Quality of life for Internally Displaced Teenagers in Rania City

Abdulsahib, Sanaش Hasn; Ameen, Blend Barzan; Mahmmod, Mahmmod Aref

doi:10.33899/mjn.2019.162122

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Quality of life for Internally Displaced Teenagers in Rania City

Mosul Journal of Nursing

Article 3, Volume 7, Issue 1, 2019, Pages 21-29 PDF (790.77 K)

Document Type: Original Articles

DOI: 10.33899/mjn.2019.162122

Authors

Sanaش hasn Abdulsahib^* ; Blend barzan Ameen^* ; Mahmmod aref Mahmmod

College of Nursing, University of Raparin

Abstract

Aims of the study: To determine the quality of life domains and the level of quality of life for internally displaced teenage students in Rania city. And to find out the relationship between the quality life domains and some of their sociodemographic characteristics of the sample such as age, level of education of students, and family income.
Methodology:
Methodology: A descriptive study, using the assessment approach was conducted on Internally Displaced teenage students from the 2^nd of August 2015 to the 3rd of February 2016. To achieve the objectives of the study, non-probability sample of (165) students selected for the study. A questionnaire was adapted from the world health organization quality of life (WHOQOL-BREF), a questionnaire ⁽¹⁾, for the purpose of the study. The WHOQOL-BREF questionnaire contains two items from the overall quality of life and general Health with (24) items of satisfaction that divided into four domains: Physical health, psychological health, social relationships, and environmental health. Each item is rated on a 5-point Likert scale. Each item of the WHOQOL-BREF scored from 1 to 5 on a response scale. A pilot study was carried out on (10) students for the study questionnaire's reliability through the use of stability (test-retest method). A panel of (5) experts was involved in the determination of the questionnaire's content validity. Data were analyzed through the application of the descriptive statistical data analysis approach (frequency, percentage, mean of scores) and inferential statistical data analysis approach (Pearson correlation coefficient and chi-square).
Result: The study indicated that the majority of the students are aged between (14-16) years old, (77%) of family are nuclear. Concerning the students' educational level (39.4%), of them was in 3^rd class in secondary school. Also the study shows (42.4%), of family income are sufficient, and the majority of the samples were displaced from Al-Anbar province (87.3%). Regarding receiving help from the Iraqi government, the majority of them did not receive help from the Iraqi government. The findings of the study indicated that quality of life was affected by physical, and environmental domain. Age, level of education of students, and family income had significant relationship with quality of life domains.
Conclusion: The quality of life of female teenagers displaced persons affected by their displaced, especially (environmental domain, physical domain, and psychological domain).
Recommendation: Establishing a humanitarian program helps to raise their Qol of displaced persons in all dimensions. Organize a plan of action by the Iraqi government with Iraqi civil society organizations (internal and external organizations) to support teenagers displaced people in all domains of quality of life
Keyword: Quality of life, Teenagers, internal displacement.

Keywords

Quality of life; Nursing; Rania

Full Text

Quality of life for Internally Displaced Teenagers in Rania City

Sana'a H. Abdulsahib, PhD *

Blend B. Ameen, Msc**

Mahmmod A. Mahmmod, Msc***

* Assistant Professor, College of Nursing, University of Raparin

** Lecturer, College of Nursing, University of Raparin

*** Assistant Lecturerr, College of Nursing, University of Raparin

Abstract

Methodology:

Methodology: A descriptive study, using the assessment approach was conducted on Internally Displaced teenage students from the 2^nd of August 2015 to the 3rd of February 2016. To achieve the objectives of the study, non-probability sample of (165) students selected for the study. A questionnaire was adapted from the world health organization quality of life (WHOQOL-BREF), a questionnaire ⁽¹⁾, for the purpose of the study. The WHOQOL-BREF questionnaire contains two items from the overall quality of life and general Health with (24) items of satisfaction that divided into four domains: Physical health, psychological health, social relationships, and environmental health. Each item is rated on a 5-point Likert scale. Each item of the WHOQOL-BREF scored from 1 to 5 on a response scale. A pilot study was carried out on (10) students for the study questionnaire's reliability through the use of stability (test-retest method). A panel of (5) experts was involved in the determination of the questionnaire's content validity. Data were analyzed through the application of the descriptive statistical data analysis approach (frequency, percentage, mean of scores) and inferential statistical data analysis approach (Pearson correlation coefficient and chi-square).

