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Murali-Larson J. CORR Insights®: What Proportion of East African Refugees Report Musculoskeletal Problems? A Cross-sectional Survey. Clin Orthop Relat Res 2024; 482:57-58. [PMID: 37668466 PMCID: PMC10723883 DOI: 10.1097/corr.0000000000002824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 07/24/2023] [Indexed: 09/06/2023]
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Rapaport S, Ngude H, Ficke JR, Yenokyan G, Rafiq MY, Juma O, Sakran JV, Stevens KA, Enumah ZO. What Proportion of East African Refugees Report Musculoskeletal Problems? A Cross-sectional Survey. Clin Orthop Relat Res 2024; 482:47-56. [PMID: 37470791 PMCID: PMC10723852 DOI: 10.1097/corr.0000000000002729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/14/2023] [Accepted: 05/10/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Musculoskeletal conditions are the leading cause of disability worldwide and disproportionally affect individuals in low-income and middle-income countries. There is a dearth of evidence on musculoskeletal problems among refugees, 74% of whom reside in low-income and middle-income countries. QUESTIONS/PURPOSES (1) What proportion of refugees in Nyarugusu Camp, Kigoma, western Tanzania, are affected by musculoskeletal problems and what are the characteristics of those individuals? (2) What are the characteristics of these musculoskeletal problems, including their causes, location, and duration? (3) What forms of healthcare do those with musculoskeletal problems seek, including those for both musculoskeletal and nonmusculoskeletal problems? METHODS We conducted a cross-sectional study among refugees in Nyarugusu Camp, using the Surgeons OverSeas Assessment of Surgical Need tool. The Surgeons OverSeas Assessment of Surgical Need tool is a validated population-based survey tool developed for use in limited-resource settings that is intended to determine the prevalence of surgical disease in a community. It uses a cluster random sampling methodology with house-to-house data collection in the form of a verbal head-to-toe examination that is performed by a trained community healthcare worker. A total of 99% responded, and 3574 records were analyzed. The mean age of respondents was 23 ± 18 years, with under 18 as the most-represented age group (44% [1563]). A total of 57% (2026) of respondents were women, 79% (2802 of 3536) were generally healthy, and 92% (3297 of 3570) had visited a camp medical facility. Only records endorsing musculoskeletal problems (extremity or back) were included in this analysis. Using all refugees surveyed as our denominator and refugees who endorsed a musculoskeletal problem (extremity or back) as the numerator, we calculated the proportion of refugees who endorsed a musculoskeletal problem. We then analyzed the characteristics of those endorsing musculoskeletal problems, including their healthcare-seeking behavior, and the characteristics of the musculoskeletal problems themselves. RESULTS Among 3574 refugees interviewed, 22% (769) reported musculoskeletal problems, with 17% (609) reporting extremity problems and 7% (266) reporting back problems. Among all people surveyed, 8% (290) reported current extremity problems while 5% (188) reported current back problems. Among those reporting musculoskeletal problems, respondents younger than 18 years were the most-represented age group for extremity problems (28% [169 of 609]) whereas respondents between 30 and 44 years of age were the most-represented age group for back problems (29% [76 of 266]). Wounds from an injury or trauma (24% [133 of 557]) and acquired disability (24% [133 of 557]) were the most-common causes of extremity problems, whereas acquired disability (53% [97 of 184]) followed by a wound not from injury or trauma (25% [45 of 184]) were the most common causes of back problems. Fifty percent (303) of those with extremity problems characterized it as disabling, whereas 76% (203) of those with back problems did. CONCLUSION Over one of five refugees endorsed musculoskeletal problems, which are most often caused by acquired disease and injury. These musculoskeletal problems are often characterized as disabling, yet only slightly more than half have sought treatment for problems. This warrants further research on care-seeking behavior in this setting, and emphasizes that investing in the spectrum of musculoskeletal health systems, including medical management and rehabilitation services, is critical to decreasing disability caused by musculoskeletal problems. LEVEL OF EVIDENCE Level IV, prognostic study.
