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The integration of culturally salient idioms of distress into mental healthcare delivery is essential for effective screening, diagnosis, and treatment. This study systematically explored idioms, explanatory models, and conceptualizations in Maryland County, Liberia to develop a culturally-resonant screening tool for mental distress. We employed a sequential mixed-methods process of: (1) free-lists and semi-structured interviews (n = 20); patient chart reviews (n = 315); (2) pile-sort exercises, (n = 31); and (3) confirmatory focus group discussions (FGDs); (n = 3) from June to December 2017. Free-lists identified 64 idioms of distress, 36 of which were eliminated because they were poorly understood, stigmatizing, irrelevant, or redundant. The remaining 28 terms were used in pile-sort exercises to visualize the interrelatedness of idioms. Confirmatory FDGs occurred before and after the pile-sort exercise to explain findings. Four categories of idioms resulted, the most substantial of which included terms related to the heart and to the brain/mind. The final screening tool took into account 11 idioms and 6 physical symptoms extracted from patient chart reviews. This study provides the framework for culturally resonant mental healthcare by cataloguing language around mental distress and designing an emic screening tool for validation in a clinical setting.

Between 1989 and 2003, Liberia experienced a brutal civil war characterized by ethnic killings, sexual violence and the use of child soldiers. Five years after the war ended, half the population of Liberia was under 18 years old. Understanding the needs of these youth is thus essential to the recovery of the nation. This study focuses on the narratives of two female adolescents, selected from 75 in-depth individual interviews with post-conflict Liberian youth conducted in 2012. A narrative analysis approach was employed to examine each interview for multiple layers of meaning. The aim of the study was to elucidate factors that may enable post-conflict youth to reclaim a sense of agency and return to normal developmental tasks. The study explores the ways in which these youth navigate complicated power dynamics in the post-conflict setting and how gender impacts their experiences of their own agency and capability. The dynamics between the participants and the interviewer are explored to further illustrate how power dynamics manifest. These narratives support the involvement of youth in projects that help others as an avenue for promoting agency and resilience for themselves.

We report two cases of malaria diagnosed in Rhode Island. First, a 21-year-old female who presented with 5 days of fevers, chills, headache, and myalgias after returning from a trip to Liberia, found to have uncomplicated malaria due to P. ovale which was treated successfully with atovaquone/proguanil and primaquine. Second, a chronically ill 55-year-old male presented with 3 days of headache followed by altered mental status, fever, and new-onset seizures after a recent visit to Sierra Leone, found to have P. falciparum malaria requiring ICU admission and IV artesunate treatment. The diagnosis and management of malaria in the United States (US), as well as its rare association with subdural hemorrhage are subsequently reviewed.

Epidemiological studies focusing on Latino immigrant health have found links between acculturation (time and language competency), weight gain, and disease risk. Since time and language competency are not mechanisms by which diets and activities change, associations between acculturation and weight change offer little to public health professionals who aim to develop nutrition and health interventions. We present a conceptual model and use a mixed-methods biocultural approach to address the fine-grained details of diet and activity choice for new arrivals to the USA. The results of our anthropological work with Liberian and Somali Bantu refugees indicate that, in addition to standard surveys (individual-level characteristics, socioeconomic status, employment, and acculturation), epidemiological research would benefit from the data generated from ethnography and more nuanced behavioral studies. A focus on the lived experiences of new Americans and the explicit examination of institutional support, peer support, and interactions between children and caretakers might offer points of intervention for immigrant health which is a growing public health concern.