Result: The study indicated that the majority of the students are aged between (14-16) years old, (77%) of family are nuclear. Concerning the students' educational level (39.4%), of them was in 3^rd class in secondary school. Also the study shows (42.4%), of family income are sufficient, and the majority of the samples were displaced from Al-Anbar province (87.3%). Regarding receiving help from the Iraqi government, the majority of them did not receive help from the Iraqi government. The findings of the study indicated that quality of life was affected by physical, and environmental domain. Age, level of education of students, and family income had significant relationship with quality of life domains.

Conclusion: The quality of life of female teenagers displaced persons affected by their displaced, especially (environmental domain, physical domain, and psychological domain).

Recommendation: Establishing a humanitarian program helps to raise their Qol of displaced persons in all dimensions. Organize a plan of action by the Iraqi government with Iraqi civil society organizations (internal and external organizations) to support teenagers displaced people in all domains of quality of life

Keyword: Quality of life, Teenagers, internal displacement.

Introduction

The displacement or forced migration of people within their own countries is today a common international phenomenon. Such migration may be caused by internal armed conflicts, situations of general violence, ethnic fights, and mass violation of human rights, violations of international humanitarian law or natural disasters. Displaced people are highly vulnerable. They suffer from discrimination, experience significant deprivation and are frequently impoverished. Marginalized within their own society and facing the emotional trauma of their uprooting experience, displaced people turn into excluded people who suffer loss of economic opportunities, breakdown of cultural identity, loosening of social and familial structures, interruption of schooling and increased poverty levels. They also suffer from grief relating to dead or missing family members and, in extreme cases, resort to delinquency and begging in order to survive ⁽²⁾.

As of the end of 2014, 38 million people around the world had been forced to flee their homes by armed conflict and generalized violence, and were living in displacement within the borders of their own country. This represents a 15 per cent increase on 2013, and includes 11 million people who were newly displaced during the year, the equivalent of 30,000 people a day. Iraq suffered most new displacement, with at least 2.2 million people fleeing from areas that fell under the Islamic State (ISIL) control ⁽³⁾. The UN Refugee Agency, the UNHCR, distinguishes between refugees and internally displaced persons as follows: “Both groups often leave their homes for similar reasons. Civilians are recognized as ‘refugees’ when they cross an international frontier to seek sanctuary in another country. The internally displaced, for whatever reason, remain in their own states ⁽⁴⁾.

Since the onset of violence in December 2013, Sulaymaniah saw the arrival of new IDPs fleeing in the aftermath of three security incidents: the January Anbar Crisis, the June Mosul Crisis and the August Sinjar offensive. Currently, the Governorate is a safe haven for almost 180,000 IDP individuals,in addition to 30,000 Syrian refugees.
Sulaymaniyah enjoys stable security, which was the main pull factor for those who displaced there. However, an increasing population has placed a strain on the local economy, services and local infrastructure, impeding the delivery of basic services and stretching the economic capacity of the KRG to its limit. Sulaymaniah was facing problems with regards to the central budget allocation that caused delays in salary payments. Notably, the poverty rate in the KRI has increased from 3.5% to 8.1% since 2013⁽⁵⁾.

According to ⁽⁶⁾, study on Postconflict internally displaced persons in Ethiopia. Over 50% of the continent’s population is below 18 years of age that needs proper attention and care. And yet, young women and children are susceptible to all forms of human-made misery. Therefore, necessary attention should be given to the most vulnerable and affected groups of the society.

