indicated that residents in the slums generally eat for bare survival, with little concern for quality. The narratives described heightened vulnerability during the 2007/2008 postelection violence in Kenya in the perception of slum residents. Prices of staple foods like maize flour doubled and simultaneously household purchasing power was eroded due to worsened unemployment situation. The use of negative coping strategies to address food insecurity such as reducing the number of meals, reducing food variety and quality, scavenging, and eating street foods was prevalent. In conclusion, this study describes the deeply intertwined nature of chronic poverty and acute crisis, and the subsequent high levels of food insecurity in urban slum settings. Households are extremely vulnerable to food insecurity; the situation worsening during periods of crisis in the perception of slum residents, engendering frequent use of negative coping strategies. Effective response to addressing vulnerability to household food insecurity among the urban poor should focus on both the underlying vulnerabilities of households due to chronic poverty and added impacts of acute crises.

BACKGROUND: The evidence evaluating the benefits of programmatic nutrition interventions to HIV-infected individuals in developing countries, where there is a large overlap between HIV prevalence and malnutrition, is limited. This study evaluates the impact of food assistance (FA) on change in weight and disease progression as measured by WHO staging. METHODS: We utilize program data from The AIDS Support Organization (TASO) in Uganda to compare outcomes among FA recipients to a control group, using propensity score matching (PSM) methods among 14,481 HIV-infected TASO clients. RESULTS: FA resulted in a significant mean weight gain of 0.36 kg over one year period. This impact was conditional on anti-retroviral therapy (ART) receipt and disease stage at baseline. FA resulted in mean weight gain of 0.36 kg among individuals not receiving ART compared to their matched controls. HIV-infected individuals receiving FA with baseline WHO stage II and III had a significant weight gain (0.26 kg and 0.2 kg respectively) compared to their matched controls. Individuals with the most advanced disease at baseline (WHO stage IV) had the highest weight gain of 1.9 kg. The impact on disease progression was minimal. Individuals receiving FA were 2 percentage points less likely to progress by one or more WHO stage compared to their matched controls. There were no significant impacts on either outcome among individuals receiving ART. CONCLUSIONS: Given the widespread overlap of HIV and malnutrition in sub-Saharan Africa, FA programs have the potential to improve weight and delay disease progression, especially among HIV-infected individuals not yet on ART. Additional well designed prospective studies evaluating the impact of FA are urgently needed.

Orang Asli are the indigenous minority peoples of peninsular Malaysia. Despite proactive socioeconomic development initiated by the Malaysian Government in upgrading the quality of life of the Orang Asli communities since 1978, they still remained poor with a current poverty rate of 76.9%. Poverty exacerbates the health problems faced by these communities which include malnourishment, high incidences of infectious diseases (eg. tuberculosis, leprosy, malaria) and the perpetual problem with intestinal parasitic infections. Studies reported that the mean infection rate of intestinal parasitic infections in Orang Asli communities has reduced from 91.1% in 1978, to 64.1% in the subsequent years. Although the results was encouraging, it has to be interpreted with caution because nearly 80% of studies carried out after 1978 still reported high prevalence (i.e. >50%) of soil-transmitted helminthiases (STH) among Orang Asli communities. Prior to 1978, hookworm infection is the most predominant STH but today, trichuriasis is the most common STH infections. The risk factors for intestinal parasitic infections remained unchanged and studies conducted in recent years suggested that severe STH infections contributed to malnutrition, iron deficiency anaemia and low serum retinol in Orang Asli communities. In addition, STH may also contribute to poor cognitive functions and learning ability. Improvements in socioeconomic status in Malaysia have shown positive impact on the reduction of intestinal parasitic infections in other communities however, this positive impact is less significant in the Orang Asli communities. In view of this, a national parasitic infections baseline data on morbidity and mortality in the 18 subgroups of Orang Asli, will assist in identifying intervention programmes required by these communities. It is hope that the adoption of strategies highlighted in the World Health Organisation- Healthy Village Initiatives (WHO-HVI) into Orang Asli communities will ensure the whole mechanism of delivery and empowerment by the government agencies become more efficient and productive in alleviating intestinal parasitic infections in these communities.

