Conference Material > Abstract
Robinson E, van Braak F, Rose L, Yadenzi MS
MSF Scientific Days International 2021: Research. 2021 May 19
INTRODUCTION
Protracted conflict in CAR has led to widespread political unrest and fragile health systems. Hyperendemic malaria is the main cause of morbidity. Alongside global calls to prioritise malaria prevention during the COVID-19 pandemic, MSF initiated mass drug administration (MDA) for children aged between three months and 15 years within three communes of the Bossangoa health district between 17 August and 24 November 2020. The MDA comprised three cycles of dihydroartemisin-piperaquine (DHA-PQ), given at four-week intervals. We evaluated coverage and clinical impact of the MDA, and describe community perspectives.
METHODS
We conducted a two-stage cluster household survey between 22 November and 9 December 2020. We undertook structured interviews with the heads of households and with eligible children, focusing on participation in the MDA. Participation was verified against the MDA card, if available. Using routine MSF surveillance data, we compared the following indicators during the MDA intervention to the same periods of time during 2018 and 2019: consultations, confirmed malaria cases, and positivity rates of malaria rapid diagnostic tests (mRDT’s) in MSF facilities in the intervention area, overall and by age group (≥5; <5 years); hospital admissions and in-hospital deaths with a primary diagnosis of severe malaria among children <15 years from the MDA intervention area. Following each cycle we conducted nine focus groups discussions (FGD’s) with caregivers, community leaders, and community health workers (CHW’s) Participants were selected using purposive sampling. The topic guide inluded the key themes of reasons for participation, difficulties encountered, satisfaction, and experiences throughout the MDA.
ETHICS
This study was approved by the MSF Ethics Review Board (ERB) and by the national ERB of CAR.
RESULTS
In total, we distributed 134,117 DHA-PQ courses. Among eligible children, 93.1% (95% confidence interval, CI, 85.6-96.8) received all three cycles. We estimated significant reductions only for confirmed outpatient malaria cases overall (9.2%; 95% CI 5.6-12.8), and among those aged <5 years (20.5%; 95% CI 15.3-25.8). Following the first MDA cycle, FGD participants described positive perceptions and high adherence with regard to MDA, linked with the involvement of community leaders. Participants reported reductions in childhood malaria, as well as reduced household expenditure on healthcare. Rumours about ‘drug trials’ and concerns about side effects were initial reasons for refusal, however these concerns were overcome after seeing the positive impact on participating children. Participants’ recommendations included continuing the programme and expanding eligibility.
CONCLUSION
This is one of the first such MDA’s in CAR; our experience demonstrates MDA is feasible in complex emergencies. Although preliminary analysis of routine surveillance data suggested a limited impact on malaria diagnoses, community acceptance was high. Of note, outpatient surveillance data was limited to three structures in only one commune, and not available for the specific target ages of the MDA. Participants noted positive perceptions of impact, with a desire for repeated MDA’s. Further analysis will help to further elucidate the potential impact, and inform recommendations.
Protracted conflict in CAR has led to widespread political unrest and fragile health systems. Hyperendemic malaria is the main cause of morbidity. Alongside global calls to prioritise malaria prevention during the COVID-19 pandemic, MSF initiated mass drug administration (MDA) for children aged between three months and 15 years within three communes of the Bossangoa health district between 17 August and 24 November 2020. The MDA comprised three cycles of dihydroartemisin-piperaquine (DHA-PQ), given at four-week intervals. We evaluated coverage and clinical impact of the MDA, and describe community perspectives.
METHODS
We conducted a two-stage cluster household survey between 22 November and 9 December 2020. We undertook structured interviews with the heads of households and with eligible children, focusing on participation in the MDA. Participation was verified against the MDA card, if available. Using routine MSF surveillance data, we compared the following indicators during the MDA intervention to the same periods of time during 2018 and 2019: consultations, confirmed malaria cases, and positivity rates of malaria rapid diagnostic tests (mRDT’s) in MSF facilities in the intervention area, overall and by age group (≥5; <5 years); hospital admissions and in-hospital deaths with a primary diagnosis of severe malaria among children <15 years from the MDA intervention area. Following each cycle we conducted nine focus groups discussions (FGD’s) with caregivers, community leaders, and community health workers (CHW’s) Participants were selected using purposive sampling. The topic guide inluded the key themes of reasons for participation, difficulties encountered, satisfaction, and experiences throughout the MDA.
ETHICS
This study was approved by the MSF Ethics Review Board (ERB) and by the national ERB of CAR.