Method

A descriptive study, using the assessment approach was conducted on internally displaced teenage students from 1st of August 2015 to the end of February 2016. In order to determine the quality of life domains and the level of quality of life of students in Rania city, which is located in the Sulaymaniyah governorate Kurdistan region/Iraq.

Non-probability purposive sample of (165) students’ selected for the study. A questionnaire was adapted from the world health organization quality of life (WHOQOL-BREF). Questionnaire (WHO, 1998) for the purpose of the study.

The WHOQOL-BREF questionnaire contains two items from the overall quality of life and general health and 24 items of satisfaction that divided into four domains: Physical health with 7 items (DOM1), psychological health with 6 items (DOM2), social relationships with 3 items (DOM3) and environmental health with 8 items (DOM4). Each item is rated on a 5-point Likert scale. Each item of the WHOQOL-BREF is scored from 1 to 5 on a response scale. The two items for the overall quality of life and general health calculate sparely with other four domains.

A pilot study was carried out on (10) students for the study questionnaire's reliability through the use of stability (test-retest method). A panel of (5) experts was involved in the determination of the questionnaire's content validity.

Data were analyzed through the application of the descriptive statistical data analysis approach (frequency, percentage, mean of scores) and inferential statistical data analysis approach (Pearson correlation coefficient and chi-square) and (SPSS).

Result

Descriptive Characteristics of Students and Their Parents

Table 1. Distribution of the Students and Their Parent According to their Sociodemographic Characteristics.

Age	F	%
11 – 13 yeas	10	6.1
14 – 16 years	96	58.2
17- 19 years	59	35.8
Total	165	100
Type Of Family	F	%
Nuclear	127	77
Extend	38	23
Total	165	100
Educational Status	F	%
1^st Class Secondary School	7	4.2
2^nd Class Secondary School	18	10.9
3^rd Class Secondary School	65	39.4
4^th Class Intermediate School	11	6.7
5^th Class Intermediate School	29	17.6
6^th Class Intermediate School	35	21.2
Total	165	100
Father Educational Levels	F	%
An able to read and write	2	1.2
Able to read and write	38	23
Graduated from primary school	30	18.2
Graduated from Secondary School	26	15.8
Graduated from Intermediate School	16	9.7
Graduated from Institution School	17	10.3
Graduated from college	34	20.6
Master + Phd	2	1.2
Total	165	100

= frequency, %= percentage

Mothers Educational Levels	F	%
An able to read and write	18	10.9
Able to read and write	47	28.5
Graduated from primary school	64	38.8
Graduated from Secondary School	21	12.7
Graduated from Intermediate School	5	3.0
Graduated from Institution School	4	2.4
Graduated from college	6	3.6
Total	165	100
Marital status	F	%
Single	159	96.4
Married	6	3.6
Total	165	100
Family Numbers	F	%
three	1	0.6
Four	7	4.2
Five	11	6.7
Six	24	14.5
Seven	38	23
Eight	23	13.9
Nine	19	11.5
Ten	16	9.7
Eleven	9	5.5
Twelve	6	3.6
Thirteen	1	0.6
Fourteen	1	0.6
Fifteen	5	30
Sixteen	2	12
Seventeen	1	0.6
Twenty-three	1	0.6
Total	165	100
Father Occupation Status	F	%
Employee	60	36.4
Retired	22	13.3
Worker	45	27.3
Jobless	31	18.8
Dead	7	4.2
Total	165	10.3

F= frequency, %= percentage

Mothers Occupational Status	F	%
Employee	9	5.5
House Wife	154	93.3
Dead	64	1.2
Total	165	100
Family Income	F	%
Sufficient	70	42.4
Barley Sufficient	35	21.2
Insufficient	60	36.4
Total	165	100
Origen residential area	F	%
Anbar	144	87.3
Salah Aldin	5	3.0
Ninawa	7	4.2
Baghdad	1	0.6
Babil	5	3.0
Diala	3	1.8
Total	165	100
Origen residential area	F	%
Urban	105	63.6
Suburban	57	34.5
Rural	3	1.8
Total	165	100
Housing	F	%
Owner	2	1.2
Rent	163	98.8
Total	165	100
Iraq Government Help	F	%
No Helping	75	45.5
Sufficient	12	7.3
Barley Sufficient	9	5.5
insufficient	69	41.8
Total	165	100
Internal Organization Help	F	%
No Helping	23	13.9
Sufficient	21	12.7
Barley Sufficient	90	54.5
insufficient	31	18.8
Total	165	100