OBJECTIVES: To examine the use of middle upper arm circumference measurement (MUAC [cm]) and body mass index measurement (BMI [kg/m2]) in the screening of severely malnourished adults during famine. DESIGN: Nonrandomized cohort study, correlating measurements of MUAC and BMI. SETTING: The Concern Worldwide adult feeding center in the village of Ayod in south Sudan. The area has experienced several years of war, leading to severe famine during early 1993. PARTICIPANTS: A total of 98 adult inpatients belonging to the Nuer tribe. Criteria for entry into the study were prior admission to the feeding center and the ability to stand and have a BMI measured. MAIN OUTCOME MEASURES: A comparison of the ease of use of MUAC and BMI assessments, and a correlation of MUAC and BMI measurements. RESULTS: An MUAC measurement was easier to perform on severely malnourished adults than BMI assessment. For MUAC, the patient could be standing, sitting, or, in extreme cases, lying. For BMI, patients were required to stand. Measuring BMI requires a height board, weighing scales, and mathematical calculations; to measure MUAC, only a tape measure is required. A correlation between measurements of MUAC and BMI was demonstrated (r=0.88; 95% confidence interval, 0.82-0.92 P<.001). The proportions of the population and the actual individuals identified as malnourished by the 2 indicators were similar. CONCLUSIONS: The MUAC measurement reflects adult nutritional status as defined by BMI. During famine, MUAC may be better suited to screening admissions to adult feeding centers than BMI. Studies to assess the capacity of MUAC cutoffs to predict mortality in severe adult malnutrition are needed.

The aim of this study was to investigate the effect of victim resistance in attempted homicide. The study examined 93 cases of attempted homicide. Chi-square analysis revealed that certain behaviors, such as multiple acts of violence and methods of control, are more likely to occur if the victim resists. A multivariate analysis of crime-scene actions was carried out using Smallest Space Analysis. The plot showed three clusters of variables that reflected the offender's perception of the victim as an object, vehicle, or significant person. In the first of these roles, the offender was likely to escalate the level of violence; in the vehicle role, however, the offender employed physical controls and used single acts of violence. Finally, if the victim was personally significant to the offender, the latter was more likely to use verbal control strategies and knowledge of the victim. The implications of victim resistance in light of these role functions are discussed.

> Courage rather than cowardice, compassionate human concern of one for the other; and resilience in the face of overwhelming stress.1 Many of today's violent conflicts can be characterised as “complex humanitarian emergencies.” Complex humanitarian emergencies are defined by Leaning as “Crises in life support and security that threaten large civilian populations with suffering and death and impose severe constraints on those who would seek to offer help.”2 Lauttze interprets these emergencies as “complicated disaster situations that have political, military and humanitarian dimensions and are often associated with natural disasters, especially drought.”3 Kosovo, Rwanda, Sudan, and Afghanistan are recent examples. The rapid growth, in capacity and number, of humanitarian relief organisations in response to complex humanitarian emergencies has created concern about the professionalism of their relief workers. The risk to the psychological wellbeing of relief workers caused by exposure to traumatic events is a particular worry and has been studied little.4 Research on the psychological sequelae to trauma has focused on primary victims,5–7 domestic rescue workers, 8 9 military personnel,10 and psychologists.11 Complex humanitarian emergencies may generate more stress among relief workers than “natural” disasters for several reasons. Firstly, an element of physical insecurity, with the risk of violent personal assault or injury, is increasingly present.12 Secondly, work in these situations necessarily involves moral and ethical dilemmas—for example, negotiating with warlords; witnessing human rights abuses, but being constrained from responding by operational considerations; and concern that humanitarian aid may perpetuate conflicts.13–16 Finally, caring for people with serious injuries caused by violence, witnessing unnatural deaths, and handling dead bodies or body parts are highly traumatic experiences in themselves.17 #### Summary points