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Affiliation(s)
- Sarah Rapaport
- Global Surgery Initiative, Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Hilary Ngude
- Tanzania Red Cross Society, Dar es Salaam, Tanzania
| | - James R. Ficke
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Gayane Yenokyan
- Johns Hopkins Biostatistics Center, Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | | | - Omar Juma
- Ifakara Health Institute, Ifakara, Tanzania
| | - Joseph V. Sakran
- Global Surgery Initiative, Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Kent A. Stevens
- Global Surgery Initiative, Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Zachary Obinna Enumah
- Global Surgery Initiative, Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
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Enumah ZO, Rafiq MY, Juma O, Manyama F, Ngude H, Stevens K, Sakran J. Access to Health Services Among Forced Migrants in Tanzania: A Cluster Randomized Cross Sectional Study of 3560 Congolese and Burundian Refugees. J Immigr Minor Health 2023; 25:115-122. [PMID: 36040581 DOI: 10.1007/s10903-022-01387-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2022] [Indexed: 01/07/2023]
Abstract
Despite significant advances in the understanding of the global burden of surgical disease, limited research focuses on access to health and surgical services among refugees, especially in east Africa. The goal of this study was to describe patterns of access to transportation to health services among Congolese and Burundian refugees in Tanzania. We utilized cluster random sampling to perform a large, cross-sectional study in Nyarugusu refugee camp, Tanzania using an adapted version of the Surgeon Overseas Assessment Tool (SOSAS). We randomly selected 132 clusters out of 1472 clusters, randomly selected two people from all households in those clusters. Data analysis was performed in STATA (Stata Version 16, College Station, TX). A total of 3560 participants were included in the study including 1863 Congolese refugees and 1697 Burundian refugees. The majority of refugees reported they were generally healthy (n = 2792, 79.3%). The most common period of waiting to be seen at the health center was between three and 5 h (n = 1502, 45.8%), and over half of all refugees waited between 3 and 12 h to be seen. There was heterogeneity in other intra-camp referral networks (e.g. to and from traditional healer and hospital). Finally, a low percentage (3%) of participants reported leaving the refugee camp to seek health care elsewhere, and Congolese refugees were more likely to pursue self-referral in this manner. To our knowledge, this is the largest study focused on access to transportation among refugees in Tanzania and sub-Saharan Africa. Most participants reported financial difficulty always affording transportation costs with significant wait times occurring once arrived at the hospital. Our study does suggest that some independent health care seeking did occur outside of the camp-based services. Future research may focus more specifically on barriers to timely servicing of patients and patterns of self-referral.Please confirm if the author names are presented accurately and in the correct sequence (given name, middle name/initial, family name). Author 1 Given name: [Zachary Obinna] Last Name [Enumah] and Author 2 Given name: [Mohamed Yunus] Last Name [Rafiq]. Also, kindly confirm the details in the metadata are correct.Confirmed.
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Affiliation(s)
- Zachary Obinna Enumah
- Department of Surgery, Johns Hopkins Global Surgery Initiative (JHGSI), Johns Hopkins Hospital, Tower 110 Doctor's Lounge 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
| | | | - Omar Juma
- Ifakara Health Institute, Bagamoyo, Tanzania
| | - Frank Manyama
- Department of Surgery, Johns Hopkins Global Surgery Initiative (JHGSI), Johns Hopkins Hospital, Tower 110 Doctor's Lounge 600 N. Wolfe Street, Baltimore, MD, 21287, USA
| | - Hilary Ngude
- Tanzania Red Cross Society, Dar es Salaam, Tanzania
| | - Kent Stevens
- Department of Surgery, Johns Hopkins Global Surgery Initiative (JHGSI), Johns Hopkins Hospital, Tower 110 Doctor's Lounge 600 N. Wolfe Street, Baltimore, MD, 21287, USA
| | - Joseph Sakran
- Department of Surgery, Johns Hopkins Global Surgery Initiative (JHGSI), Johns Hopkins Hospital, Tower 110 Doctor's Lounge 600 N. Wolfe Street, Baltimore, MD, 21287, USA
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Enumah ZO, Rafiq MY, Manyama F, Ngude H, Juma O, Sakran JV, Stevens K. Reasons for referral and referral compliance among Congolese and Burundian refugees living in Tanzania: a community-based, cross-sectional survey. BMJ Open 2022; 12:e058778. [PMID: 36192098 PMCID: PMC9535181 DOI: 10.1136/bmjopen-2021-058778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES In order to prevent overburdening of higher levels of care, national healthcare systems rely on processes of referral, including for refugee populations which number 26 million globally. The goal of this study is to use data from a population-based household survey to describe patterns of referral services among a population of Congolese and Burundian refugees living in Tanzania. DESIGN Cross-sectional survey using cluster randomised sampling. SETTING Nyarugusu refugee camp, Kigoma, Tanzania. PARTICIPANTS 153 refugees. PRIMARY OUTCOME Referral compliance. SECONDARY OUTCOMES Proportion of referrals that were surgical; proportion of referrals requiring diagnostic imaging. RESULTS Out of 153 individuals who had been told they needed a referral, 96 (62.7%) had gone to the referral hospital. Of the 57 who had not gone, 36 (63%) reported they were still waiting to go and had waited over a month. Of the participants who had been referred (n=96), almost half of the participants reported they were referred for a surgical problem (n=43, 45%) and the majority received radiological testing at an outside hospital (n=72, 75%). Congolese refugees more frequently had physically completed their referral compared with Burundians (Congolese: n=68, 76.4% vs Burundian: n=28, 43.8%, p<0.001). In terms of intracamp referral networks, most refugees reported being referred to the hospital or clinic by a community health worker (n=133, 86.9%). CONCLUSION To our knowledge, this is the first community-based study on patterns of referral healthcare among refugees in Tanzania and sub-Saharan Africa. Our findings suggest patients were referred for surgical problems and for imaging, however not all referrals were completed in a timely fashion. Future research should attempt to build prospective referral registries that allow for better tracking of patients and examination of waiting times.