RESULTS
In total, we distributed 134,117 DHA-PQ courses. Among eligible children, 93.1% (95% confidence interval, CI, 85.6-96.8) received all three cycles. We estimated significant reductions only for confirmed outpatient malaria cases overall (9.2%; 95% CI 5.6-12.8), and among those aged <5 years (20.5%; 95% CI 15.3-25.8). Following the first MDA cycle, FGD participants described positive perceptions and high adherence with regard to MDA, linked with the involvement of community leaders. Participants reported reductions in childhood malaria, as well as reduced household expenditure on healthcare. Rumours about ‘drug trials’ and concerns about side effects were initial reasons for refusal, however these concerns were overcome after seeing the positive impact on participating children. Participants’ recommendations included continuing the programme and expanding eligibility.
CONCLUSION
This is one of the first such MDA’s in CAR; our experience demonstrates MDA is feasible in complex emergencies. Although preliminary analysis of routine surveillance data suggested a limited impact on malaria diagnoses, community acceptance was high. Of note, outpatient surveillance data was limited to three structures in only one commune, and not available for the specific target ages of the MDA. Participants noted positive perceptions of impact, with a desire for repeated MDA’s. Further analysis will help to further elucidate the potential impact, and inform recommendations.
Journal Article > ResearchFull Text
Confl Health. 2017 May 15; Volume 11 (Issue 1); 7.; DOI:10.1186/s13031-017-0110-4
Coldiron ME, Roederer T, Llosa AE, Bouhenia M, Madi S, et al.
Confl Health. 2017 May 15; Volume 11 (Issue 1); 7.; DOI:10.1186/s13031-017-0110-4
The Central African Republic has known long periods of instability. In 2014, following the fall of an interim government installed by the Séléka coalition, a series of violent reprisals occurred. These events were largely directed at the country's Muslim minority and led to a massive displacement of the population. In 2014, we sought to document the retrospective mortality among refugees arriving from the CAR into Chad by conducting a series of surveys.
Conference Material > Poster
Gohy B, Brodin N, Musambi M, Mafuko JM, Ndiramiye E, et al.
MSF Scientific Days International 2021: Research. 2021 May 18
Journal Article > ResearchFull Text
Confl Health. 2010 June 17; Volume 4; 12.; DOI:10.1186/1752-1505-4-12
O'Brien DP, Venis S, Greig J, Shanks L, Ellman T, et al.
Confl Health. 2010 June 17; Volume 4; 12.; DOI:10.1186/1752-1505-4-12
INTRODUCTION
Many countries ravaged by conflict have substantial morbidity and mortality attributed to HIV/AIDS yet HIV treatment is uncommonly available. Universal access to HIV care cannot be achieved unless the needs of populations in conflict-affected areas are addressed.
METHODS
From 2003 Médecins Sans Frontières introduced HIV care, including antiretroviral therapy, into 24 programmes in conflict or post-conflict settings, mainly in sub-Saharan Africa. HIV care and treatment activities were usually integrated within other medical activities. Project data collected in the Fuchia software system were analysed and outcomes compared with ART-LINC data. Programme reports and other relevant documents and interviews with local and headquarters staff were used to develop lessons learned.
RESULTS
In the 22 programmes where ART was initiated, more than 10,500 people were diagnosed with HIV and received medical care, and 4555 commenced antiretroviral therapy, including 348 children. Complete data were available for adults in 20 programmes (n = 4145). At analysis, 2645 (64%) remained on ART, 422 (10%) had died, 466 (11%) lost to follow-up, 417 (10%) transferred to another programme, and 195 (5%) had an unclear outcome. Median 12-month mortality and loss to follow-up were 9% and 11% respectively, and median 6-month CD4 gain was 129 cells/mm3. Patient outcomes on treatment were comparable to those in stable resource-limited settings, and individuals and communities obtained significant benefits from access to HIV treatment. Programme disruption through instability was uncommon with only one program experiencing interruption to services, and programs were adapted to allow for disruption and population movements. Integration of HIV activities strengthened other health activities contributing to health benefits for all victims of conflict and increasing the potential sustainability for implemented activities.
CONCLUSIONS
With commitment, simplified treatment and monitoring, and adaptations for potential instability, HIV treatment can be feasibly and effectively provided in conflict or post-conflict settings.
Many countries ravaged by conflict have substantial morbidity and mortality attributed to HIV/AIDS yet HIV treatment is uncommonly available. Universal access to HIV care cannot be achieved unless the needs of populations in conflict-affected areas are addressed.