PROBLEM: The 2010 earthquake in Haiti displaced about 1.5 million people, many of them into camps for internally displaced persons. It was expected that disruption of breastfeeding practices would lead to increased infant morbidity, malnutrition and mortality. APPROACH: Haiti's health ministry and the United Nations Children's Fund, in collaboration with local and international nongovernmental organizations, established baby tents in the areas affected by the earthquake. The tents provided a safe place for mothers to breastfeed and for non-breastfed infants to receive ready-to-use infant formula. Such a large and coordinated baby tent response in an emergency context had never been mounted before anywhere in the world. LOCAL SETTING: Baby tents were set up in five cities but mainly in Port-au-Prince, where the majority of Haiti's 1555 camps for displaced persons had been established. RELEVANT CHANGES: Between February 2010 and June 2012, 193 baby tents were set up; 180 499 mother-infant pairs and 52 503 pregnant women were registered in the baby tent programme. Of infants younger than 6 months, 70% were reported to be exclusively breastfed and 10% of the "mixed feeders" moved to exclusive breastfeeding while enrolled. In 2010, 13.5% of registered infants could not be breastfed. These infants received ready-to-use infant formula. LESSONS LEARNT: Thanks to rapid programme scale-up, breastfeeding practices remained undisrupted. However, better evaluation methods and comprehensive guidance on the implementation and monitoring of baby tents are needed for future emergencies, along with a clear strategy for transitioning baby tent activities into facility and community programmes.

BACKGROUND: Somalia has been affected by conflict since 1991, with children aged <5 years presenting a high acute malnutrition prevalence. Cash-based interventions (CBIs) have been used in this context since 2011, despite sparse evidence of their nutritional impact. We aimed to understand whether a CBI would reduce acute malnutrition and its risk factors. METHODS AND FINDINGS: We implemented a non-randomised cluster trial in internally displaced person (IDP) camps, located in peri-urban Mogadishu, Somalia. Within 10 IDP camps (henceforth clusters) selected using a humanitarian vulnerability assessment, all households were targeted for the CBI. Ten additional clusters located adjacent to the intervention clusters were selected as controls. The CBI comprised a monthly unconditional cash transfer of US$84.00 for 5 months, a once-only distribution of a non-food-items kit, and the provision of piped water free of charge. The cash transfers started in May 2016. Cash recipients were female household representatives. In March and September 2016, from a cohort of randomly selected households in the intervention (n = 111) and control (n = 117) arms (household cohort), we collected household and individual level data from children aged 6-59 months (155 in the intervention and 177 in the control arms) and their mothers/primary carers, to measure known malnutrition risk factors. In addition, between June and November 2016, data to assess acute malnutrition incidence were collected monthly from a cohort of children aged 6-59 months, exhaustively sampled from the intervention (n = 759) and control (n = 1,379) arms (child cohort). Primary outcomes were the mean Child Dietary Diversity Score in the household cohort and the incidence of first episode of acute malnutrition in the child cohort, defined by a mid-upper arm circumference < 12.5 cm and/or oedema. Analyses were by intention-to-treat. For the household cohort we assessed differences-in-differences, for the child cohort we used Cox proportional hazards ratios. In the household cohort, the CBI appeared to increase the Child Dietary Diversity Score by 0.53 (95% CI 0.01; 1.05). In the child cohort, the acute malnutrition incidence rate (cases/100 child-months) was 0.77 (95% CI 0.70; 1.21) and 0.92 (95% CI 0.53; 1.14) in intervention and control arms, respectively. The CBI did not appear to reduce the risk of acute malnutrition: unadjusted hazard ratio 0.83 (95% CI 0.48; 1.42) and hazard ratio adjusted for age and sex 0.94 (95% CI 0.51; 1.74). The CBI appeared to increase the monthly household expenditure by US$29.60 (95% CI 3.51; 55.68), increase the household Food Consumption Score by 14.8 (95% CI 4.83; 24.8), and decrease the Reduced Coping Strategies Index by 11.6 (95% CI 17.5; 5.96). The study limitations were as follows: the study was not randomised, insecurity in the field limited the household cohort sample size and collection of other anthropometric measurements in the child cohort, the humanitarian vulnerability assessment data used to allocate the intervention were not available for analysis, food market data were not available to aid results interpretation, and the malnutrition incidence observed was lower than expected. CONCLUSIONS: The CBI appeared to improve beneficiaries' wealth and food security but did not appear to reduce acute malnutrition risk in IDP camp children. Further studies are needed to assess whether changing this intervention, e.g., including specific nutritious foods or social and behaviour change communication, would improve its nutritional impact. TRIAL REGISTRATION: ISRCTN Registy ISRCTN29521514.

