Does spending on refugees make a difference? A cross-sectional study of the association between refugee program spending and health outcomes in 70 sites in 17 countries
In: Conflict and health, Volume 10, Issue 1
ISSN: 1752-1505
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In: Conflict and health, Volume 10, Issue 1
ISSN: 1752-1505
In: Conflict and health, Volume 14, Issue 1
ISSN: 1752-1505
Abstract
Background
Accurately identifying the magnitude of gender-based violence (GBV) in humanitarian settings is hindered by logistical and methodological complexities. The 'Neighborhood Method', an adapted household survey that uses primary and secondary reporting to assess the prevalence of GBV in humanitarian settings, reduces the length of time and cost associated with traditional surveys. Primary female adult respondents disclose incidents of physical violence, intimate and non-intimate partner rape for themselves, other females in their homes (standard reporting) and other women and children in their social networks (secondary reporting). This study examines the reliability and validity of this inclusion of secondary reporting to determine the comparability of the Neighborhood Method to a traditional survey approach.
Methods
Drawing on data from 1180 women reporting on 3744 females in respondent households and 15,086 in neighboring households across four humanitarian settings (Ethiopia/ Somalia, Liberia, Sri Lanka, and Uganda), reliability of secondary reporting was measured through intra-class correlation coefficients (ICCs) and Cohen's kappas. Validity was assessed using two-sample z-tests for differences between standard versus secondary reporting.
Results
Prevalence estimates comparing a respondent's household with a neighboring household show closer agreement (ICC: 0.999–0.986) than self-reports vs. secondary reporting on a female counterpoint in a neighboring home (ICC: 0.939–0.98). Kappa statistics analyzing the reliability of two separate neighbors reporting on a third neighbor showed moderate agreement beyond chance alone (κ = 0.45 for physical violence and 0.48 for rape). Prevalence rates corresponded between standard and secondary reports (i.e. showed no statistical difference) in 18 out of 24 compared populations.
Conclusions
For prevalence of GBV, secondary reporting about neighbors can serve as a useful adjunct to standard survey methodology. Findings offer important initial insights into the consistency and accuracy of secondary reporting as a tool for field epidemiologists in humanitarian settings.