METHODS
From 2003 Médecins Sans Frontières introduced HIV care, including antiretroviral therapy, into 24 programmes in conflict or post-conflict settings, mainly in sub-Saharan Africa. HIV care and treatment activities were usually integrated within other medical activities. Project data collected in the Fuchia software system were analysed and outcomes compared with ART-LINC data. Programme reports and other relevant documents and interviews with local and headquarters staff were used to develop lessons learned.
RESULTS
In the 22 programmes where ART was initiated, more than 10,500 people were diagnosed with HIV and received medical care, and 4555 commenced antiretroviral therapy, including 348 children. Complete data were available for adults in 20 programmes (n = 4145). At analysis, 2645 (64%) remained on ART, 422 (10%) had died, 466 (11%) lost to follow-up, 417 (10%) transferred to another programme, and 195 (5%) had an unclear outcome. Median 12-month mortality and loss to follow-up were 9% and 11% respectively, and median 6-month CD4 gain was 129 cells/mm3. Patient outcomes on treatment were comparable to those in stable resource-limited settings, and individuals and communities obtained significant benefits from access to HIV treatment. Programme disruption through instability was uncommon with only one program experiencing interruption to services, and programs were adapted to allow for disruption and population movements. Integration of HIV activities strengthened other health activities contributing to health benefits for all victims of conflict and increasing the potential sustainability for implemented activities.
CONCLUSIONS
With commitment, simplified treatment and monitoring, and adaptations for potential instability, HIV treatment can be feasibly and effectively provided in conflict or post-conflict settings.
Journal Article > ResearchFull Text
Public Health Action. 2019 September 1; Volume 9 (Issue 3); 107-112.; DOI:10.5588/pha.18.0045
Gil Cuesta J, Trelles M, Naseer A, Momin A, Ngabo Mulamira L, et al.
Public Health Action. 2019 September 1; Volume 9 (Issue 3); 107-112.; DOI:10.5588/pha.18.0045
English
Français
Español
INTRODUCTION
Conflicts frequently occur in countries with high maternal and neonatal mortality and can aggravate difficulties accessing emergency care. No literature is available on whether the presence of conflict influences the outcomes of mothers and neonates during Caesarean sections (C-sections) in high-mortality settings.
OBJECTIVE
To determine whether the presence of conflict was associated with changes in maternal and neonatal mortality during C-sections.
METHODS
We analysed routinely collected data on C-sections from 17 Médecins Sans Frontières (MSF) health facilities in 12 countries. Exposure variables included presence and intensity of conflict, type of health facility and other types of access to emergency care.
RESULTS
During 2008–2015, 30,921 C-sections were performed in MSF facilities; of which 55.4% were in areas of conflict. No differences were observed in maternal mortality in conflict settings (0.1%) vs. non-conflict settings (0.1%) (P = 0.08), nor in neonatal mortality between conflict (12.2%) and non-conflict settings (11.5%) (P = 0.1). Among the C-sections carried out in conflict settings, neonatal mortality was slightly higher in war zones compared to areas of minor conflict (P = 0.02); there was no difference in maternal mortality (P = 0.38).
CONCLUSIONS
Maternal and neonatal mortality did not appear to be affected by the presence of conflict in a large number of MSF facilities. This finding should encourage humanitarian organisations to support C-sections in conflict settings to ensure access to quality maternity care.
Conflicts frequently occur in countries with high maternal and neonatal mortality and can aggravate difficulties accessing emergency care. No literature is available on whether the presence of conflict influences the outcomes of mothers and neonates during Caesarean sections (C-sections) in high-mortality settings.
OBJECTIVE
To determine whether the presence of conflict was associated with changes in maternal and neonatal mortality during C-sections.
METHODS
We analysed routinely collected data on C-sections from 17 Médecins Sans Frontières (MSF) health facilities in 12 countries. Exposure variables included presence and intensity of conflict, type of health facility and other types of access to emergency care.
RESULTS
During 2008–2015, 30,921 C-sections were performed in MSF facilities; of which 55.4% were in areas of conflict. No differences were observed in maternal mortality in conflict settings (0.1%) vs. non-conflict settings (0.1%) (P = 0.08), nor in neonatal mortality between conflict (12.2%) and non-conflict settings (11.5%) (P = 0.1). Among the C-sections carried out in conflict settings, neonatal mortality was slightly higher in war zones compared to areas of minor conflict (P = 0.02); there was no difference in maternal mortality (P = 0.38).