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Affiliation(s)
- Zachary Obinna Enumah
- Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Mohamed Yunus Rafiq
- Department of Anthropology, New York University Shanghai, Shanghai, China
- Ifakara Health Institute, Bagamoyo, Tanzania
| | | | - Hilary Ngude
- Tanzania Red Cross Society, Dar es Salaam, Tanzania
| | - Omar Juma
- Ifakara Health Institute, Bagamoyo, Tanzania
| | - Joseph V Sakran
- Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Kent Stevens
- Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Enumah ZO, Rafiq MY, Rhee D, Manyama F, Ngude H, Stevens K, Juma O, Sakran JV. Prevalence of pediatric surgical problems among east African refugees: estimates from a cross-sectional survey using random cluster sampling. BMC Pediatr 2022; 22:518. [PMID: 36050745 PMCID: PMC9434863 DOI: 10.1186/s12887-022-03576-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 05/10/2022] [Indexed: 11/10/2022] Open
Abstract
IMPORTANCE Surgery is a foundational aspect to high functioning health care systems. In the wake of the Lancet Commission on Global Surgery, previous research has focused on defining the burden of surgical conditions among a pediatric population, however these studies often fail to include forced migrant or refugees. The goal of this study was to estimate the prevalence of pediatric surgical conditions among refugees in east Africa. METHODS We used the previously validated Surgeons OverSeas Assessment of Surgical Need (SOSAS) that utilizes cross-sectional design with random cluster sampling to assess prevalence of surgical disease among participants aged 0 to 18 years in Nyarugusu refugee camp, Tanzania. We used descriptive and multivariable analyses including an average marginal effects model. RESULTS A total of 1,658 participants were included in the study. The mean age of our sample was 8.3 ± 5.8 years. A total of 841 participants (50.7%) were male and 817 participants (49.3%) were female. A total of 513 (n = 30.9%) reported a history or presence of a problem that may be surgical in nature, and 280 (54.6%) of them reported the problem was ongoing or untreated. Overall, 16.9% had an ongoing problem that may be amenable to surgery. We found that increasing age and recent illness were associated with having a surgical problem on both our multivariable analyses. CONCLUSION To our knowledge, this is the first and largest study of prevalence of surgical conditions among refugee children in sub-Saharan Africa. We found that over 16% (one-in-six) of refugee children have a problem that may be amenable to surgery. Our results provide a benchmark upon which other studies in conflict or post-conflict zones with refugee or forced migrant populations may be compared.
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Affiliation(s)
- Zachary Obinna Enumah
- Department of Surgery, Johns Hopkins Global Surgery Initiative (JHGSI), Johns Hopkins Hospital, Tower 110 Doctor's Lounge, 600 N. Wolfe Street, Baltimore, MD, 21287, USA. .,Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA.
| | - Mohamed Yunus Rafiq
- Department of Anthropology, New York University Shanghai, Shanghai, China.,Ifakara Health Institute, Bagamoyo, Tanzania
| | - Daniel Rhee
- Department of Surgery, Johns Hopkins Global Surgery Initiative (JHGSI), Johns Hopkins Hospital, Tower 110 Doctor's Lounge, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
| | | | - Hilary Ngude
- Tanzania Red Cross Society, Dar es Salaam, Tanzania
| | - Kent Stevens
- Department of Surgery, Johns Hopkins Global Surgery Initiative (JHGSI), Johns Hopkins Hospital, Tower 110 Doctor's Lounge, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.,Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Omar Juma
- Ifakara Health Institute, Bagamoyo, Tanzania
| | - Joseph V Sakran
- Department of Surgery, Johns Hopkins Global Surgery Initiative (JHGSI), Johns Hopkins Hospital, Tower 110 Doctor's Lounge, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
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