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Cadman V, Soltani H, Spencer R, Marvin-Dowle K, Harrop D. Cesarean birth rates among migrants in Europe: A systematic review. Birth 2023; 50:657-671. [PMID: 36939837 DOI: 10.1111/birt.12718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 01/27/2023] [Accepted: 02/07/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND Cesarean birth (CB) rates have increased over recent years with concerns over differences between these rates in migrant communities compared with the rates among women in their receiving country. This review aimed at summarizing the available literature regarding the incidence of CB among migrants in Europe. METHODS A systematic search of four electronic databases was carried out, including CINAHL, MEDLINE, Scopus, and Maternity and Infant Care. Identified studies were screened and their quality assessed. Meta-analysis was undertaken using Rev Man 5.4 where sufficient data were available. Otherwise, data were synthesized narratively. RESULTS From the 435 records identified in searches, 21 papers were included. Analysis shows that overall CB rates were significantly lower for Syrian refugee women compared with women in their receiving country (Turkey) and higher for Iranian migrants than women in their host country. Emergency CB rates were significantly higher for migrant women from "Sub Saharan Africa" and the "South East Asia, Asia and Pacific" region than rates in the receiving country. Statistical significance was not found between other populations. CONCLUSIONS This review highlights differences between CB rates in certain migrant groups in comparison with women native to their host country, which merits further investigation for potential explanations. We also identified a need to standardize definitions and population groupings to enable more meaningful analysis. This review also highlights a substantial lack of data on CB rates between different population groups that could negatively impact the provision of care.
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Affiliation(s)
- Victoria Cadman
- Department of Allied Health Professions, College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, UK
| | - Hora Soltani
- College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, UK
| | - Rachael Spencer
- Department of Nursing and Midwifery College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, UK
| | - Katie Marvin-Dowle
- College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, UK
| | - Deborah Harrop
- College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, UK
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2
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Inal HA, Inal ZO. Comparison of Perinatal Outcomes Between Syrian Refugees and Turkish Women in the Middle Anatolia Region of Turkey. Matern Child Health J 2023; 27:2139-2146. [PMID: 37393424 DOI: 10.1007/s10995-023-03748-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 07/03/2023]
Abstract
OBJECTIVE To compare the results of perinatal outcomes between Syrian refugees and Turkish women between 2016 and 2020. METHODS The birth results of 17,997 participants (Syrian refugees: 3579 and Turkish women: 14,418) who delivered in the Labor Department of our hospital between January 2016 and December 2020 were retrospectively analyzed. RESULTS Maternal age was younger (24.73 ± 6.08 vs. 27.4 ± 5.91 years, p < 0.001) and adolescent pregnancy rate was higher (19.4% vs. 5.6%, p < 0.001) in Syrian refuges than in Turkish women. Bishop scores on admission (4.6 ± 1.6 vs. 4.4 ± 1.1, p < 0.001), birth weight (3088.19 ± 575.32 g vs. 3109.76 ± 540.89 g, p = 0.044), low birth weight (11.3% vs. 9.7%, p = 0.004), and the rate of primary cesarean deliveries (10.1% vs. 15.8%, p < 0.001) were also statistically different. Additionally, the rates of anemia (65.9% vs. 29.2%, p < 0.001), preeclampsia (1.4% vs. 2.7%, p < 0.001), stillbirth (1.3% vs. 0.6%, p < 0.001), preterm premature rupture of membranes (2.7% vs. 1.9%, p = 0.002), and obstetric complications were different between the groups. CONCLUSIONS This study showed that inadequate antenatal care, communication and language barrier problems in Syrian refugees caused some adverse perinatal outcomes. All birth data of Syrian refugees must be disclosed by the Ministry of Health to confirm the accuracy of our data.
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Affiliation(s)
- Hasan Ali Inal
- Departmant of Obstetric and Gynecology, Konya Training and Research Hospital, Konya, Turkey.
| | - Zeynep Ozturk Inal
- Departmant of Obstetric and Gynecology, Konya Training and Research Hospital, Konya, Turkey
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Al-Shatanawi TN, Khader Y, Abdel Razeq N, Khader AM, Alfaqih M, Alkouri O, Alyahya M. Disparities in Obstetric, Neonatal, and Birth Outcomes Among Syrian Women Refugees and Jordanian Women. Int J Public Health 2023; 68:1605645. [PMID: 38024216 PMCID: PMC10654197 DOI: 10.3389/ijph.2023.1605645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives: To compare obstetric and neonatal characteristics and birth outcomes between Syrian refugees and native women in Jordan. Methods: We used the Jordan Stillbirths and Neonatal Deaths Surveillance System to extract sociodemographic and obstetric characteristics of the mothers and birth characteristics of newborns. Multivariate analysis was used to compare the characteristics of 26,139 Jordanian women (27,468 births) and 3,453 Syrian women refugees (3,638 births) who gave birth in five referral hospitals (May 2019 and December 2020). Results: The proportions of low birthweight (14.1% vs. 11.8%, p < 0.001) and small for gestational age (12.0% vs. 10.0%, p < 0.001) newborns were significantly higher for those born to Syrian women compared to those born to Jordanian women. The stillbirth rate (15.1 vs. 9.9 per 1,000 births, p = 0.003), the neonatal death rate (21.2 vs. 13.2 per 1,000 live births, p < 0.001), and perinatal death rate (21.2 vs. 13.2 per 1,000 births, p < 0.001) were significantly higher for the Syrian births. After adjusting for sociodemographic and obstetric characteristics of women, only perinatal death was statistically significantly higher among Syrian babies compared to Jordanian babies (OR = 1.3, 95% CI: 1.1-1.7, p = 0.035). Conclusion: Syrian refugee mothers had a significantly higher risk of adverse obstetric and neonatal outcomes including higher rate of perinatal death compared to Jordanian women.
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Affiliation(s)
- Tariq N. Al-Shatanawi
- Department of Public Health and Community Medicine, Al-Balqa Applied University, Al-Salt, Jordan
| | - Yousef Khader
- Department of Public Health, Jordan University of Science and Technology, Irbid, Jordan
| | - Nadin Abdel Razeq
- Department of Maternal and Child Health Nursing, School of Nursing, The University of Jordan, Amman, Jordan
| | - Ahmed M. Khader
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Mahmoud Alfaqih
- Department of Physiology and Biochemistry, Jordan University of Science and Technology, Irbid, Jordan
| | - Osama Alkouri
- Faculty of Nursing, Yarmouk University, Irbid, Jordan
| | - Mohammad Alyahya
- Department of Health Management and Policy, Jordan University of Science and Technology, Irbid, Jordan
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Ramadan M, Rukh-E-Qamar H, Yang S, Vang ZM. Fifty years of evidence on perinatal experience among refugee and asylum-seeking women in Organization for Economic Co-operation and Development (OECD) countries: A scoping review. PLoS One 2023; 18:e0287617. [PMID: 37883411 PMCID: PMC10602334 DOI: 10.1371/journal.pone.0287617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/08/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Members of the Organization for Economic Co-operation and Development (OECD) play a significant role in hosting and supporting refugees. Refugees and asylum seekers in OECD countries may face unique challenges in accessing perinatal healthcare. These challenges can impact their use of and experience with perinatal health services leading to poor maternal and infant outcomes. This scoping review describes the general trends in perinatal health research among refugees/asylum seekers in OECD countries over the past fifty years (1970 to 2021) as well as summarizes their perinatal experience. METHODS Databases including Embase and Medline were searched using relevant key words for "refugee/ asylum seeker", "perinatal ", and " OECD countries.". Articles were excluded if they only involved economic migrants or internally displaced persons, conducted in non-OECD countries, only assessed health behaviors and practices during pregnancy (e.g., smoking), or were published in a language other than English. The final list of articles included 82 unique studies. RESULTS In the 40 years between 1970 and 2009, very few studies (n = 9) examined perinatal health among refugees/ asylum seekers in OECD countries. However, an increasing trend was observed over the past decade. Early studies (1980 to 2009) focused more on traditional perinatal outcomes; however, from 2010 onwards, studies related to perinatal experience were more likely to emerge in the global health literature. Access to timely prenatal care remains a challenge with failure to address the root causes of the problem in several OECD countries including those with a long history of hosting refugees. The limited availability of interpretation services and the lack of a patient-centered approach to care have also interfered with the perceived quality of care. In addition, perceived isolation and the limited social support experienced by this vulnerable population have negatively impacted their perinatal experiences in several OECD countries. CONCLUSION Refugee/asylum seekers in OECD countries face a number of challenges during the perinatal period. Policy changes and further research are needed to address access barriers and identify specific interventions that can improve their well-being during this critical period.