CONCLUSIONS
Maternal and neonatal mortality did not appear to be affected by the presence of conflict in a large number of MSF facilities. This finding should encourage humanitarian organisations to support C-sections in conflict settings to ensure access to quality maternity care.
Technical Report > Evidence Brief
Pasquier E, Owolabi OO, Fetters T, Chen H, Williams TN, et al.
2022 August 30
English
Français
Abortion complications remain a major cause of maternal mortality worldwide and abortion-related mortality has decreased very little over the last decade, unlike maternal mortality linked to other main causes such as haemorrhage, infection or obstructed labour. Global estimates suggest that most abortion-related deaths are the result of unsafe induced abortions, 97% of which occur in low- and middle-income countries which can be largely prevented by providing comprehensive abortion care, including post- abortion care, contraceptive services, and safe abortion care.
At 829 deaths for every 100,000 live births, the Central African Republic (CAR) has one of the world’s highest maternal mortality ratios. Abortion-related complications are a major contributor to maternal mortality, estimated at almost one in four (24%) of the maternal deaths in one study led by the Central African Ministry of Health and UNFPA. Further, CAR is one of the most fragile countries in the world, rating 174th out of the 178 countries in the Fund for Peace Fragility Index with different parts of the country regularly affected by decades-long armed conflict.
A lack of evidence on abortion complications in fragile settings limits the understanding of women’s needs in access to comprehensive abortion care in this context. This study describes the burden of abortion-related complications and their contributing factors in the maternity of Castors in Bangui, CAR. This evidence brief presents selected results of two components of the AMoCo Study (Abortion-related Morbidity and Mortality in Conflict-affected and Fragile Settings): 1) A quantitative observational study of clinical characteristics of women presenting with any type of abortion complications, and 2) A quantitative survey with a sub-group of these women who were hospitalized.
At 829 deaths for every 100,000 live births, the Central African Republic (CAR) has one of the world’s highest maternal mortality ratios. Abortion-related complications are a major contributor to maternal mortality, estimated at almost one in four (24%) of the maternal deaths in one study led by the Central African Ministry of Health and UNFPA. Further, CAR is one of the most fragile countries in the world, rating 174th out of the 178 countries in the Fund for Peace Fragility Index with different parts of the country regularly affected by decades-long armed conflict.
A lack of evidence on abortion complications in fragile settings limits the understanding of women’s needs in access to comprehensive abortion care in this context. This study describes the burden of abortion-related complications and their contributing factors in the maternity of Castors in Bangui, CAR. This evidence brief presents selected results of two components of the AMoCo Study (Abortion-related Morbidity and Mortality in Conflict-affected and Fragile Settings): 1) A quantitative observational study of clinical characteristics of women presenting with any type of abortion complications, and 2) A quantitative survey with a sub-group of these women who were hospitalized.
Conference Material > Poster
Kenntner S, Samba Yadensi M, Fiddler J, Baieli E, Leone G, et al.
MSF Paediatric Days 2022. 2022 November 30; DOI:10.57740/j7vc-x981
Journal Article > ResearchFull Text
BMC Pediatr. 2021 December 13; Volume 21 (Issue 1); 750.; DOI:10.1186/s12887-021-02911-w
Nebbioso A, Ogundipe OF, Repetto EC, Mekiedje C, Sanke-Waigana H, et al.
BMC Pediatr. 2021 December 13; Volume 21 (Issue 1); 750.; DOI:10.1186/s12887-021-02911-w
BACKGROUND
Infectious diseases account for the third most common cause of neonatal deaths. Globally, antibiotic resistance (ABR) has been increasingly challenging neonatal sepsis treatment, with 26 to 84% of gram-negative bacteria resistant to third-generation cephalosporins. In sub-Saharan Africa, limited evidence is available regarding the neonatal microbiology and ABR. To our knowledge, no studies have assessed neonatal bacterial infections and ABR in Central-African Republic (CAR). Therefore, this study aimed to describe the pathogens isolated and their specific ABR among patients with suspected antibiotic-resistant neonatal infection admitted in a CAR neonatal unit.
METHODS
This retrospective cohort study included neonates admitted in the neonatal unit in Bangui, CAR, from December 2018 to March 2020, with suspected antibiotic-resistant neonatal infection and subsequent blood culture. We described the frequency of pathogens isolated from blood cultures, their ABR prevalence, and factors associated with fatal outcome.
