The health of internally displaced children in sub-Saharan Africa: a scoping review

Bukola Salami, Stella Iwuagwu, Oluwakemi Amodu, Mia Tulli, Chizoma Ndikom, Hayat Gommaa, Tina Lavin, Michael Kariwo

BMJ Global Health, Volume 5, Issue 8 (2020)


This paper examines what is known about the health and health concerns of internally displaced children in sub-Saharan Africa. 25 articles met the inclusion criteria for the scoping review, including 16 quantitative, six qualitative and three mixed methods studies. Six articles focused on childhood infections or diseases, including studies in Sudan, Nigeria, South Sudan and northern Uganda. Six articles concerned child growth and nutrition, with studies conducted in Rwanda, Nigeria, Zambia, Kasese district along the Uganda–Congo border, northern Uganda, and Somalia. Eight articles focused on children’s mental health and psychological wellbeing, conducted in Democratic Republic of the Congo, Sierra Leone and northern Uganda. Five articles focused on health services delivery in Sudan and South Sudan.

Main findings:

  • Internally displaced children in sub-Saharan Africa are at an increased risk of infectious diseases. Several studies found a high rate of infectious diseases among internally displaced children, including parasitic infections that cause diarrhea, cholera, schistosomiasis, malaria and sexually transmitted infections. Poor sanitation and living conditions, insecurity, and sexual exploitation were the main factors that increase the risk of infectious diseases. Some studies found that gender is associated with the likelihood of infection (e.g. higher rates of intestinal parasitic worm infection among displaced boys in Khartoum). The existing research does not examine which contextual factors or interventions may decrease the prevalence of infectious diseases among internally displaced children.
  • Findings on nutritional status of internally displaced children are mixed. Nutritional status is found to be poorer among internally displaced children in some studies, and poorer among host population children in other studies. Mixed results reflect variations across settings, for example due to differences in the quality of health services provided by aid agencies in IDP camps versus public health services provided to the host population. Access to nutritional foods (rather than lack of education about healthy nutrition) and the extent to which children’s food needs are prioritized over adults’ needs or other household expenditures, are also found to be relevant factors. Internally displaced children under five years are at a higher risk of malnutrition compared with older children, which may be due to maternal early infant-feeding practices. Gender was not a noted factor in these studies. The available studies also suggest that community interventions, including incentive-based nutrition education, do not improve growth and nutrition for internally displaced children.
  • Internally displaced children in sub-Saharan Africa are at an increased risk of mental health problems. Experiences of violence were a compounding factor in mental health problems that emerged during or after displacement. Mental health problems result from a complex interplay of factors at the individual level (e.g. exposure to violence, child’s age, exposure to sexual abuse), family factors (e.g. low income), community factors (e.g. extent of social support following migration) and social factors (e.g. pre-migration and post-migration conditions). Interventions in classroom settings and group psychotherapy interventions were found to be more beneficial for girls than boys. School-based trauma treatment programs including drama and art therapy techniques were found to improve emotional outcomes in children. Additionally, adverse life experiences after exposure to conflict (such as the death of a family member) can impede the success of interventions.
  • Internally displaced children experience challenges with access to health services. Overall, infant care in IDP camps was inadequate. Age-appropriate reproductive healthcare was also lacking in IDP camps, often resulting in unplanned pregnancies.
  • Overall, results indicate poorer health outcomes among internally displaced children in the areas of mental health and infectious disease. Several pre-migration factors (e.g. trauma) and post-migration factors (e.g. humanitarian assistance in displacement settings) contribute to the health of internally displaced children, however further research is needed to better understand options for improving the health of internally displaced children.

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