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Affiliation(s)
- Marwa Ramadan
- Department of Sociology, McGill University, Montreal, Quebec, Canada
| | - Hani Rukh-E-Qamar
- Department of Sociology, McGill University, Montreal, Quebec, Canada
| | - Seungmi Yang
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Zoua M. Vang
- Department of Sociology, McGill University, Montreal, Quebec, Canada
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5
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Aktoz F, Tercan C, Vurgun E, Gelir BD, Polat I, Yucel B. Evaluation of Perinatal and Neonatal Outcomes of Syrian Refugees Compared to Turkish Population: A Snapshot During the COVID-19 Pandemic. J Immigr Minor Health 2023; 25:522-528. [PMID: 36952151 PMCID: PMC10034225 DOI: 10.1007/s10903-023-01470-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND The perinatal and neonatal outcomes of Syrian refugees during the coronavirus disease 2019 (COVID-19) pandemic are unknown. Therefore, in this study, we aimed to evaluate these outcomes. METHODS Turkish (n = 303) and Syrian refugees (n = 303) who delivered in our hospital between June 1, 2020 and December 31, 2020 were included in the study. Demographic, perinatal, and neonatal data were obtained by retrospectively evaluating hospital records. RESULTS Adolescent pregnancy was more common in Syrian refugees (p < 0.001). The rates of antenatal visits, performed combined test, triple test, quadruple test, fetal anatomy ultrasound, and glucose tolerance test were lower in all refugees (p < 0.01). Furthermore, there was no difference in the mode of delivery, Hb after delivery, gestational age, birth weight, Apgar score, stillbirth, and fetal anomaly (p > 0.05 for all). CONCLUSION Despite poorer antenatal care during the COVID-19 pandemic, Syrian refugee pregnant women had similar perinatal and neonatal outcomes compared with the Turkish pregnant population.
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Affiliation(s)
- Fatih Aktoz
- Department of Obstetrics and Gynecology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey.
| | - Can Tercan
- Department of Obstetrics and Gynecology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Eren Vurgun
- Department of Medical Biochemistry, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Busra Deniz Gelir
- Department of Obstetrics and Gynecology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Ibrahim Polat
- Department of Obstetrics and Gynecology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Burak Yucel
- Department of Obstetrics and Gynecology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
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Cuadrado C, Libuy M, Moreno-Serra R. What is the impact of forced displacement on health? A scoping review. Health Policy Plan 2023; 38:394-408. [PMID: 36629500 PMCID: PMC10019572 DOI: 10.1093/heapol/czad002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 12/21/2022] [Accepted: 01/10/2023] [Indexed: 01/12/2023] Open
Abstract
While there is a broad literature analysing the effects of migration on health, important knowledge gaps persist particularly on the causal effects of forced displacement on health outcomes. We undertake a scoping review of applied epidemiological, statistical and econometric studies examining causal health impacts of forced displacement, which initially identified 1454 studies from the health and social sciences disciplines published up to May 2021. Our study makes two key contributions. First, we offer a comprehensive overview of the evidence generated, methodologies adopted and analytical challenges faced by current research examining the causal relationship between forced displacement and health. Second, we present concrete examples of how key challenges around study design and estimation approaches influence the strength of the evidence-base on the topic, using as a case study the broad domain of reproductive health. We find that, beyond the increased mortality risk that can be attributed to forced displacement, most of the available empirical evidence for a wide range of health outcomes is prone to substantial bias, making it difficult to draw firm conclusions. Our synthesis of credible studies conducted in different settings indicates that current research practice in the field could be strengthened through selection of valid control groups and application of more appropriate causal inference methods. Our findings are useful to promote the generation of further evidence on the topic that can reliably inform the design of policies to protect the health of displaced populations.
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Affiliation(s)
| | - Matías Libuy
- Escuela de Salud Pública, Universidad de Chile, Av. Independencia 939, Independencia, Santiago, Chile
| | - Rodrigo Moreno-Serra
- *Corresponding author. Centre for Health Economics, University of York, Alcuin A Block, Heslington, York YO10 5DD, UK. E-mail:
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AlArab N, Nabulsi D, El Arnaout N, Dimassi H, Harb R, Lahoud J, Nahouli L, Abou Koura A, El Saddik G, Saleh S. Reproductive health of Syrian refugee women in Lebanon: a descriptive analysis of the Sijilli electronic health records database. BMC Womens Health 2023; 23:81. [PMID: 36823589 PMCID: PMC9951425 DOI: 10.1186/s12905-023-02231-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/16/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND The Syrian conflict has been responsible for the highest exodus of refugees, with Lebanon hosting the greatest number of refugees per capita, which placed a significant strain on an already overburdened healthcare system. Women are the most vulnerable group in times of conflict and displacement, with sexual and reproductive health and rights often neglected. This study focuses on the obstetric characteristics and pregnancy outcomes of Syrian Refugee (SR) women in Lebanon, in Comparison to their pre-displacement data. METHODS This study is a secondary analysis of de-identified data from the Sijilli database. The data reported and analyzed were the refugees' socio-demographics, obstetric history, pregnancy outcomes, experienced maternal and neonatal complications, breastfeeding history and duration, and contraception use and types. Data were reported in both frequencies and means/medians. Chi-square test, t-test, and ANOVA tests were used to compare pregnancies in Syria to those that happened in Lebanon. RESULTS A total of 1065 female records were included in this study, with 634 ever-pregnant women and the total number of pregnancies being 3272. SR women were shown to get pregnant in Lebanon at a younger age compared to cases in Syria. The number of gravidities is equal in women who got pregnant in Syria and those who moved later to Lebanon. The mean spacing between pregnancies has decreased comparing SR women who got pregnant in Syria only versus those who got pregnant in Lebanon only. Among the mixed group, the mean spacing between pregnancies as well as the prevalence of spontaneous abortions significantly increased after displacing to Lebanon. C-section rate was higher among SR women after moving to Lebanon. Also, maternal complications and not breastfeeding have increased after moving to Lebanon. A prior pregnancy was significantly associated with higher contraception use rate. The most common methods of contraception were oral contraceptive pills and intra-uterine devices. CONCLUSION The C-section deliveries, spontaneous abortions and maternal complications have all increased among SR women after being displaced to Lebanon. While the age at first pregnancy, mean spacing between their pregnancies and breastfeeding rates have decreased after moving to Lebanon. SR women are less likely to use contraceptives after their displacement. It is necessary to address access to reproductive healthcare and antenatal care delivery among displaced refugee women living in informal tented settlements.
