The social determinants of health and health seeking behaviour in populations affected by armed conflict: a qualitative systematic review

Figures & data

Figure 1. PRISMA flow diagram

Table 1. Summary of included studies

Study Author(s) and Title	Conflict zone	Population	Aim	CASP
Rujumba and Kwiringira (2010)	Northern Uganda	Total participants: not provided Gender and Age: Women: aged 15 and above Marital status: unmarried Education level: Primary education, and 1/3 with no education at all.	Through 12 FGDs and 15 key informants’ interviews, the authors conducted a thematic analysis to explore population’s perceptions of the link between insecurity, culture and HIV/AIDS in Northern Uganda	18/20
Chi et al. (2015a)	Burundi and Northern Uganda	Total participant (n = 115) Gender: Women (n = 46) Age: 17 to 55 Marital status: not provided Occupation: Local health providers n = 32, NGO staff n = 37 Community primary occupation: farming, housewife, “petit” trading Religion: not provided	Through 63 semi-structured in-depths interviews and 8 FGDs, a thematic analysis used to explore armed conflicts’ impacts on maternal health in Northern Uganda and Burundi	19/20
Chi et al. (2015b)	Burundi and Northern Uganda	Total participant (n = 115) Gender: Women (n = 46) Age: 17 to 55 Marital status: not provided Occupation: Local health providers n = 32, NGO staff n = 37, Community primary occupation: farming, housewife, “petit” trading Religion: not provided	Through 63 semi-structured in-depths interviews and 8 FGDs in two post conflict settings in Sub-Saharan Africa, a thematic analysis used to explore how exposure to armed conflicts affects the factors that determine the uptake of maternal, sexual and reproductive health services.	19/20
Roberts et al. (2009)	Northern Uganda	Total number (n = 21) Gender: Women (n = 12), Men (n = 9) Average age: 32 Education level: not provided Occupation: Not provided Religion: Catholic faith (n = 13), Pentecostal faith (n = 8)	21 interviews and thematic analysis to understand the social determinants of overall mental and physical health of displaced populations and their health needs’ coping strategies	18/20
O’Laughlin et al. (2013)	Uganda	Total number (n = 73) Average age: 40 Education level: average years of education (4.5) Marital status: Majority married and Christian, Only 2 separated	65 In-person open ended interviews and grounded theory to explore the experiences of refugees in testing for HIV/AIDS and the circumstances that made testing possible	18/20
Kabakian-Khasholian et al. (2017)	Lebanon	Total participants (n = 84) Gender: not provided Age: 18–25 years (n = 32), 26–35 years (n = 29), 36–45 years (n = 27) Education level: mostly elementary or secondary level Occupation: Healthcare providers: 6 Obstetricians: 2 females, 4 males, 5 nurses: all females, 2 midwives: all females	12 FGDs and 13 In-depths interviews to explore women and service providers ’perspectives on fertility behaviours and the utilization of services by Syrian refugee women	17/20
Dumit and Honein‐Abouhaidar (2019)	Lebanon	Total participants (n = 12) Gender: Women: (n = 9), Male: (n = 3) Age range (27–52) Education level: Masters (n = 4), Bachelors (n = 8) Occupation: not provided	In-depths interviews and thematic analysis to explore the perceptions of the effects of the protracted Syrian refugee crisis on health providers in Lebanon	17/20

Table 2. Quality assessment of included studies

CASP Questions	Rujumba and Kwiringira (2010)	Chi et al. (2015a)	Chi et al. (2015b)	Roberts et al. (2009)	Kabakian-Khasholian et al. (2017)	O’Laughlin et al. (2013)	Dumit and Honein‐Abouhaidar (2019)
1	2	2	2	2	2	2	2
2	2	2	2	2	2	2	2
3	2	2	2	2	2	2	2
4	2	2	2	2	2	2	2
5	2	2	2	2	2	2	2
6	0	1	1	0	0	0	0
7	2	2	2	2	2	2	2
8	2	2	2	2	2	2	2
9	2	2	2	2	2	2	2
10	2	2	2	2	1	2	1
Total	18	19	19	18	17	18	17

Table 3. Analytical themes and included studies

Analytical themes	Rujumba and Kwiringira 2010	Chi et al. (2015a)	Chi et al. (2015b)	Roberts et al. (2009)	Kabakian-Khasholian et al. (2017)	O’Laughlin et al. (2013)	Dumit and Honein‐Abouhaidar (2019)
Individual and economic determinants	✓	✓	✓	✓	✓	✓	✓
Sociocultural determinants	✓	✓	✓	✓		✓
Political and healthcare system determinants	✓	✓	✓		✓

Rujumba, J., and J. Kwiringira. 2010. “Interface of Culture, Insecurity and HIV and AIDS: Lessons from Displaced Communities in Pader District, Northern Uganda.” Conflict and Health 4 (1): 18. doi:https://doi.org/10.1186/1752-1505-4-18.

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Chi, P. C., P. Bulage, H. Urdal, and J. Sundby. 2015a. “Perceptions of the Effects of Armed Conflict on Maternal and Reproductive Health Services and Outcomes in Burundi and Northern Uganda: A Qualitative Study.” BMC International Health and Human Rights 15 (1): 7. doi:https://doi.org/10.1186/s12914-015-0045-z.

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Chi, P. C., P. Bulage, H. Urdal, and J. Sundby. 2015b. “A Qualitative Study Exploring the Determinants of Maternal Health Service Uptake in Post-conflict Burundi and Northern Uganda.” BMC Pregnancy and Childbirth 15 (1): 18. doi:https://doi.org/10.1186/s12884-015-0449-8.

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Roberts, B., V. N. Odong, J. Browne, K. F. Ocaka, W. Geissler, and E. Sondorp. 2009. “An Exploration of Social Determinants of Health Amongst Internally Displaced Persons in Northern Uganda.” Conflict and Health 3 (1): 10. doi:https://doi.org/10.1186/1752-1505-3-10.

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O’Laughlin, K. N., S. A. Rouhani, Z. M. Faustin, and N. C. Ware. 2013. “Testing Experiences of HIV Positive Refugees in Nakivale Refugee Settlement in Uganda: Informing Interventions to Encourage Priority Shifting.” Conflict and Health 7 (1): 2. doi:https://doi.org/10.1186/1752-1505-7-2.

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Kabakian-Khasholian, T., R. Mourtada, H. Bashour, F. E. Kak, and H. Zurayk. 2017. “Perspectives of Displaced Syrian Women and Service Providers on Fertility Behaviour and Available Services in West Bekaa, Lebanon.” Reproductive Health Matters 25 (sup1): 75–86. doi:https://doi.org/10.1080/09688080.2017.1378532.

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Dumit, N. Y., and G. Honein‐Abouhaidar. 2019. “The Impact of the Syrian Refugee Crisis on Nurses and the Healthcare System in Lebanon: A Qualitative Exploratory Study.” Journal of Nursing Scholarship 51 (3): 289–298. doi:https://doi.org/10.1111/jnu.12479.

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