BACKGROUND: Stunting is a major public health problem in Africa and is associated with poor child survival and development. We investigate factors associated to child stunting in three Tanzanian regions. METHODS: A cross-sectional two-stage cluster sampling survey was conducted among children aged 6-59 months. The sample included 1360 children aged 6-23 months and 1904 children aged 24-59 months. Descriptive statistics and binary and multivariate logistic regression analyses were used. RESULTS: Our main results are: in the younger group, stunting was associated with male sex (adjusted odds ratio [AOR]: 2.17; confidence interval [CI]: 1.52-3.09), maternal absence (AOR: 1.93; CI: 1.21-3.07) and household diet diversity (AOR: 0.61; CI: 0.41-0.92). Among older children, stunting was associated with male sex (AOR: 1.28; CI: 1.00-1.64), age of 4 and 5 (AOR: 0.71; CI: 0.54-0.95; AOR: 0.60; CI: 0.44-0.83), access to improved water source (AOR: 0.70; CI: 0.52-0.93) and to a functioning water station (AOR: 0.63; CI: 0.40-0.98) and mother breastfeeding (AOR: 1.97; CI: 1.18-3.29). CONCLUSIONS: Interventions that increase household wealth and improve water and sanitation conditions should be implemented to reduce stunting. Family planning activities and programmes supporting mothers during pregnancy and lactation can positively affect both newborns and older siblings.

Molecular data concerning the prevalence and subtype (ST) distribution of the intestinal parasite Blastocystis sp. remain scarce in the Middle East. Accordingly, we performed the first molecular epidemiological survey ever conducted in the Syrian population. A total of 306 stool samples were collected from Syrian refugees living in 26 informal tented settlements (ITS) subjected or not to water, sanitation, and hygiene (WASH) interventions in North Lebanon, then screened for the presence of Blastocystis sp. by real-time polymerase chain reaction followed by subtyping. The overall prevalence of the parasite was shown to reach 63.7%. Blastocystis sp. colonization was not significantly associated with gender, age, symptomatic status, abdominal pain or diarrhea. In contrast, WASH intervention status of ITS was identified as a risk factor for infection. Among a total of 164 subtyped isolates, ST3 was predominant, followed by ST1, ST2, and ST10. No particular ST was reported to be associated with age, gender, symptomatic status, digestive disorders, or WASH intervention status of ITS. Intra-ST diversity of ST1 to ST3 was low suggesting large-scale anthroponotic transmission. Moreover, comparative analysis of ST1 to ST3 genotypes revealed that the circulation of the parasite between Syrian refugees and the host population was likely limited.

BACKGROUND: Assessment of the impact of emergency cash transfer programs on child nutritional status has been difficult to achieve due to the considerable logistic and ethical constraints that characterize humanitarian settings. METHODS: We present the findings from a quasi-experimental longitudinal study of a conditional emergency cash transfer program implemented by Concern Worldwide in 2012 during a food crisis in Tahoua, Niger, in which the use of a concurrent control group permits estimation of the program's impact on child weight gain. Program beneficiaries received three transfers totaling approximately 65% of Niger's gross national per capita income; mothers attended mandatory sessions on child and infant feeding and care practices. Dietary and anthropometric data from 211 vulnerable households and children targeted by the intervention were compared with 212 similarly vulnerable control households and children from the same 21 villages. We used multilevel mixed effects regression to estimate changes in weight and weight-for-height Z scores (WHZ) over time, and logistic regression to estimate the probability of acute malnutrition. RESULTS: < 0.001). CONCLUSIONS: We conclude that this emergency cash transfer program promoted child weight gain and reduced the risk of acute malnutrition among children in the context of a food crisis. We suspect that the use of strategic conditional terms and a valuable transfer size were key features in achieving this result. Limitations in study design prevent us from attributing impact to particular aspects of the program, and preclude a precise estimation of impact. Future studies of this nature would benefit from pre-baseline measurements, more exhaustive data collection on household characteristics and transfer use, and further investigation into the use of conditional terms in emergency settings.