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Affiliation(s)
- Natally AlArab
- grid.22903.3a0000 0004 1936 9801Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Dana Nabulsi
- grid.22903.3a0000 0004 1936 9801Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Nour El Arnaout
- grid.22903.3a0000 0004 1936 9801Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Hani Dimassi
- grid.411323.60000 0001 2324 5973School of Pharmacy, Lebanese American University, Beirut, Lebanon
| | - Ranime Harb
- grid.411323.60000 0001 2324 5973School of Pharmacy, Lebanese American University, Beirut, Lebanon
| | - Julien Lahoud
- grid.22903.3a0000 0004 1936 9801Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Lara Nahouli
- grid.411654.30000 0004 0581 3406Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Abdulghani Abou Koura
- grid.411654.30000 0004 0581 3406Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ghaidaa El Saddik
- grid.18112.3b0000 0000 9884 2169Beirut Arab University, Beirut, Lebanon
| | - Shadi Saleh
- Global Health Institute, American University of Beirut, Beirut, Lebanon. .,Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Riad El Solh, Beirut, 1107 2020, Lebanon.
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Cinaroglu S. The effect of increases in the Syrian refugee population in Turkey on public maternal and child health outcomes. Health Care Women Int 2023; 44:95-110. [PMID: 33395368 DOI: 10.1080/07399332.2020.1842411] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Our purpose in this study is to explore the effect that increases in the Syrian refugee population could have on public maternal and child health outcomes. Data collected from official records from 81 Turkish provinces in 2018, and then, subjected to mediating analysis using a path analytic approach to examine the interrelationships between the Syrian population, adolescent marriage, and economic integration factors on refugee maternal and child health outcomes. An increase in the Syrian population would lead to a rise in adolescent birth rates and under-5 mortality under the mediating effect of an increase in adolescent female marriage.
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Affiliation(s)
- Songul Cinaroglu
- Department of Health Care Management, Faculty of Economics and Administrative Sciences (FEAS), Hacettepe University, Beytepe, Ankara, Turkey
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Karaca Kurtulmuş S, Şahin Güleç E, Gür EB. Differences in Obstetric Outcomes and Antenatal Follow-up Between Syrian Refugees and Resident Women: A Retrospective Comparative Study in a Maternity Hospital Aydın, Turkey. MEANDROS MEDICAL AND DENTAL JOURNAL 2022. [DOI: 10.4274/meandros.galenos.2022.26566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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10
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Adverse Pregnancy Outcomes and International Immigration Status: A Systematic Review and Meta-analysis. Ann Glob Health 2022; 88:44. [PMID: 35854922 PMCID: PMC9248985 DOI: 10.5334/aogh.3591] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 06/02/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Disparities in health outcomes between immigrant and native-origin populations, particularly pregnant women, pose significant challenges to healthcare systems. The aim of this systematic-review and meta-analysis was to investigate the risk of adverse pregnancy outcomes among immigrant-women compared to native-origin women in the host country. Methods: PubMed (including MEDLINE), Scopus, and Web of Science were searched to retrieve studies published in English language up to September 2020. All observational studies examining the prevalence of at least one of the short-term single pregnancy outcomes for immigrants who crossed international borders compared to native-origin pregnant population were included. The meta-prop method was used for the pooled-estimation of adverse pregnancy-outcomes’ prevalence. For pool-effect estimates, the association between the immigration-status and outcomes of interest, the random-effects model was applied using the model described by DerSimonian and Laird. I2 statistic was used to assess heterogeneity. The publication bias was assessed using the Harbord-test. Meta-regression was performed to explore the effect of geographical region as the heterogeneity source. Findings: This review involved 11 320 674 pregnant women with an immigration-background and 56 102 698 pregnant women as the native-origin population. The risk of emergency cesarean section (Pooled-OR = 1.1, 95%CI = 1.0–1.2), shoulder dystocia (Pooled-OR = 1.1, 95%CI = 1.0–1.3), gestational diabetes mellites (Pooled-OR = 1.4, 95%CI = 1.2–1.6), small for gestational age (Pooled-OR=1.3, 95%CI = 1.1–0.4), 5-min Apgar less than 7 (Pooled-OR = 1.2, 95%CI = 1.0–1.3) and oligohydramnios (Pooled-OR = 1.8, 95%CI = 1.0–3.3) in the immigrant women were significantly higher than those with the native origin background. The immigrant women had a lower risk of labor induction (Pooled-OR = 0.8, 95%CI = 0.7–0.8), pregnancy induced hypertension (Pooled-OR = 0.6, 95%CI = 0.5–0.7) preeclampsia (Pooled-OR = 0.7, 95%CI = 0.6–0.8), macrosomia (Pooled-OR = 0.8, 95%CI = 0.7–0.9) and large for gestational age (Pooled-OR = 0.8, 95%CI = 0.7–0.8). Also, the risk of total and primary cesarean section, instrumental-delivery, preterm-birth, and birth-trauma were similar in both groups. According to meta-regression analyses, the reported ORs were not influenced by the country of origin. Conclusion: The relationship between the immigration status and adverse perinatal outcomes indicated a heterogenous pattern, but the immigrant women were at an increased risk of some important adverse pregnancy outcomes. Population-based studies with a focus on the various aspects of this phenomena are required to explain the source of these heterogenicities.
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KÜKRER S, PEPEKAL KÜKRER A, ARLIER S, GENÇ S, KARAGÜN Ş. Evaluation of obstetric and neonatal outcomes and cesarean section rates of Syrian and Turkish adolescent pregnant women according to the Robson ten group classification system. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1084388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aim: Our research has two purposes. To begin with, we sought to determine whether there were any differences in maternal and newborn outcomes between Syrian adolescent and adult pregnant women living in Turkey after the Syrian civil war and Turkish adolescent and adult pregnant women. Second, we wanted to examine and compare the rates of cesarean section (CS) and spontaneous vaginal delivery (SVD) in adolescent and adult pregnant women using the Robson ten group classification system (RTGCS).
Material and Method: Our study investigated data from a retrospective cross-sectional study of 1823 Turkish and Syrian pregnant women who gave birth between September 2020 and August 2021 in a tertiary reference hospital in Turkey's Mediterranean area. Our study enrolled 838 pregnant adolescent girls between the ages of 13 and 19 and 985 pregnant adult women between the ages of 20 and 47.
Results: The probability of adolescent pregnancy is 3.081 times greater among Syrian refugees than among Turkish natives (p
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Affiliation(s)
- Sadık KÜKRER
- University of Health Sciences Adana City Training and Research Hospital, Department of Obstetrics and Gynecology, Adana, Turkey
| | | | - Sefa ARLIER
- University of Health Sciences Adana City Training and Research Hospital, Department of Obstetrics and Gynecology, Adana, Turkey
| | - Simten GENÇ
- Prof. Dr. Cemil Taşçıoğlu City Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey
| | - Şebnem KARAGÜN
- Mersin University, Faculty of Medicine Hospital, Department of Perinatology, Mersin, Turkey
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12
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Behboudi-Gandevani S, Bidhendi-Yarandi R, Panahi MH, Mardani A, Gåre Kymre I, Paal P, Vaismoradi M. A Systematic Review and Meta-Analysis of the Risk of Stillbirth, Perinatal and Neonatal Mortality in Immigrant Women. Int J Public Health 2022; 67:1604479. [PMID: 35664648 PMCID: PMC9156626 DOI: 10.3389/ijph.2022.1604479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 04/28/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives: This study aimed to investigate the risk of stillbirth, perinatal and neonatal mortality in immigrant women compared to native-origin women in host countries. Methods: A systematic literature review and meta-analysis was conducted. Relevant studies were identified using a thorough literature search and their quality was appraised. The analysis of heterogeneous data was carried out using the random effects model and publication bias was assessed using the Harbord-test. Also, the pooled odds ratio of events was calculated through the DerSimonian and Laird, and inverse variance methods. Results: In the search process 45 studies were retrieved consisting of 8,419,435 immigrant women and 40,113,869 native-origin women. The risk of stillbirth (Pooled OR = 1.35, 95% CI = 1.22–1.50), perinatal mortality (Pooled OR = 1.50, 95% CI = 1.35–1.68), and neonatal mortality (Pooled OR = 1.09, 95% CI = 1.00–1.19) in the immigrant women were significantly higher than the native-origin women in host countries. According to the sensitivity analyses, all results were highly consistent with the main data analysis results. Conclusion: The immigrant women compared to the native-origin women had the higher risks of stillbirth, perinatal and neonatal mortality. Healthcare providers and policy makers should improve the provision of maternal and neonatal healthcare for the immigrant population.
