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As of 2024, 123.2 million people had been forcibly displaced as a result of persecution, armed conflict or climate-related catastrophes, and these numbers are predicted to rise. There is a growing awareness of possible intergenerational effects of trauma on life-course health and well-being, however few studies have followed individuals longitudinally starting prenatally. This paper describes the first large prenatal birth cohort study in a refugee context in a lower middle-income country. This study aims to investigate the potential lifespan health and developmental implications of being born into a protracted humanitarian context, and what factors can buffer from the adversity posed by conflict and displacement.
We outline our approach of recruiting, consenting and gathering data from pregnant Rohingya refugee and host community women (N=2888; 80% Rohingya) over the course of 12 months in Cox’s Bazar, Bangladesh.
A fifth wave of data collection, when children were 6 months old, was completed in April 2025. Rohingya women were substantially less literate; were marrying and having children at slightly younger ages, were more likely to live in crowded, resource-limited households and exhibited higher rates of clinically significant post-traumatic stress disorder and anxiety than host community women.
There is a critical need for research in displaced populations in order to elucidate potentially lasting transgenerational impacts of experiencing conflict and displacement trauma, and the prenatal and postnatal factors that support health and development across the life span. The next follow-up is planned when the children turn 36 months of age (starting March 2026).
by Aziza Lakhani, Samar Fatima, Areej Khawaja, Qurratulain Virani, Muzna Hashmi, Tehreem Khan, Khairunnissa Hooda
BackgroundSafe and coordinated patient transfers are essential for reducing morbidity, mortality, and adverse events. In outpatient clinics, early recognition of patient deterioration and standardized transfer protocols are key to enhancing safety. This quality improvement initiative addresses these gaps by ensuring the timely identification of critically ill patients, prompt management, and efficient transfer to the emergency department.
MethodsThis study was conducted in two phases. In the pre-implementation phase (August 1–September 14, 2022), a multidisciplinary panel employed a modified Delphi method to revise early warning signs for critically ill clinic patients and developed a structured handoff tool to improve transfer communication. The tool was pilot tested and refined. The implementation phase (September 15–November 30, 2022) included hospital-wide training through webinars and in-person sessions, with effectiveness evaluated in forty staff members using pre- and post-training assessments. The quality initiative, comprising revised early warning criteria and standardized handoff documentation, was formally rolled out on December 1, 2022. Prospective data collection continued for one year (December 2022–November 2023) to evaluate the impact.
ResultsPost-test scores demonstrated significant improvement in staff knowledge, particularly in identifying critically ill patients and initiating appropriate interventions. Among 268 patients requiring transfer, the majority (51.49%) were aged ≥60 years, and 56.3% were male. The most common presenting complaint was acute respiratory distress (31.7%). Compliance with the handoff tool was high (≥70% in 65.6% of cases). However, prolonged emergency department (ED) stays (>7 hours in 45.5% of cases) and a 5.2% mortality rate underscored ongoing challenges in patient flow and triaging.
ConclusionImplementing structured transfer protocols, staff training, and standardized handoff tools can significantly improve patient transfer safety and efficiency in outpatient settings. However, further refinements, including enhanced triaging and digitizing documentation practices, are necessary for sustainable improvement. This project highlights the importance of systematic approaches in optimizing intra-hospital transfers in low-resource settings.
FreshRSS 