BACKGROUND: Concern Worldwide is an international humanitarian nongovernmental organization that piloted and is now implementing and researching community-based therapeutic care (CTC) approaches to managing acute malnutrition. Experience in several countries suggests that there are key issues to be addressed at the international, national, regional, and community levels for community-based treatment of acute malnutrition to be sustainable. NATIONAL LEVEL: At the national level there must be demonstrated commitment to a clear health policy and strategy to address outpatient treatment of acute malnutrition. In addition, locally available, affordable ready-to-use therapeutic food (RUTF) must be accessible. REGIONAL LEVEL: At the regional level a functional health system and appropriate capacity for service provision are required. Integration of outpatient services should be viewed as a process with different levels of inputs at different phases depending on the capacity of the Ministry of Health (MOH). There is a need for indicators to facilitate scale-up and scale-back for future emergency response. COMMUNITY LEVEL: Strong community participation and active screening linked to health service provision at the local level is paramount for sustainable assessment and referral of severe acute malnutrition. FUTURE CHALLENGES TO SUSTAIN COMMUNITY-BASED THERAPEUTIC CARE. Key challenges to the sustainable treatment of severe acute malnutrition include the development of locally produced RUTF, development of international standards on local RUTF production, the integration of outpatient treatment protocols into international health and nutrition guidelines, and further operational research into integration of community-based treatment of severe acute malnutrition into health systems in nonemergency contexts.

The authors assessed whether livelihood interventions integrated with HIV and AIDS care and treatment programmes share a clearly elucidated causal pathway to impact, and examined their service delivery and utilisation plans to realise intended impacts on food security. They conducted multiple in-depth key informant interviews, along the livelihood programme chain, with staff from the AIDS Support Organisation and 16 collaborating partners implementing livelihood programmes in eastern and northern Uganda. They present their results using a programme theory framework, highlighting the quality of conceptualisation of programme impact pathways by programme staff, and identify key steps along the process pathway as they relate to successful delivery of interventions, programme participation, and uptake of services by beneficiaries. Key research questions include the following: Do programmes possess coherent, consistent and plausible objectives and approaches to attaining them? Are the impact and process theories clearly defined and logical? Through analysis of programme staff interviews, the authors highlight critical gaps in conceptualisation of causal pathways and programme processes that need to be addressed in order to maximise programme impact.

HIV care and treatment providers across sub-Saharan Africa are integrating livelihood interventions to improve food security of their clientele. Many integrated HIV and livelihood programmes (IHLPs) require the formation and use of groups of HIV-infected/affected individuals as the operational target for programme interventions, indeed, virtually without exception the group is the focal point for material and intellectual inputs of IHLPs. We sought to critically examine the group approach to programming among IHLPs in Uganda, and to explore and problematise the assumptions underpinning this model. A case study approach to studying 16 IHLPs was adopted. Each IHLP was treated as a case comprising multiple in-depth interviews conducted with staff along the livelihood programme chain. Additionally, in-depth interviews were conducted with staff from The AIDS Support Organization (TASO), and with members of 71 HIV-infected TASO-registered client households. Our analysis reveals three important considerations in IHLP programming regarding the group-centred approach: (1) Group membership is widely held to confer benefits in the form of psycho-social and motivational support, particularly in empowering individuals to access HIV services and handle stigma. This is contrasted with the problem of stigma inherent in joining groups defined by HIV-status; (2) Membership in groups can bring economic benefits through the pooling of labour and resources. These benefits however need to be set against the costs of membership, when members are required to make contributions in the form of money, goods or labour; (3) Sharing of goods and labour in the context of group membership allow members to access benefits which would otherwise be inaccessible. In exchange, individual choice and control are diminished and problems of resources held in common can arise. While the group model can bring benefits to IHLP efficiency and by extension to food security, and other outcomes, its application needs to be carefully scrutinised at the individual programme level, in terms of whether it is an appropriate approach, and in terms of mitigating potentially adverse effects.