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Affiliation(s)
- Samira Behboudi-Gandevani
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- *Correspondence: Samira Behboudi-Gandevani,
| | - Razieh Bidhendi-Yarandi
- Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohammad Hossein Panahi
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Mardani
- Nursing Care Research Center, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | | | - Piret Paal
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
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Behboudi-Gandevani S, Bidhendi-Yarandi R, Panahi MH, Mardani A, Prinds C, Vaismoradi M. Perinatal and Neonatal Outcomes in Immigrants From Conflict-Zone Countries: A Systematic Review and Meta-Analysis of Observational Studies. Front Public Health 2022; 10:766943. [PMID: 35359776 PMCID: PMC8962623 DOI: 10.3389/fpubh.2022.766943] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 02/03/2022] [Indexed: 12/16/2022] Open
Abstract
Objectives There are controversies regarding the risk of adverse pregnancy outcomes among immigrants from conflict-zone countries. This systematic review and meta-analysis aimed to investigate the risk of perinatal and neonatal outcomes among immigrants from conflict-zone countries compared to native-origin women in host countries. Methods A systematic search on the databases of PubMed/MEDLINE, Scopus, and Web of Science was carried out to retrieve studies on perinatal and neonatal outcomes among immigrants from Somalia, Iraq, Afghanistan, Yemen, Syria, Nigeria, Sudan, Ethiopia, Eritrea, Kosovo, Ukraine, and Pakistan. Only peer-reviewed articles published in the English language were included in the data analysis and research synthesis. The odds ratio and forest plots were constructed for assessing the outcomes of interests using the DerSimonian and Laird, and the inverse variance methods. The random-effects model and the Harbord test were used to account for heterogeneity between studies and assess publication bias, respectively. Further sensitivity analysis helped with the verification of the reliability and stability of our review results. Results The search process led to the identification of 40 eligible studies involving 215,718 pregnant women, with an immigration background from the conflict zone, and 12,806,469 women of native origin. The adverse neonatal outcomes of the risk of small for gestational age (Pooled OR = 1.8, 95% CI = 1.6, 2.1), a 5-min Apgar score <7 (Pooled OR = 1.4, 95% CI = 1.0, 2.1), stillbirth (Pooled OR = 1.9, 95% CI = 1.2, 3.0), and perinatal mortality (Pooled OR = 2, 95% CI = 1.6, 2.5) were significantly higher in the immigrant women compared to the women of native-origin. The risk of maternal outcomes, including the cesarean section (C-S) and emergency C-S, instrumental delivery, preeclampsia, and gestational diabetes was similar in both groups. Conclusion Although the risk of some adverse maternal outcomes was comparable in the groups, the immigrant women from conflict-zone countries had a higher risk of neonatal mortality and morbidity, including SGA, a 5-min Apgar score <7, stillbirth, and perinatal mortality compared to the native-origin population. Our review results show the need for the optimization of health care and further investigation of long-term adverse pregnancy outcomes among immigrant women.
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Affiliation(s)
- Samira Behboudi-Gandevani
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- *Correspondence: Samira Behboudi-Gandevani
| | - Razieh Bidhendi-Yarandi
- Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohammad Hossein Panahi
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Mardani
- Nursing Care Research Center, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Christina Prinds
- Department of Clinical Research, University South Denmark, Odense, Denmark
- Department of Midwifery Education, University College South Denmark, Esbjerg, Denmark
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Ammoura O, Sehouli J, Kurmeyer C, Richter R, Kutschke N, Henrich W, Inci MG. Perinatal Data of Refugee Women from the Gynaecology Department of Charité University Hospital Berlin Compared with German Federal Analysis. Geburtshilfe Frauenheilkd 2021; 81:1238-1246. [PMID: 34754273 PMCID: PMC8568502 DOI: 10.1055/a-1397-6888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 02/19/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction
The aim of this study was to record the perinatal data of refugee women at Charité Hospital, Berlin, and to evaluate possible differences in pre-, peri- and postnatal outcomes compared with indigenous women.
Material and Methods
All pregnant women who gave birth in the period from 1 January 2014 to 30 September 2017 and were registered at least once in the hospital as “refugee” were included in the analysis. The data recorded from the refugee women were compared with the perinatal data of the German Federal obstetric analysis for the year 2016, which was published by the IQTIG (Institut für Qualitätssicherung und Transparenz im Gesundheitswesen [Institute for Quality Assurance and Transparency in Healthcare]).
Results
The analysis comprised 907 refugee women and 928 infants (21 twin pregnancies). Pregnant refugee women were significantly younger than the pregnant women from the Federal analysis (birth before the age of 30: 66 vs. 41%, p < 0.001, RR: 1.6, 95% CI: 62.9 – 69.2). They had a history both of more pregnancies (≥ 3 pregnancies: 29.4 vs. 13.4%, p < 0.001, RR: 2.2, 95% CI: 26.4 – 32.5) and of more miscarriages (> 2 miscarriages: 9.7 vs. 5.9%, p < 0.001, RR: 1.6, 95% CI: 7.9 – 11.8) and more often had a history of suffering from psychological stress (11.1 vs. 4.1%, p < 0.001, RR: 2.70, 95% CI: 9.2 – 13.4). There were more premature births (10.3 vs. 3.0%, p < 0.001, RR: 3.36, 95% CI: 8.4 – 12.4), post-term pregnancies (8.5 vs. 0.5%, p < 0.001, RR: 15.4, 95% CI: 6.7 – 10.5), and cases of postpartum anaemia (28.7 vs. 22.0%, p < 0.001, RR: 1.30, 95% CI: 25.7 – 31.7) and puerperal endometritis (1 vs. 0.2%, p = 0.006, RR: 4.3, 95% CI: 0.5 – 1.9)
compared with the Federal analysis. The neonatal outcome showed an increased rate of hypotrophy (11 vs. 7%, p < 0.001, RR: 1.6, 95% CI: 9.1 – 13.2), more stillbirths (0.7 vs. 0.2%, p = 0.006, RR: 3, 95% CI: 0.2 – 1.4) and increased congenital malformations (2.8 vs. 0.4%, p < 0.001, RR: 3, 95% CI: 0.2 – 1.4).
Conclusion
Both refugee women and their infants showed significant differences. Despite the average younger age of the pregnant refugee women, the rates of premature birth and stillbirth and congenital malformations were significantly more frequent. More intensive antenatal screening with differentiated foetal organ diagnostics including psychosomatic care could contribute to early identification and prompt diagnosis. As regards the postpartum anaemia and puerperal endometritis, which occur more often in refugee women, midwife engagement and an improvement in the living situation in homes and accommodation facilities could be of great importance.