RESULTS
Blood cultures were positive in 33 (26.6%) of 124 patients tested (17.9% for early-onset and 46.3% for late-onset infection; p = 0.002). Gram-negative bacteria were isolated in 87.9% of positive samples; with most frequently isolated bacteria being Klebsiella pneumoniae (39.4%), Escherichia coli (21.2%) and Klebsiella oxytoca (18.2%). All tested bacteria were resistant to ampicillin. Resistance to third-generation cephalosporins was observed in 100% of tested Klebsiella pneumoniae, 83.3% of isolated Klebsiella oxytoca and 50.0% of tested Escherichia coli. None of the tested bacteria were resistant to carbapenems. Approximately 85.7 and 77.8% of gram-negative tested bacteria were resistant to first-line (ampicillin-gentamicin) and second-line (third-generation cephalosporins) treatments, respectively. In hospital mortality, adjusted for blood culture result, presence of asphyxia, birth weight and sex was higher among neonates with positive blood culture (adjusted relative risk [aRR] = 2.32; 95% confidence interval [CI] = 1.17-4.60), male sex (aRR = 2.07; 95% CI = 1.01-4.26), asphyxia (aRR = 2.42; 95% CI = 1.07-5.47) and very low birth weight (1000-1499 g) (aRR = 2.74; 95% CI = 1.3-5.79).
CONCLUSION
Overall, 77.8% of confirmed gram-negative neonatal infections could no longer effectively be treated without broad-spectrum antibiotics that are not routinely used in sub-Saharan Africa referral hospitals. Carbapenems should be considered an option in hospitals with surveillance and antibiotic stewardship.
Infectious diseases account for the third most common cause of neonatal deaths. Globally, antibiotic resistance (ABR) has been increasingly challenging neonatal sepsis treatment, with 26 to 84% of gram-negative bacteria resistant to third-generation cephalosporins. In sub-Saharan Africa, limited evidence is available regarding the neonatal microbiology and ABR. To our knowledge, no studies have assessed neonatal bacterial infections and ABR in Central-African Republic (CAR). Therefore, this study aimed to describe the pathogens isolated and their specific ABR among patients with suspected antibiotic-resistant neonatal infection admitted in a CAR neonatal unit.
METHODS
This retrospective cohort study included neonates admitted in the neonatal unit in Bangui, CAR, from December 2018 to March 2020, with suspected antibiotic-resistant neonatal infection and subsequent blood culture. We described the frequency of pathogens isolated from blood cultures, their ABR prevalence, and factors associated with fatal outcome.
RESULTS
Blood cultures were positive in 33 (26.6%) of 124 patients tested (17.9% for early-onset and 46.3% for late-onset infection; p = 0.002). Gram-negative bacteria were isolated in 87.9% of positive samples; with most frequently isolated bacteria being Klebsiella pneumoniae (39.4%), Escherichia coli (21.2%) and Klebsiella oxytoca (18.2%). All tested bacteria were resistant to ampicillin. Resistance to third-generation cephalosporins was observed in 100% of tested Klebsiella pneumoniae, 83.3% of isolated Klebsiella oxytoca and 50.0% of tested Escherichia coli. None of the tested bacteria were resistant to carbapenems. Approximately 85.7 and 77.8% of gram-negative tested bacteria were resistant to first-line (ampicillin-gentamicin) and second-line (third-generation cephalosporins) treatments, respectively. In hospital mortality, adjusted for blood culture result, presence of asphyxia, birth weight and sex was higher among neonates with positive blood culture (adjusted relative risk [aRR] = 2.32; 95% confidence interval [CI] = 1.17-4.60), male sex (aRR = 2.07; 95% CI = 1.01-4.26), asphyxia (aRR = 2.42; 95% CI = 1.07-5.47) and very low birth weight (1000-1499 g) (aRR = 2.74; 95% CI = 1.3-5.79).
CONCLUSION
Overall, 77.8% of confirmed gram-negative neonatal infections could no longer effectively be treated without broad-spectrum antibiotics that are not routinely used in sub-Saharan Africa referral hospitals. Carbapenems should be considered an option in hospitals with surveillance and antibiotic stewardship.
Conference Material > Poster
Eibs T, Koscalova A, Jimenez C, Lasry E, Kohler G, et al.
MSF Scientific Days UK 2019: Research. 2019 April 30; DOI:10.7490/f1000research.1116694.1
Conference Material > Abstract
Venables E, Seisun C, Malou EN, Gatkuoth MM, Chop Kuony C, et al.