F= frequency, %= percentage

External Organization Help	F	%
No Helping	20	12.1
Sufficient	15	9.1
Barley Sufficient	86	52.1
insufficient	44	26.7
Total	165	100

F= frequency, %= percentage

This table shows the distribution of (165) students and their parents, which indicate (58.2%) of the students (14-16) years, (77%) of family are nuclear, and (39.4%) of students are from 3^rd class, secondary school. Regarding father educational level the table shows (23 (%of them graduated from secondary school, mother educational level the table shows (38 (%of them graduated from primary school. Also the table shows (96.4%) of students are single, (23%) of the family consist of (7) numbers, regarding the parents’ occupational status (36%) of students the father are employers, and (93.3%) of mothers are house wife.

The study shows that the (87.3) of the family displaced from Al-Anbar province, about the current residential area (72%), of the family are living now in urban (Rania city), (98.8%) are sitting in renting a house. Regarding Iraqi government help for internal displacement, family (45.5%) of family not receiving any help. The concerning internal organization helps for them (54.5%) of family receiving help but it’s insufficient. Also family received help from external organization helps, but it’s insufficient.

Table 2. Distribution of QoL domains of students, according to the level of effect,t according to WHOQOL-BREF (0-100)

	N	Minimum	Maximum	Mean	Std. Deviation
Physical Domain	165	14.31	78.56	42.55	14.81
Psychological Domain	165	8.31	95.31	49.92	16.15
Social Domain	165	8.31	100	63.38	21.90
Environmental Domain	165	3.31	81.25	40.56	16.95

Table 3. Association between the age of students and the QoL domains

		Age	Physical	Psychological	Social	Environmental
Age	Pearson Correlation	1	.051	.038	.086	-.043
	Sig. (2-tailed)		.512	.628	.274	.582
	N	165	165	165	165	165

This table shows correlation is significant at the 0.01 level

Table 4. Association between the family income of students and the QoL domains

		Family Income	Physical	Psychological	Social	Environmental
Family Income	Pearson Correlation	1	-.187^*	-.121	-.232^**	-.360^**
	Sig. (2-tailed)		.016	.122	.003	.000
	N	165	165	165	165	165

This table shows correlation is significant at the 0.01 level

Table5. Association between the level of education of students and the QoL domains

		Educational Status	Physical	Psychological	Social	Environmental
Educational Status	Pearson Correlation	1	.059	.164^*	.051	.049
	Sig. (2-tailed)		.451	.036	.514	.529
	N	165	165	165	165	165

This table shows correlation is significant at the 0.01 level

Table6. How would you rate your quality of life?

Scale	Frequency	Percent
Very poor	16	9.7
Poor	25	15.2
Neither poor nor good	84	50.9
Good	35	21.2
Very good	5	3.0
Total	165	100

Table7. How satisfied are you with your health?

Scale	Frequency	Percent
Very poor	7	4.2
Poor	46	27.9
Neither poor nor good	27	16.4
Good	61	37.0
Very good	24	14.5
Total	165	100