Defining the core activity of psychiatric nursing is helpful if the discipline seeks professionalization. A definition offers a sense of stability within the current culture of change in care provision. However, core activity may be incongruent with postmodern ideas and practice. The paper attempts to square this circle. It addresses the complexity of describing core activity when this is based on implicit knowledge of practice, based in art rather than science. Using a phenomenological research approach, the research involved encouraging psychiatric nurses within residential schemes to consider the meaning of their concrete activity. Initial findings suggest that the core activity is working with extraordinary people within 'ordinary' relationships, and in 'ordinary' contexts.

No abstract available for this article.

BACKGROUND: Cash transfer programmes are increasingly used in humanitarian contexts to help address people's needs across multiple sectors. However, their impact on the key objectives of reducing malnutrition and excess mortality remains unclear. mHealth interventions show great promise in many areas of public health, but evidence for their impact on reducing the risk factors for malnutrition is uncertain. We therefore implemented a trial to determine the impacts of 2 interventions in a protracted humanitarian context, a cash transfer conditionality and mHealth audio messages. METHODS AND FINDINGS: A 2 × 2 factorial cluster-randomised trial was implemented in camps for internally displaced people (IDP) near Mogadishu, Somalia, starting in January 2019. The main study outcomes were assessed at midline and endline and included coverage of measles vaccination and the pentavalent immunisation series, timely vaccination, caregiver's health knowledge, and child diet diversity. Twenty-three clusters (camps) were randomised to receive or not receive conditional cash transfers (CCTs) and an mHealth intervention, and 1,430 households were followed up over 9 months. All camps received cash transfers made at emergency humanitarian level (US$70/household/month) for 3 months followed by a further 6 months at a safety net level (US$35). To be eligible to receive cash, households in camps receiving CCT were required to take their children <5 years age to attend a single health screening at a local clinic and were issued with a home-based child health record card. Participants in camps receiving the mHealth intervention were asked (but not required) to listen to a series of audio messages about health and nutrition that were broadcast to their mobile phone twice a week for 9 months. Participants and investigators were not blinded. Adherence to both interventions was monitored monthly and found to be high (>85%). We conducted intention-to-treat analysis. During the humanitarian intervention phase, the CCT improved coverage of measles vaccination (MCV1) from 39.2% to 77.5% (aOR 11.7, 95% CI [5.2, 26.1]; p < 0.001) and completion of the pentavalent series from 44.2% to 77.5% (aOR 8.9, 95% CI [2.6, 29.8]; p = < 0.001). By the end of the safety net phase, coverage remained elevated from baseline at 82.2% and 86.8%, respectively (aOR 28.2, 95% CI [13.9, 57.0]; p < 0.001 and aOR 33.8, 95% CI [11.0, 103.4]; p < 0.001). However, adherence to timely vaccination did not improve. There was no change in the incidence of mortality, acute malnutrition, diarrhoea, or measles infection over the 9 months of follow-up. Although there was no evidence that mHealth increased Mother's knowledge score (aOR 1.32, 95% CI [0.25, 7.11]; p = 0.746) household dietary diversity increased from a mean of 7.0 to 9.4 (aOR 3.75, 95% CI [2.04, 6.88]; p < 0.001). However, this was not reflected by a significant increase in child diet diversity score, which changed from 3.19 to 3.63 (aOR 2.1, 95% CI [1.0, 4.6]; p = 0.05). The intervention did not improve measles vaccination, pentavalent series completion, or timely vaccination, and there was no change in the incidence of acute malnutrition, diarrhoea, measles infection, exclusive breastfeeding, or child mortality. No significant interactions between the interventions were found. Study limitations included the limited time available to develop and test the mHealth audio messages and the necessity to conduct multiple statistical tests due to the complexity of the study design. CONCLUSIONS: A carefully designed conditionality can help achieve important public health benefits in humanitarian cash transfer programmes by substantially increasing the uptake of child vaccination services and, potentially, other life-saving interventions. While mHealth audio messages increased household diet diversity, they failed to achieve any reductions in child morbidity, malnutrition, or mortality. TRIAL REGISTRATION: ISRCTN ISRCTN24757827. Registered November 5, 2018.