MSF Scientific Days International 2021: Research. 2021 May 19
INTRODUCTION
Sexual violence remains commonplace in conflict settings and has a devastating impact on the physical and mental health of survivors. We built on previous research by the ICRC, examining local norms and values surrounding violence, by focusing on how young men and their communities perceive sexual violence and its prevention. The ICRC seeks to protect and assist people affected by armed conflict and other situations of violence, and has been present in South Sudan since 1980 and CAR since 1983.
METHODS
We carried out a qualitative study, including 79 interviews and 16 focus group discussions. Participants included purposively selected young men and women (aged 15-33 years); community leaders (such as chiefs, cattle herders, traditional court members and health-care providers), and key informants with expertise in the field of sexual violence. Sites in South Sudan (Unity and Lakes States) and CAR (Bangui) were chosen because of the ICRC’s ongoing presence and the availability of referral services if required. Interviews and focus groups were conducted in French, English, Sango, Arabic, Nuer, and Dinka, transcribed and translated before being coded and thematically analysed using NVivo. Informed consent/assent was obtained from all participants.
ETHICS
This study was approved by the ICRC Ethics Review Board, the Comité Ethique et Scientifique of the University of Bangui, CAR, and by the Institutional Review Board of the Ministry of Health, South Sudan.
RESULTS
Findings from both countries linked male perpetration of sexual violence with prolonged conflict and insecurity; the presence of weapons; a weak justice system and impunity; revenge and punishment, and strong gendered norms and ideas around masculinity. Some men believed that women were to blame because of their behaviour or clothing. Participants saw the need to engage young men and their communities in prevention activities, but few were able to reflect upon their potential individual role in this. Strong community values and a sense of male responsibility were present in all study sites, and involving male leaders was believed to be essential for prevention activities. Interviewees in both countries suggested that providing information about HIV could be an entry point to talking about sexual violence with potential perpetrators.
CONCLUSION
Studies on sexual violence often understandably focus on survivors, and this is the first time the ICRC has conducted qualitative research of this kind with young men. Results, including discussions around local norms of masculinity, will contribute to and serve to strengthen existing sensitisation sessions and dialogue on the prevention of sexual violence. Strengthening existing partnerships with other actors is also essential. Whilst we found that participants were willing to discuss sexual violence, some may have been uncomfortable sharing their thoughts with the research team.
CONFLICTS OF INTEREST
None declared.
Sexual violence remains commonplace in conflict settings and has a devastating impact on the physical and mental health of survivors. We built on previous research by the ICRC, examining local norms and values surrounding violence, by focusing on how young men and their communities perceive sexual violence and its prevention. The ICRC seeks to protect and assist people affected by armed conflict and other situations of violence, and has been present in South Sudan since 1980 and CAR since 1983.
METHODS
We carried out a qualitative study, including 79 interviews and 16 focus group discussions. Participants included purposively selected young men and women (aged 15-33 years); community leaders (such as chiefs, cattle herders, traditional court members and health-care providers), and key informants with expertise in the field of sexual violence. Sites in South Sudan (Unity and Lakes States) and CAR (Bangui) were chosen because of the ICRC’s ongoing presence and the availability of referral services if required. Interviews and focus groups were conducted in French, English, Sango, Arabic, Nuer, and Dinka, transcribed and translated before being coded and thematically analysed using NVivo. Informed consent/assent was obtained from all participants.
ETHICS
This study was approved by the ICRC Ethics Review Board, the Comité Ethique et Scientifique of the University of Bangui, CAR, and by the Institutional Review Board of the Ministry of Health, South Sudan.
RESULTS
Findings from both countries linked male perpetration of sexual violence with prolonged conflict and insecurity; the presence of weapons; a weak justice system and impunity; revenge and punishment, and strong gendered norms and ideas around masculinity. Some men believed that women were to blame because of their behaviour or clothing. Participants saw the need to engage young men and their communities in prevention activities, but few were able to reflect upon their potential individual role in this. Strong community values and a sense of male responsibility were present in all study sites, and involving male leaders was believed to be essential for prevention activities. Interviewees in both countries suggested that providing information about HIV could be an entry point to talking about sexual violence with potential perpetrators.
CONCLUSION
Studies on sexual violence often understandably focus on survivors, and this is the first time the ICRC has conducted qualitative research of this kind with young men. Results, including discussions around local norms of masculinity, will contribute to and serve to strengthen existing sensitisation sessions and dialogue on the prevention of sexual violence. Strengthening existing partnerships with other actors is also essential. Whilst we found that participants were willing to discuss sexual violence, some may have been uncomfortable sharing their thoughts with the research team.
CONFLICTS OF INTEREST
None declared.