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Affiliation(s)
- Ola Ammoura
- Charité - Universitätsmedizin Berlin, Klinik für Gynäkologie, Campus Virchow-Klinikum, Berlin, Germany
| | - Jalid Sehouli
- Charité - Universitätsmedizin Berlin, Klinik für Gynäkologie, Campus Virchow-Klinikum, Berlin, Germany
| | - Christine Kurmeyer
- Charité - Universitätsmedizin Berlin, Frauen- und Gleichstellungsbeauftragte, Berlin, Germany
| | - Rolf Richter
- Charité - Universitätsmedizin Berlin, Klinik für Gynäkologie, Campus Virchow-Klinikum, Berlin, Germany
| | - Nadja Kutschke
- Charité - Universitätsmedizin Berlin, Klinik für Gynäkologie, Campus Virchow-Klinikum, Berlin, Germany
| | - Wolfgang Henrich
- Charité - Universitätsmedizin Berlin, Klinik für Geburtsmedizin, Berlin, Germany
| | - Melisa Guelhan Inci
- Charité - Universitätsmedizin Berlin, Klinik für Gynäkologie, Campus Virchow-Klinikum, Berlin, Germany
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15
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Sayili U, Ozgur C, Bulut Gazanfer O, Solmaz A. Comparison of Clinical Characteristics and Pregnancy and Neonatal Outcomes Between Turkish Citizens and Syrian Refugees with High-Risk Pregnancies. J Immigr Minor Health 2021; 24:1177-1185. [PMID: 34635997 PMCID: PMC8504429 DOI: 10.1007/s10903-021-01288-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2021] [Indexed: 11/25/2022]
Abstract
Refugee women experience more negative pregnancy and neonatal outcomes, such as low birth weight and preterm birth. The aim of the present study was to compare the clinical characteristics and pregnancy and neonatal outcomes between Turkish citizens and Syrian refugees with high-risk pregnancies. This prospective cohort study was conducted between March and December 2020 in Sanliurfa, Turkey. The maternal characteristics and pregnancy and neonatal outcomes were compared between the two groups. In this study, a total of 302 high-risk pregnant women (233 Turkish citizens and 69 Syrian refugees) were included. Parity and pregnancy spacing shorter than 2 years were significantly higher in Syrian refugees. Age, previous abortion or miscarriage and rates of cesarean section (C/S) were significantly higher in Turkish citizens. The live birth (Turkish: 94.8% vs Syrian: 92.8%), preterm birth (Turkish: 10% vs Syrian: 9.4%), low birth weight (Turkish: 7.7% vs Syrian: 3.1%) rates and birth weight (g) (Turkish: 3097.5 ± 501.3 g; Syrian: 2980.2 ± 395.0 g) were not significantly different between Turkish citizens and Syrian refugees with high-risk pregnancy. Similar pregnancy and neonatal outcomes could be attributed to the Syrians receiving adequate and free maternity care, similar to the Turkish citizens.
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Affiliation(s)
- Ugurcan Sayili
- Karakopru District Health Directorate, Republic of Turkey Ministry of Health, Sanliurfa, Turkey
| | - Cigdem Ozgur
- Haliliye District Health Directorate, Republic of Turkey Ministry of Health, Sanliurfa, Turkey
| | - Oznur Bulut Gazanfer
- Public Health Services Presidency, Sanliurfa Provincial Health Directorate, Republic of Turkey Ministry of Health, Sanliurfa, Turkey
| | - Abdullah Solmaz
- Public Health Services Presidency, Sanliurfa Provincial Health Directorate, Republic of Turkey Ministry of Health, Sanliurfa, Turkey
- Department of Pediatrics, School of Medicine, Harran University, Sanliurfa, Turkey
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Silahli NY, Baris HE, Qutranji L, Ozek E, Boran P. The differences in perinatal outcomes between refugee and resident mother-infant dyads: A retrospective study in Turkey between 2013 and 2018. Health Care Women Int 2021; 45:251-264. [PMID: 34376127 DOI: 10.1080/07399332.2021.1954648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 07/08/2021] [Indexed: 10/20/2022]
Abstract
In this study, we aimed to examine and compare the perinatal outcomes between refugee and resident mother-infant dyads. Data of refugee women who had given birth in a university hospital (n = 924) and matched resident mother-infant dyads (n = 957) were included. Analysis revealed higher adolescent pregnancy rates and lower rates of antenatal care attendance among refugee mothers compared to residents. No significant differences in neonatal outcomes were found, except for a significantly higher number of preterm births among refugee infants. Interventions should be made to ensure antenatal care for all pregnant women, which can also prevent preterm birth.
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Affiliation(s)
- Nicel Yildiz Silahli
- School of Medicine, Department of Pediatrics, Division of Social Pediatrics, Marmara University, Istanbul, Turkey
| | - Hatice Ezgi Baris
- School of Medicine, Department of Pediatrics, Division of Social Pediatrics, Marmara University, Istanbul, Turkey
| | - Lubna Qutranji
- School of Medicine, Department of Pediatrics, Division of Social Pediatrics, Marmara University, Istanbul, Turkey
| | - Eren Ozek
- School of Medicine, Department of Pediatrics, Division of Neonatology, Marmara University, Istanbul, Turkey
| | - Perran Boran
- School of Medicine, Department of Pediatrics, Division of Social Pediatrics, Marmara University, Istanbul, Turkey
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Garnica-Rosas L, Granich-Armenta A, Guerra Y Guerra G, Sánchez-Dominguez M, Lamadrid-Figueroa H. Perinatal Outcomes Among Venezuelan Immigrants in Colombia: A Cross-Sectional Study. J Immigr Minor Health 2021; 23:976-985. [PMID: 34363575 PMCID: PMC8346779 DOI: 10.1007/s10903-021-01248-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 11/25/2022]
Abstract
In the last decade, Venezuela suffers a humanitarian crisis, leading to massive emigration. One of the most vulnerable migrants´ groups is pregnant women. We analyzed the perinatal outcomes of Venezuelan migrants in Colombia and identified if migration was associated with perinatal outcomes. Birth data were obtained from the 2017 Colombian national birth registry (1085 births in migrants and 654,829 in Colombians). Logistic and linear regression models were used to identify the association between the demographic, obstetric and neonatal characteristics with premature birth (PB), low birth weight (LBW), 1-min, and 5-min Apgar score. Venezuelan were more likely to have newborns with LBW, lower Apgar scores at 1-min and 5-min in comparison to Colombians. Furthermore, a difference was observed in the low health insurance coverage and antenatal care visits among Venezuelan in comparison to natives. Access to health care services for the migrants is desirable for the improvement of perinatal health conditions.
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Affiliation(s)
- Lina Garnica-Rosas
- Institute of Tropical Medicine and International Health, Charité Universitätsmedizin, Berlin, Germany
| | - Adriana Granich-Armenta
- Department of Perinatal Health, National Institute of Public Health, Mexico Av. Universidad 655 Col. Santa María Ahuacatitlán Cuernavaca, CP 62100, Cuernavaca, Morelos, Mexico
| | - German Guerra Y Guerra
- Department of Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Mario Sánchez-Dominguez
- Department of Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Hector Lamadrid-Figueroa
- Department of Perinatal Health, National Institute of Public Health, Mexico Av. Universidad 655 Col. Santa María Ahuacatitlán Cuernavaca, CP 62100, Cuernavaca, Morelos, Mexico.
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18
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Arslan E, Demir SC, Ozsurmeli M, Akcabay C. Perinatal outcomes and survival predictors of severe red-cell alloimmunization treated by intrauterine transfusion. J Obstet Gynaecol Res 2021; 47:2632-2640. [PMID: 34018269 DOI: 10.1111/jog.14860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 04/29/2021] [Accepted: 05/08/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate perinatal survival rates and predictors in severely anemic fetuses that underwent intrauterine transfusion (IUT). METHOD This was a retrospective study of both Turkish and Syrian patients who underwent IUT for fetal anemia due to Rh alloimmunization between 2015 and 2019. The association between pretransfusion factors and perinatal survival was evaluated by multivariate logistic regression. Receiver operating characteristics (ROC) curves were used to identify the level of fetal hemoglobin deficits that predict perinatal survival. RESULTS Eighty-seven IUTs were performed in 42 pregnancies. Approximately 75% of fetuses were severely anemic and the overall perinatal survival rate was 50%. The survival rate was better in Syrian refugees compared to Turkish patients (71.4% vs. 39.3%, p < 0.05). In univariate analysis, hydrops presence (odds ratio [OR] = 0.2; 95% confidence interval [CI] = 0.05-0.7; p < 0.05), first IUT week (OR = 1.4; 95% CI = 1.1-1.8; p < 0.05), pretransfusion hemoglobin level (OR = 1.99; 95% CI = 1.22-3.27; p < 0.05), hemoglobin deficit (OR = 0.5; 95% CI = 0.3-0.8; p < 0.05), and birth week (OR = 2.3; 95% CI = 1.3-3.9; p < 0.05) were associated with survival. However in a multivariate analysis, only hemoglobin deficit (OR = 0.47; 95% CI = 0.22-0.99; p < 0.05) and birth week (OR = 3.3; 95% CI = 1.1-10.3; p < 0.05) were found to be associated with survival. On ROC analysis, a hemoglobin deficit of ≤6.25 g/dl showed a sensitivity of 0.95 and specificity of 0.62 for predicting perinatal survival. CONCLUSION Despite the improvement in the treatment of fetal anemia, perinatal survival rate remains extremely low in severely anemic cases. Among pretransfusion factors, hemoglobin deficit seemed to be most important in predicting survival during fetal anemia.