F= frequency, %= percentage

Discussion

Throughout the course of data analysis, the present findings indicate that the majority of students (58.2%), their ages between (14-16) years. Regarding the students’ educational status (39.4%), of the study sample is studying at secondary school in 3^rd class. These back to that the family concern mostly for their girls to complete secondary school to gain certification and to insure that they able to read and write. Regarding the type of family the findings revealed that the highest percentages of family are nuclear (77%), Iraq people mostly are Muslims and the family is the center of life for most Iraq; it represents honor, and reputation, the family tends to have private home to gain independence and can move freely around the home. Concerning the level of education of father, the study shows that the highest percentages are able to read and write (23%). And the levels of education of mothers, the highest percentages are graduated from primary school accounts (38.8%). Regarding the marital status, the findings of the present study have shown that the majority of subjects are single and represent (96.4%), the result is expected because the samples are teenage students and most of them are single. Concerning occupational status of parents the study shows that majority of father (36.4%), are employers, and (27.3%), of them are workers in which majority of mothers are house wife (93.3%). Regarding the family income the study shows that (42.0%) of study samples have sufficient income, (36.4%) insufficient income, and (21.2%) of study samples have barely sufficient income, fortunately the study shows that the majority of families have sufficient income, maybe this back to many of immigration peoples mixed with the Kurdish peoples and they began to work, and also maybe to the helps that they gained from Iraq and other internal and external organization helps. Concerning Origen residential areas the highest percentages of the study sample are from the Al Anbar Governorate and represent (87.3%). Regarding current residential areas the highest percentages of the study sample are sitting in urban (Rania city). And the highest percentage of them (98.8%), are sitting in rent houses, IOM reports on May 2015, almost 90 percent of IDPs in Sulaymaniyah renting apartments⁽⁵⁾. Concerning taking help from the Iraqi government (45.5%), of the family not receiving any help, unfortunately the study shows that the majority of the family is not receiving help from Iraqi government or Iraqi government helps are insufficient. This may be back to firstly to the Iraq situation, war with Isis, it’s the priority of the Iraq government and the low economic situation of the country. And also maybe Iraqi helps not arrived to all family. Regarding taking help from the internal organization (54.5%), of the family received help, but it’s barely sufficient, Also (86%), of the family took help from external organization but it’s barley sufficient for their life.

The results of (table 2), shows that the IDPs teenager quality of life effected higher percentage in the environmental domain, physical domain, and psychological domains. But the teenager satisfies about their social relationship. This maybe back to that the higher percentage of IDPs teenager from Al Anbar provenance, and mostly of them relatives and they houses near each other’s. Also This study nearly contrast with study done in French about association between health-related quality of life and being an immigrant among adolescents, and the role of socioeconomic and health-related difficulties, which shows poor health-related QOL (in its four domains: physical health, psychological health, social relationships, and living environment) among European and non-European immigrants in early adolescence, and the concurrent roles of a wide range of socioeconomic difficulties, unhealthy behaviors, and violence sustained. European immigrants, and especially non-European immigrants, were more subject to poor physical health, psychological health, social relationships, and living environment⁽⁷⁾.

(Table 3), shows that there is a significant association between quality of life domains and the students' age groups. (Table 4), shows a significant association has been found between quality of life and the students’ family income. The finding of the (table 5), shows that there is a significant association has been found between quality of life and level of education of students’. The World Health Organization (WHO) defines quality of life as ‘individuals’ perceptions of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns. It is a broad concept incorporating an individual’s overall sense of well-being, physical health, psychological health, personal beliefs, social relationships, and their relationship to the salient features of their environment ⁽⁸⁾. Quality of life asks individuals how concerned or satisfied they are with their lives. It is more subjective rather than objective, since the individual evaluates his/her own quality of life ⁽⁹⁾. The quality of life affected by, lack of fulfillment of basic needs, the problem of health and sanitation, the problem of education, shortage of employment, low income, poverty, conflict within the family members, and high maternal and infant mortality rate. Immigration peoples, especially teenage deprivation from many of these basic needs.

The finding of the (table 6),shows the highest percentage of teenage rate their quality of life as neither poor nor good. The finding of the (table7),shows the highest percentage of teenager were satisfied with their health.