The purpose of this study was to understand the secondary migration and relocation of African refugees resettled in the United States. Secondary migration refers to moves out of state, while relocation refers to moves within state. Of 73 recently resettled refugee families from Burundi and Liberia followed for 1 year through ethnographic interviews and observations, 13 instances of secondary migration and 9 instances of relocation were identified. A family ecodevelopmental framework was applied to address: Who moved again, why, and with what consequences? How did moving again impact family risk and protective factors? How might policies, researchers, and practitioners better manage refugees moving again? Findings indicated that families undertook secondary migration principally for employment, affordable housing, family reunification, and to feel more at home. Families relocated primarily for affordable housing. Parents reported that secondary migration and relocation enhanced family stability. Youth reported disruption to both schooling and attachments with peers and community. In conclusion, secondary migration and relocation were family efforts to enhance family and community protective resources and to mitigate shortcomings in resettlement conditions. Policymakers could provide newly resettled refugees jobs, better housing and family reunification. Practitioners could devise ways to better engage and support those families who consider moving. RESUMEN El propósito de este estudio era comprender la emigración secundaria y la reubicación de los refugiados africanos reasentados en los Estados Unidos. La emigración secundaria se refiere a mudanzas a otro estado mientras que la reubicación se refiere a mudanzas dentro del mismo estado. De 73 familias de refugiados de Burundi y Liberia recientemente reasentadas que se controlaron durante un año a través de entrevistas etnográficas y observaciones, se identificaron 13 casos de emigración secundaria y nueve casos de reubicación. Se aplicó un marco de ecodesarrollo familiar para responder: ¿Quiénes se mudaron nuevamente, por qué y con qué consecuencias? ¿Qué efecto tuvo el volver a mudarse sobre el riesgo familiar y los factores protectores? ¿Cómo podrían las políticas, los investigadores y los profesionales controlar mejor a los refugiados que vuelven a mudarse? Los resultados indicaron que las familias emprendieron una emigración secundaria principalmente por cuestiones de empleo, viviendas más asequibles, reagrupación familiar y para sentirse más como en casa. Las familias se reubicaron principalmente en busca de una vivienda asequible. Los padres informaron que la emigración secundaria y la reubicación mejoraron la estabilidad familiar. Los jóvenes demostraron alteraciones tanto en la escuela como en las relaciones con los pares y la comunidad. En conclusión, la emigración secundaria y la reubicación fueron esfuerzos familiares para mejorar los recursos protectores de la familia y la comunidad y para atenuar las desventajas de las condiciones de reasentamiento. Los legisladores podrían proporcionarles trabajos, mejores viviendas y reagrupación familiar a los refugiados recién reasentados. Los profesionales podrían idear maneras de atraer y apoyar más a aquellas familias que están pensando en mudarse. Palabras clave: refugiado, familia, mudarse

To report a case of a US resident, originally from Liberia, with chronic hepatitis C infection who developed acute neurologic symptoms of the lower limbs. Our case is compared to previously reported similar cases, with emphasis on clinical symptoms, investigations, diagnosis, and prognosis. The patient was transferred to the University of Iowa Hospital and Clinics for further management of severe retroperitoneal bleeding and died 2 days after admission. The diagnosis of schistosomiasis was established on examination of the spinal cord at autopsy, where multiple Schistosoma mansoni eggs were seen in the vasculature of the spinal cord. The diagnosis of schistosomiasis may go undiagnosed in countries where the disease is not endemic but should be considered when investigating spinal cord disease in patients native to an endemic area or international travelers.

We report a case of symptomatic visceral Armillifer pentastomiasis in a 23-year-old female Liberian immigrant to The Netherlands. The patient was referred to the gynecologist because of lower abdominal pain. During laparotomy, multiple adhesions were seen in the lower pelvis and a hydrosalpinx with an encapsulated Armillifer nymph, most likely Armillifer armillatus, was found. Key features of the parasite's cuticle which facilitate the diagnosis of pentastomiasis, are presented. Symptomatic pentastomiasis is uncommon, and most cases are diagnosed incidentally during surgery for other reasons, or at autopsy. With regard to increasing international migration, other imported pentastomiasis cases to Europe and North America are reviewed, and more cases are likely to be seen in the future.

Objectives of this study: (1) Examine food insecurity (FI) prevalence and its relationship with sociodemographic and pre-resettlement characteristics; (2) Investigate differences in amount of money spent on food/month by food security status and socio-demographic characteristics. A pilot study with semi-structured in-home interviews was conducted with Liberian caregivers (n = 33). FI was indicated in 61 % of households. FI was higher among women >40, had ≤ high school education and those making ≤$1,000/month. Women arriving in US >15 years of age were more likely to be food insecure. Participants spent an average $109/month on groceries/member. Food insecure women, and those without a car spent more money on food (P < .10). Liberian women in this sample experience high levels of FI upon resettlement. Besides poor economic conditions, pre-resettlement characteristics were associated with food security status. These findings call for future research to understand how preresettlement conditions affect food choices, budgeting and thereby food security status.