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Affiliation(s)
- Erol Arslan
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Health Sciences, Van Research and Training Hospital, Van, Turkey
| | - Suleyman Cansun Demir
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Cukurova University, School of Medicine, Adana, Turkey
| | - Mehmet Ozsurmeli
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Health Sciences, Derince Research and Training Hospital, Kocaeli, Turkey
| | - Cigdem Akcabay
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Cukurova University, School of Medicine, Adana, Turkey
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19
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Toker E, Aktaş S. The childbirth experiences of Syrian refugee mothers living in Turkey: a qualitative study. J Reprod Infant Psychol 2021; 39:544-560. [PMID: 33896296 DOI: 10.1080/02646838.2021.1913487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective:The study aims to examine the childbirth experiences of Syrian refugee mothers living in Turkey.Methods: This qualitative study was conducted with 12 mothers who had a vaginal birth and were assisted by midwives. The data were collected using an in-depth interview form and analyzed with the thematic analysis technique.Results: The childbirth experiences of the mothers were grouped under two main headings as negative and positive experiences. "Negative childbirth experiences" were divided into 4 main themes as "negative emotions experienced during childbirth, lack of effective communication due to the language barrier, difficulties experienced related to hospital policies and dissatisfaction with midwives". "Positive birth experiences", were categorized under three main themes as "satisfaction with the midwife, finding the country safe to give birth, and mother' s positive attitude towards birth process". The mothers were satisfied with "the attitudes and behaviors of the midwives and their professional practices", and the positive attitude of mothers towards birth in religious and cultural terms contributed to the positive birth perception.Conclusion: Refugee mothers were found to have both positive and negative childbirth experiences. Individualized, empathic communication-based, culturally sensitive and evidence-based care may contribute to the positive childbirth experiences of refugee women.
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Affiliation(s)
- Eylem Toker
- Faculty of Health Sciences, Department of Midwifery, Tarsus University, Tarsus/Mersin, Turkey
| | - Songül Aktaş
- Faculty of Health Sciences, Department of Birth and WomenDiseaseNursing, Karadeniz Technical University, Trabzon, Turkey
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20
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Rosenberg-Jeß S, Sauzet O, Henrich W, David M. [Perinatal Data of Women with and without Refugee Status in Berlin - Results of a Comparative Cross-Sectional Study]. Z Geburtshilfe Neonatol 2021; 225:406-411. [PMID: 33860496 DOI: 10.1055/a-1440-1762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION In Germany,1.2 million asylum seekers have entered the country in 2015-2016. More than a third of these asylum seekers were women. To understand the situation of asylum seekers' pregnancies, we examined the primary health care of this particular group to understand what, if anything, needs to improve to make the German health system more accessible to pregnant asylum seekers. METHODOLOGY we examined 960 cases of pregnant women who delivered in 2 large maternity clinics in Berlin-Charité between January 2016-August 2017. In our comparative cross-sectional study, we compared 480 asylum-seeking women with 480 local German women. For both patient populations we acquired data on various parameters. RESULTS We found only two significant differences: (1) The number of antenatal appointments attended by refugee women during their pregnancy was lower than that of the control group. The average number of antenatal appointments in the local control group was 10.6 (Max.: 27, SD 2.85, Min: 2); the refugee women attended on average 8.0 appointments (Max.: 20, SD 3.385, Min: 0) (p=0.000, adjusted relative risk 0.77 95% CI 0.74-0.81). (2) The mean Hb value in the local control group was 11.1 g/dl, while in the asylum-seeking women's group it was 10.6 g/dl (p= 0.00, adjusted difference 0.54 95% CI -0.77 to -0.34). CONCLUSIONS This study showed that the German health care system is capable of treating asylum-seeking women. Nevertheless, it is possible that our results do not necessarily reflect the ability of the health care system but stem from other selection parameters of the health condition of our subjects, such as the "healthy migrant effect."
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Affiliation(s)
- Sivan Rosenberg-Jeß
- Klinik für Gynäkologie und Geburtshilfe, HELIOS Klinikum Berlin-Buch, Berlin, Deutschland
| | - Odile Sauzet
- Fakultät für Gesundheitswissenschaften/AG 3 Epidemiologie & International Public Health, Universität Bielefeld, Bielefeld, Deutschland
| | - Wolfgang Henrich
- Klinik für Gynäkologie, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Matthias David
- Klinik für Geburtsmedizin, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
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21
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Munyuzangabo M, Gaffey MF, Khalifa DS, Als D, Ataullahjan A, Kamali M, Jain RP, Meteke S, Radhakrishnan A, Shah S, Siddiqui FJ, Bhutta ZA. Delivering maternal and neonatal health interventions in conflict settings: a systematic review. BMJ Glob Health 2021; 5:e003750. [PMID: 33608264 PMCID: PMC7903125 DOI: 10.1136/bmjgh-2020-003750] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 01/15/2021] [Accepted: 01/26/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND While much progress was made throughout the Millennium Development Goals era in reducing maternal and neonatal mortality, both remain unacceptably high, especially in areas affected by humanitarian crises. While valuable guidance on interventions to improve maternal and neonatal health in both non-crisis and crisis settings exists, guidance on how best to deliver these interventions in crisis settings, and especially in conflict settings, is still limited. This systematic review aimed to synthesise the available literature on the delivery on maternal and neonatal health interventions in conflict settings. METHODS We searched MEDLINE, Embase, CINAHL and PsycINFO databases using terms related to conflict, women and children, and maternal and neonatal health. We searched websites of 10 humanitarian organisations for relevant grey literature. Publications reporting on conflict-affected populations in low-income and middle-income countries and describing a maternal or neonatal health intervention delivered during or within 5 years after the end of a conflict were included. Information on population, intervention, and delivery characteristics were extracted and narratively synthesised. Quantitative data on intervention coverage and effectiveness were tabulated but no meta-analysis was undertaken. RESULTS 115 publications met our eligibility criteria. Intervention delivery was most frequently reported in the sub-Saharan Africa region, and most publications focused on displaced populations based in camps. Reported maternal interventions targeted antenatal, obstetric and postnatal care; neonatal interventions focused mostly on essential newborn care. Most interventions were delivered in hospitals and clinics, by doctors and nurses, and were mostly delivered through non-governmental organisations or the existing healthcare system. Delivery barriers included insecurity, lack of resources and lack of skilled health staff. Multi-stakeholder collaboration, the introduction of new technology or systems innovations, and staff training were delivery facilitators. Reporting of intervention coverage or effectiveness data was limited. DISCUSSION The relevant existing literature focuses mostly on maternal health especially around the antenatal period. There is still limited literature on postnatal care in conflict settings and even less on newborn care. In crisis settings, as much as in non-crisis settings, there is a need to focus on the first day of birth for both maternal and neonatal health. There is also a need to do more research on how best to involve community members in the delivery of maternal and neonatal health interventions. PROSPERO REGISTRATION NUMBER CRD42019125221.