In 1998, international agencies operating in Kosovo recognised that human rights violations were causing a humanitarian crisis. The language and principles of human rights were used effectively to advocate interventions that addressed the root causes of the conflict.1 As the details of the tragedy in Kosovo have become clearer, the international community has expressed some sense of vindication that the systematic abuse of human rights justified the military intervention. According to some, the NATO led intervention sets an important precedent: human rights were given priority over the rights of a particular state, a challenge to the notion of the absolute inviolability of state sovereignty.2 This increased priority given to human rights is laudable. However, such rights, universal in scope, should not be differentially recognised; their protection must be extended beyond Europe (press release by Sergio Vieira de Mello, undersecretary-general for humanitarian affairs and emergency relief coordinator, UN Office for the Coordination of Humanitarian Affairs, 12 August 1999). The causal link between human rights violations and a humanitarian crisis must be recognised wherever it exists.3 Addressing the roots of contemporary crises requires a detailed analysis that incorporates a study of human rights, followed by multifaceted solutions supported by sustained international attention. The standard assessment of and response to humanitarian needs effectively mitigates human suffering but has virtually no role in preventing its ongoing generation.4 In this article we draw on our collective experience in Sierra Leone to illustrate some of the links between human rights violations and health effects in that country's chronic conflict. #### Summary points Human rights violations have contributed to large scale humanitarian crises in protracted conflicts in Kosovo and Sierra Leone The politico-military intervention in Kosovo exemplifies a growing international commitment to human rights and the recognition that humanitarian responses alone are often insufficient Humanitarian responses …

SUMMARY This article presents a psychoeducational group model used at Pride Institute, a gay and lesbian affirmative inpatient chemical dependency treatment program. While psychoeducational groups have long been a central component of chemical dependency treatment, gay men and lesbians have extensive treatment needs and these needs may be addressed most effectively in psychoeducational groups that are unique and specific. This model is presented to (1) identify the special needs of chemically dependent gay men and lesbians, (2) raise awareness among treatment providers, (3) apply to other populations that have been marginalized and victimized by majority culture, and (4) be adapted for use by other agencies and treatment programs.

The main indicators of the innovative development of the Russian Federation are considered on the basis of the data presented in two regulatory documents developed in 2008 and 2011. The indicators cover a wide range of areas of socio-economic development, and their values should be achieved by 2020. However, the targets of macroeconomic indicators laid down in the documents at the current moment of time are seen to be overestimated. The analysis of the main achievements in the field of innovative development of our country over a ten-year period is carried out. For the analysis, a set of statistical data published in various sources was used, as well as the values of target macroeconomic indicators published in the concept and strategy. Based on the assessment of indicators and their deviations, an analysis is made of the success of the innovative development of Russia in various areas - from the development of the high-tech sector to the publication activity of the authors. Based on the results obtained, it was concluded that these or those target values of macroeconomic indicators have been achieved at the current time and an assumption about achieving these values by 2020. In addition, based on the analysis, it was determined which of the three options for innovative development our country is implementing at the present stage. The main reasons that prevented the experts and the Government of the Russian Federation from reaching the main target indicators of the concept and strategy and transferring our country to “innovative tracks” are summarized.