{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T23:24:02Z","timestamp":1773098642634,"version":"3.50.1"},"reference-count":22,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T00:00:00Z","timestamp":1759190400000},"content-version":"unspecified","delay-in-days":29,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100015709","name":"United Nations High Commissioner for Refugees","doi-asserted-by":"crossref","award":["Not applicable"],"award-info":[{"award-number":["Not applicable"]}],"id":[{"id":"10.13039\/501100015709","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,9,11]]},"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>Documenting evidence on global health strategies and programmes that provide safeguards for vulnerable populations and strengthen overall pandemic preparedness is essential. This study aimed to identify factors associated with adherence to COVID-19 mitigation measures, COVID-19-related symptoms and testing, as well as pandemic-related income loss among internally displaced persons (IDPs) in urban and remote areas of Burkina Faso, Niger and Mali.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>This cross-sectional study used fixed-site respondent-driven sampling (RDS).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>Primary care settings across six urban and remote locations in Burkina Faso, Mali and Niger.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Participants<\/jats:title>\n                  <jats:p>4144 internally displaced adults, who had been forced from their homes within 5 years of the survey, participated in the study. The survey was conducted between August and October 2021 in two selected locations in three countries: Kaya (n=700) and Ouahigouya (n=715) in Burkina Faso; Bamako (n=707) and M\u00e9naka (n=700) in Mali; and Niamey (n=733), and Diffa (n=589) in Niger. Participants were included if they were born in the study countries, displaced due to conflict, violence or disaster, aged 18 years or older, and living or working in the study site for at least 1\u2009month.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Primary and secondary outcome measures<\/jats:title>\n                  <jats:p>The primary outcomes measured were adherence to COVID-19 mitigation measures, presence of COVID-19 symptoms, COVID-19 testing and vaccination rates and pandemic-related income loss.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among 4144 IDPs surveyed across 6 sites in Burkina Faso, Mali and Niger, over half (52%) reported experiencing at least one COVID-19 symptom in the preceding 2\u2009weeks. However, 8% had ever been tested for COVID-19, and fewer than 5% had received a vaccine in all sites except Diffa, where 54% reported vaccination. While willingness to be vaccinated was high (ranging from 56.6% in Bamako to 89.5% in Niamey), access remained limited. Compliance with public health measures varied; for example, 41.7% of IDPs were able to maintain physical distance from non-household members, and just 60.2% reported wearing a mask. Chronic health conditions were consistently associated with higher odds of COVID-19 symptoms (M\u00e9naka OR: 14.65; 95%\u2009CI: 7.36 to 29.17). Economic vulnerability was widespread, with more than half of IDPs in Bamako (58.1%) and Niamey (66.4%) reporting income loss due to the pandemic, and average monthly income declining by over 50% in most sites. IDPs in urban areas generally reported greater exposure to COVID-19 risk factors, while those in remote settings reported lower adherence and poorer access to basic preventive measures.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>This is the first known RDS study to explore the impact of the COVID-19 pandemic on IDPs. Findings suggest that IDPs in urban areas may face heightened risks of exposure and infection, underscoring the need to prioritise them in public health efforts. Low testing and vaccination rates and significant income loss call for advocacy and economic relief to address these vulnerabilities. Future pandemic responses should integrate health interventions with targeted support, especially mitigating income loss to bolster IDPs\u2019 resilience.