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Affiliation(s)
- Mariella Munyuzangabo
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michelle F Gaffey
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Dina S Khalifa
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Daina Als
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Anushka Ataullahjan
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mahdis Kamali
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Reena P Jain
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sarah Meteke
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Amruta Radhakrishnan
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Shailja Shah
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Fahad J Siddiqui
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
- Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
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Vural T, Gölbaşı C, Bayraktar B, Gölbaşı H, Yıldırım AGŞ. Are Syrian refugees at high risk for adverse pregnancy outcomes? A comparison study in a tertiary center in Turkey. J Obstet Gynaecol Res 2021; 47:1353-1361. [PMID: 33496047 DOI: 10.1111/jog.14673] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 12/01/2020] [Accepted: 01/09/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE In this study, we aim to compare obstetric and perinatal outcomes between Turkish citizens and Syrian refugees who applied to a tertiary center in Izmir. MATERIALS AND METHODS Demographic characteristics, obstetric and neonatal outcomes of 8103 Syrian refugee pregnant women and 47 151 Turkish citizen pregnant women between January 2013 and December 2018 were retrospectively compared. Our primary aim was to compare the cesarean rates and obstetrical results between two groups and to decide antenatal care secondarily. RESULTS Syrian refugee pregnant women are statistically younger (p < 0.001), mean pregnancy duration and mean birth weight is statistically lower (p < 0.001 and p < 0.001, respectively). Adolescent pregnancy rates, preterm birth rates and anemia are statistically higher in refugee group (p < 0.001, p < 0.001, and p < 0.001, respectively). Primary cesarean section rates, combined and triple screening tests application rates, gestational diabetes screening rates are meaningfully lower in refugee group (p < 0.001, p < 0.001, p < 0.001, and p < 0.001, respectively). CONCLUSION Syrian refugees are at risk for inadequate antenatal care, adolescent pregnancy, and adverse pregnancy outcomes. Therefore, care should be given to these risks during pregnancy and childbirth to Syrian refugees.
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Affiliation(s)
- Tayfun Vural
- Department of Obstetrics and Gynecology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
| | - Ceren Gölbaşı
- Department of Obstetrics and Gynecology, İzmir Tınaztepe University Faculty of Medicine, Izmir, Turkey
| | - Burak Bayraktar
- Department of Obstetrics and Gynecology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
| | - Hakan Gölbaşı
- Department of Obstetrics and Gynecology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
| | - Alkım G Ş Yıldırım
- Department of Obstetrics and Gynecology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
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Harakow HI, Hvidman L, Wejse C, Eiset AH. Pregnancy complications among refugee women: A systematic review. Acta Obstet Gynecol Scand 2021; 100:649-657. [PMID: 33372265 DOI: 10.1111/aogs.14070] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 12/21/2020] [Accepted: 12/23/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Pregnancy is a time of increased vulnerability for women. Women of refugee background may be further challenged in pregnancy due to a complex series of physical, psychological and social factors. Previous studies show ambiguous results, with some showing increased the risk of prenatal complications in refugees compared with their native counterparts, whereas other studies report the opposite. With the current steep rise in the number of refugees and displaced persons worldwide, research is important to understand whether pregnancy disparities between this population and their native counterparts exist, and the causes. This systematic literature review aims to find out whether refugee women have a higher prevalence of adverse pregnancy outcomes and prenatal infections compared with native women. MATERIAL AND METHODS We conducted a literature search in the databases PubMed and Embase, supplemented with screening of reference lists and citations for relevant literature. We included studies published in English reporting risk of preeclampsia, spontaneous abortion and stillbirths, preterm birth, preterm prelabor rupture of membranes (PPROM) and adverse prenatal infectious diseases in women of refugee status. PROSPERO registration CRD42020205628. RESULTS We identified 19 articles eligible for inclusion: 12 were cross-sectional, six were cohort studies and one was a case-control study. The most frequently reported outcome in the literature was preterm birth (reported in 16 of the studies) and preeclampsia (reported in 11 of the studies). Refugees had increased risk of stillbirth (reported relative risk ranging from 1.20 to 2.24) and spontaneous abortion (reported relative risk ranging from 1.56 to 1.58), when compared with native women and a decreased risk of preeclampsia (reported relative risk ranging from 0.65 to 0.81). CONCLUSIONS The small number of articles eligible for inclusion in the review highlights the lack of research and knowledge on refugee health during pregnancy. Further research is required to understand and reduce disparities in pregnancy outcomes between refugee and non-refugee women.
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Affiliation(s)
| | - Lone Hvidman
- Department of Obstetrics and Gynecology, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Christian Wejse
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Andreas H Eiset
- Department of Public Health, Aarhus University, Aarhus, Denmark
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Kaplama ME, Yukkaldiran A, Ak S. Newborn hearing screening results: Comparison of Syrian and Turkish newborns; factors influencing the difference. Int J Pediatr Otorhinolaryngol 2020; 138:110390. [PMID: 33152981 DOI: 10.1016/j.ijporl.2020.110390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 09/15/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES This study aimed to compare the hearing screening results of Syrian and Turkish newborns and reveal the risk factors faced by Syrian refugees. METHODS The neonatal hearing screening results of newborns born in, or admitted to, the Sanliurfa Research and Education Hospital, Sanliurfa/Turkey, between January 01, 2018, and December 31, 2018, were analyzed. Newborns with congenital anomalies and syndromes were excluded from the study. Also, the neonatal hearing screening results and risk factors of newborns diagnosed with hearing loss were analyzed. RESULTS A total of 6034 Syrian and 37,219 Turkish newborns were included in the study. Hearing loss was found in 84 (0.2%) of 37,219 Turkish newborns and 26 (0.4%) of 6034 Syrian newborns. In this study, the risk factors such as consanguineous marriages, familial hearing loss, hospitalization in intensive care, prematurity, low birth weight (less than 1500 g), hyperbilirubinemia, use of ototoxic drugs, history of congenital infection, blood incompatibility, and trauma at birth were found in newborns with hearing loss. The risk factors were present in 41.7% of Turkish newborns and 65.4% of Syrian newborns with hearing loss. CONCLUSIONS The high hearing loss rates found in Syrian newborns showed how accurate it was to include the Syrian migrants born in Turkey into the neonatal hearing screening program and the newborns with hearing loss into appropriate rehabilitation programs. Further studies should focus on the risk factors faced by Syrian migrants so that the number of Syrian newborns with hearing loss can be reduced.
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Affiliation(s)
- Mehmet Erkan Kaplama
- University of Health Sciences, M. Akif Inan Research Hospital, Department of Otorhinolaryngology, Sanliurfa, Turkey.
| | - Ahmet Yukkaldiran
- Sanliurfa Education and Research Hospital, Department of Otorhinolaryngology, Sanliurfa, Turkey.
| | - Semih Ak
- University of Health Sciences, M. Akif Inan Research Hospital, Department of Otorhinolaryngology, Sanliurfa, Turkey.
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Agile Application of Digital Health Interventions during the COVID-19 Refugee Response. Ann Glob Health 2020; 86:135. [PMID: 33117656 PMCID: PMC7566526 DOI: 10.5334/aogh.2995] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The intersection of digital health platforms and refugee health in the context of the novel 2019 coronavirus disease (COVID-19) has not yet been explored. We discuss the ability of a novel mobile health (mhealth) platform to be effectively adapted to improve health access for vulnerable displaced populations. In a preliminary analysis of 200 Syrian refugee women, we found positive user feedback and uptake of an mhealth application to increase access to preventive maternal and child health services for Syrian refugees under temporary protection in Turkey. Rapid adaptation of this application was successfully implemented during a global pandemic state to perform symptomatic assessment, disseminate health education, and bolster national prevention efforts. We propose that mhealth interventions can provide an innovative, cost-effective, and user-friendly approach to access the dynamic needs of refugees and other displaced populations, particularly during an emerging infectious disease outbreak.