Conclusions

There is a variable effect on the quality of life dimensions between female teenagers displaced persons: there was a mild negative effect in the psychological domain, a moderate negative effect in the physical domain, and severe negative effect in the environmental domain

Recommendations

Due to the back of services and also government support, it is necessary to arrange an especial plan to help them to save there Qol in good level, establishing a humanitarian program to arise their Qol in all dimensions. In addition to carefully dealing with their situation to able to save them from negative effectiveness on their life. Finally, organize a plan of action by the Iraqi government with Iraqi civil society organizations (internal and external organizations) to support teenagers displaced people in all domains of quality of life

References:

Development of the World Health Organization WHOQOL- BREF quality of life assessment. The WHOQOL Group. Psychol Med 1998, 28(3):551-558.

(IFSW) International Federation of Social Workers, Displaced persons: Introduction,. (2016). Available on:http://ifsw.org/policies/displaced-persons/
(IDMC) Internal Displacement Monitoring Centre, Global Overview., (2015). Available on: www.internal-displacement.org
(UNHCR)United Nations High Commissioner for Refugees., (2007). Internally displaced persons: questions and answers. from http://www.unhcr.org/cgi-bin/texis/vtx/protect/opendoc.htm
(IOM) International Organization for Migration, Sulaymaniyah governorate profile., (2015). Available on: http://iomiraq.net/reports/sulaymaniyah-governorate-profile-may-2015.
Mesfin Araya., (2007). Postconflict internally displaced persons in Ethiopia: Mental distress and quality of life in relation to traumatic life events, coping strategy, social support, and living conditions. Available on: http://umu.diva-portal.org/smash/get/diva2:141049/FULLTEXT01.pdf
Michèle Baumann, Kénora Chau, Bernard Kabuth, and Nearkasen Chau P., (2014). Association Between Health-Related Quality of Life and Being an Immigrant Among Adolescents, and the Role of Socioeconomic and Health-Related Difficulties. 2014. ByInt. J. Environ. Res. Public Health 2014, 11, 1694-1714;
(WHO) World Health Organization., (2016). WHOQOL: Measuring Quality of Life: Introducing the WHOQOL instrument. Available on: http://www.who.int/healthinfo/survey/whoqol-qualityoflife/en/

(CDC) Centers for Disease Control and Prevention., (2000). Measuring healthy days: Population Assessment of Health-Related Quality of Life . Atlanta, GA: CDC. Page 5. Available on: http://www.cdc.gov/hrqol/pdfs/mhd.pdf

References

(IDMC) Internal Displacement Monitoring Centre, Global Overview., (2015). Available on: www.internal-displacement.org

(IFSW) International Federation of Social Workers, Displaced persons: Introduction,. (2016). Available on:http://ifsw.org/policies/displaced-persons/

(IOM) International Organization for Migration, Sulaymaniyah governorate profile., (2015). Available on: http://iomiraq.net/reports/sulaymaniyah-governorate-profile-may-2015.

(UNHCR)United Nations High Commissioner for Refugees., (2007). Internally displaced persons: questions and answers. from http://www.unhcr.org/cgi-bin/texis/vtx/protect/opendoc.htm

(WHO) World Health Organization., (2016). WHOQOL: Measuring Quality of Life: Introducing the WHOQOL instrument. Available on: http://www.who.int/healthinfo/survey/whoqol-qualityoflife/en/

Development of the World Health Organization WHOQOL- BREF quality of life assessment. The WHOQOL Group. Psychol Med 1998, 28(3):551-558.

Mesfin Araya., (2007). Postconflict internally displaced persons in Ethiopia: Mental distress and quality of life in relation to traumatic life events, coping strategy, social support, and living conditions. Available on: http://umu.diva-portal.org/smash/get/diva2:141049/FULLTEXT01.pdf

Michèle Baumann, Kénora Chau, Bernard Kabuth, and Nearkasen Chau P., (2014). Association Between Health-Related Quality of Life and Being an Immigrant Among Adolescents, and the Role of Socioeconomic and Health-Related Difficulties. 2014. ByInt. J. Environ. Res. Public Health 2014, 11, 1694-1714;

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