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-096795","type":"journal-article","created":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T08:00:31Z","timestamp":1759305631000},"page":"e096795","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Assessing the impact of the COVID-19 pandemic among internally displaced persons in Burkina Faso, Mali and Niger: a cross-sectional study using respondent-driven sampling"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5696-2933","authenticated-orcid":false,"given":"Phuong N","family":"Pham","sequence":"first","affiliation":[{"name":"Harvard Medical School, Boston, Massachusetts, USA"},{"name":"Harvard TH Chan School of Public Health, Boston, Massachusetts, USA"},{"name":"Department of Emergency Medicine, Brigham and Women\u2019s Hospital, Boston, Massachusetts, USA"},{"name":"Harvard Humanitarian Initiative, Cambridge, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katrina","family":"Keegan","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Brigham and Women\u2019s Hospital, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa Grazina","family":"Johnston","sequence":"additional","affiliation":[{"name":"LGJ Consultants Inc, Valencia, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dramane Yacouba","family":"Diallo","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Brigham and Women\u2019s Hospital, Boston, Massachusetts, USA"},{"name":"\u00c9cole Nationale d\u2019Administration Publique, Bamako, Mali"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"O\u2019Mealia","sequence":"additional","affiliation":[{"name":"Harvard TH Chan School of Public Health, Boston, Massachusetts, USA"},{"name":"Harvard Humanitarian Initiative, Cambridge, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0491-5385","authenticated-orcid":false,"given":"Maple","family":"Goh","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Brigham and Women\u2019s Hospital, Boston, Massachusetts, USA"},{"name":"Harvard Humanitarian Initiative, Cambridge, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick","family":"Vinck","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston, Massachusetts, USA"},{"name":"Harvard TH Chan School of Public Health, Boston, Massachusetts, USA"},{"name":"Department of Emergency Medicine, Brigham and Women\u2019s Hospital, Boston, Massachusetts, USA"},{"name":"Harvard Humanitarian Initiative, Cambridge, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,9,30]]},"reference":[{"key":"2025100101001041000_15.9.e096795.1","unstructured":"ReliefWeb . Global peace index 2021 - world. Available: https:\/\/reliefweb.int\/report\/world\/global-peace-index-2021 [Accessed 1 Feb 2022]."},{"key":"2025100101001041000_15.9.e096795.2","doi-asserted-by":"crossref","DOI":"10.1186\/s13031-020-00307-8","article-title":"Addressing COVID-19 in humanitarian settings: a call to action","volume":"14","author":"Alawa","year":"2020","journal-title":"Confl Health"},{"key":"2025100101001041000_15.9.e096795.3","doi-asserted-by":"publisher","DOI":"10.9745\/GHSP-D-20-00272"},{"key":"2025100101001041000_15.9.e096795.4","doi-asserted-by":"crossref","DOI":"10.1186\/s13031-021-00425-x","article-title":"Challenges to the implementation and adoption of physical distancing measures against COVID-19 by internally displaced people in Mali: a qualitative study","volume":"15","author":"Ag Ahmed","year":"2021","journal-title":"Confl Health"},{"key":"2025100101001041000_15.9.e096795.5","doi-asserted-by":"crossref","DOI":"10.1186\/s13031-021-00382-5","article-title":"Lockdowns, lives and livelihoods: the impact of COVID-19 and public health responses to conflict affected populations - a remote qualitative study in Baidoa and Mogadishu, Somalia","volume":"15","author":"Braam","year":"2021","journal-title":"Confl Health"},{"key":"2025100101001041000_15.9.e096795.6","doi-asserted-by":"crossref","DOI":"10.1016\/j.jmh.2021.100056","article-title":"SARS-CoV-2 among migrants and forcibly displaced populations: A rapid systematic review","volume":"4","author":"Hintermeier","year":"2021","journal-title":"J Migr Health"},{"key":"2025100101001041000_15.9.e096795.7","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1007\/s11625-020-00848-0","article-title":"Ignored and invisible: internally displaced persons (IDPs) in the face of COVID-19 pandemic","volume":"16","author":"Orendain","year":"2021","journal-title":"Sustain Sci"},{"key":"2025100101001041000_15.9.e096795.8","doi-asserted-by":"crossref","first-page":"100393","DOI":"10.1016\/j.wdp.2022.100393","article-title":"The impact of COVID-19 on the living and survival conditions of internally displaced persons in Burkina Faso","volume":"25","author":"Ozer","year":"2022","journal-title":"World Dev Perspect"},{"key":"2025100101001041000_15.9.e096795.9","doi-asserted-by":"crossref","unstructured":"Rohwerder B . The Socioeconomic Impacts of the Covid-19 Pandemic on Forcibly Displaced Persons. 2021.","DOI":"10.19088\/CC.2021.006"},{"key":"2025100101001041000_15.9.e096795.10","unstructured":"NRC . Downward spiral: the economic impact of covid-19 on refugees and displaced people. Available: https:\/\/www.nrc.no\/resources\/reports\/downward-spiral-the-economic-impact-of-covid-19-on-refugees-and-displaced-people\/ [Accessed 2 Feb 2022]."},{"key":"2025100101001041000_15.9.e096795.11","unstructured":"ACAPS . Burkina faso, mali and niger vulnerability to covid-19 containment measures. 2020. Available: https:\/\/www.acaps.org\/sites\/acaps\/files\/products\/files\/20200429_acaps_vulnerabilities_to_covid-19_containment_measures_in_burkina_faso_mali_and_niger.pdf"},{"key":"2025100101001041000_15.9.e096795.12","unstructured":"ACAPS . Humanitarian Access Overview. 2021. Available: https:\/\/www.acaps.org\/special-report\/humanitarian-access-overview-6"},{"key":"2025100101001041000_15.9.e096795.13","doi-asserted-by":"publisher","DOI":"10.1111\/j.1467-9531.2007.00188.x"},{"key":"2025100101001041000_15.9.e096795.14","doi-asserted-by":"publisher","DOI":"10.2307\/3096941"},{"key":"2025100101001041000_15.9.e096795.15","unstructured":"Johnston L . Introduction to Respondent Driven Sampling. Introduction to HIV\/AIDS and Sexually Transmitted Infection Surveillance. Geneva Switzerland: World Health Organization, 2013. Available: http:\/\/applications.emro.who.int\/dsaf\/EMRPUB_2014_EN_1686.pdf"},{"key":"2025100101001041000_15.9.e096795.16","unstructured":"Kobo toolbox. 2012. Available: http:\/\/www.kobotoolbox.org"},{"key":"2025100101001041000_15.9.e096795.17","doi-asserted-by":"publisher","DOI":"10.1111\/j.1467-9531.2010.01223.x"},{"key":"2025100101001041000_15.9.e096795.18","unstructured":"RDS analyst. Available: www.hpmrg.org [Accessed 28 Jan 2022]."},{"key":"2025100101001041000_15.9.e096795.19","unstructured":"UNHCR . Vulnerability screening tool - identifying and addressing vulnerability: a tool for asylum and migration systems. 2016. Available: https:\/\/www.unhcr.org\/protection\/detention\/57fe30b14\/unhcr-idc-vulnerability-screening-tool-identifying-addressing-vulnerability.html [Accessed 3 Feb 2022]."},{"key":"2025100101001041000_15.9.e096795.20","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2021-054820","article-title":"Assessing the impact of the COVID-19 pandemic among Venezuelan refugees and migrants in Colombia using respondent-driven sampling (RDS)","volume":"12","author":"Pham","year":"2022","journal-title":"BMJ Open"},{"key":"2025100101001041000_15.9.e096795.21","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(20)30120-1"},{"key":"2025100101001041000_15.9.e096795.22","doi-asserted-by":"crossref","unstructured":"Tyldum G , Johnston LG . Applying Respondent Driven Sampling to Migrant Populations: Lessons from the Field. London: Palgrave Pivot, 2014.","DOI":"10.1057\/9781137363619"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2024-096795","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T08:00:41Z","timestamp":1759305641000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2024-096795"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9]]},"references-count":22,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,9,30]]},"published-print":{"date-parts":[[2025,9]]}},"alternative-id":["10.1136\/bmjopen-2024-096795"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2024-096795","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9]]}}}