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Nassar AH, Theron G, Wright A. FIGO Statement: Antenatal care and refugees. Int J Gynaecol Obstet 2020; 152:152-154. [PMID: 32981105 DOI: 10.1002/ijgo.13394] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 09/22/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Anwar H Nassar
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Gerhard Theron
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
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- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon.,FIGO (International Federation of Gynecology and Obstetrics), London, UK
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Comparison of hearing screening results of Syrian refugees and Turkish newborns. Int J Pediatr Otorhinolaryngol 2020; 135:110095. [PMID: 32422369 DOI: 10.1016/j.ijporl.2020.110095] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 05/05/2020] [Accepted: 05/05/2020] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To analyze Turkish (Host) and Syrian (Refugee) newborn hearing screening results and factors of risk. METHODS All newborns between 02.12.2017 and 31.06.2019 were screened with Automated Auditory Brainstem Response (AABR) test. A total of 874 newborns were examined (172 refugee and 702 host newborns). All screened patients were questioned in terms of consanguineous marriage, speech disorder in family, delivery method (normal vaginal birth/caesarean birth), birth weight, birth week, newborn intensive care unit (ICU) necessity, newborn icterus and phototherapy. RESULT As for the host newborns, 360 (51.3%) passed ABR screening, 161 (23%) failed in either one ear, and 181 (25.8%) failed both ears. As for the refugee newborns, 60 (34.9%) passed ABR screening, 38 (22.1%) failed in either one ear, and 74 (43.0%) failed both ears. There was a significant statistical difference between host and refugee newborns' ears in terms of hearing loss detected in the screening test (p = 0.017). In terms of delivery method, the caesarean rate was higher in refugees, and a statistically significant difference existed between two groups (p = 0.023). There was a significant difference between refugee newborns and host newborns in terms of newborn ICU necessity rate (p = 0.014). CONCLUSIONS It was demonstrated clearly that hearing screening test results between the two groups were affected by low socio-economic level when host and refugees newborns were compared. In line with the findings of this study, it should be taken into account that bad living conditions depending on war and immigration throughout pregnancy, delivery method, and the need for newborn ICU in the newborn period may affect hearing results in newborns significantly.
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Inci MG, Kutschke N, Nasser S, Alavi S, Abels I, Kurmeyer C, Sehouli J. Unmet family planning needs among female refugees and asylum seekers in Germany - is free access to family planning services enough? Results of a cross-sectional study. Reprod Health 2020; 17:115. [PMID: 32727500 PMCID: PMC7389815 DOI: 10.1186/s12978-020-00962-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 07/08/2020] [Indexed: 11/18/2022] Open
Abstract
Background After the 1968 United Nations International Conference on Human Rights, access to family planning services became a human right. Such a service is of central importance to women’s empowerment and is empirically needed to provide adequate healthcare. For registered refugees and asylum seekers in Germany complementary family planning services, including all forms of contraception, are free of charge. Yet, the success of these services remains unclear. The aim of this study is to describe the current reproductive health status of female refugees and to provide an initial overview of their existing unmet family planning and contraception needs. Methods Over the course of 2 years, from December 2015 to December 2017, a set of 50 female-only discussion groups were conducted in community shelters for registered refugees in Berlin. A total of 410 women between the ages of 14 and 74 participated. A convenience sampling strategy was then applied and a total of 307 semi-structured questionnaires covering 41 items related to demographic data and women’s health were distributed to volunteering female participants over the age of 17. The statistical analysis of the questionnaires was performed using SPSS (IBM, PASW, Version 24). P-values less than or equal to 0.05 were considered statistically significant. Results Of the 307 participants, the majority were from Syria and Afghanistan (30% respectively). The mean age was 33 years (range: 18–63). On average, each woman had 2.5 births (range: 0–10). Twenty-four women (8%) were pregnant and fifty-four of the women (18%) were trying to become pregnant. The majority of women were classified as “requiring contraception” (n = 195; 63%) of which 183 gave further information on if and how they used family planning methods. The calculated unmet need for family planning in this group was 47%. Of the remaining 53% of the women who used contraception, many utilised “traditional” methods (34% withdrawal method; 8% calendar method) which have a pearl index of 4–18 and can therefore be classified as rather insufficient birth control methods. Intrauterine contraceptive devices were used by 30%. Conclusion Our study revealed that despite the provision of complementary family planning services, there remains unmet family planning and education needs in the female refugee community in Berlin. This study indicates that there is a major access gap to these services. Further research needs to be carried out to evaluate the access gap and clearly identify and implement action plans to address possible causes such as language barriers, lack of childcare and traumatic experiences.
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Affiliation(s)
- Melisa Guelhan Inci
- Department of Gynecology, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Nadja Kutschke
- Department of Gynecology, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Sara Nasser
- Department of Gynecology, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Sara Alavi
- Department of Gynecology, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Ingar Abels
- Mentoring Competence Center, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117, Berlin, Germany
| | - Christine Kurmeyer
- Women and equal opportunities officer, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353, Berlin, Germany
| | - Jalid Sehouli
- Department of Gynecology, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
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Çöl M, Bilgili Aykut N, Usturalı Mut AN, Koçak C, Uzun SU, Akın A, Say L, Kobeissi L. Sexual and reproductive health of Syrian refugee women in Turkey: a scoping review within the framework of the MISP objectives. Reprod Health 2020; 17:99. [PMID: 32571350 PMCID: PMC7310196 DOI: 10.1186/s12978-020-00948-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 06/14/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Turkey hosts the world's largest community of Syrians displaced by the conflict. The Minimum Initial Service Package (MISP) is a coordinated set of priority reproductive health services. There is not any scoping review assessing the RH situation of Syrian refugees in Turkey within the framework of the MISP objectives. The objectives of this review is to identify the situation of sexual and reproductive health (SRH) among Syrian refugee women in Turkey, and document the health services provided for them in terms of the components of MISP. We hoped to show evidence of gaps and help guide future research to focus on priority areas to improve the range, quality, and access to SRH services and to recommend public health interventions. METHOD The literature search was conducted in Turkish and English. Multiple electronic databases (Turkish Medline, Google Scholar, PubMed, Web of Science, Medline, Cochrane Database of Systematic Reviews, EBSCOHost, CINAHL, and Embase) were searched from January 2011 to May 2018. References published in the peer-reviewed literature, the grey-literature, and on websites were eligible for inclusion if they had conducted research on one or more of the following SRH topics specifically for Syrian women in Turkey: maternal and neonatal health/antenatal care, HIV and sexually transmitted infections, use of contraceptives, sexual violence, and services delivery and accessibility. References were excluded if any of the following criteria were relevant: not specific to Syrian women refugees in Turkey. Firstly, the titles and abstracts of the articles that were found were examined to determine if they met the eligibility criteria. Secondly, if the abstracts and titles met one or more of the eligibility criteria, the full text of the articles have been examined. Finally, standard forms were prepared and used to summarize the articles narratively. The results of the screening were recorded in Excel spreadsheets for comparison, and any disagreements among the researchers were resolved by consensus. The studies were grouped according to the MISP objectives. RESULTS A total of 24 publications were eligible for inclusion in the review. Consanguineous marriage rate was 56%. The rate of marriage under age 18 were very high. Mean age at first marriage was found to be between 18 and 20. The rate of antenatal care was inadequate. The rate of using a modern contraceptive method was 24% among married and all age groups of Syrian women. The rates of unmet family planning needs were about 35%. Among patients admitted to gynecology outpatient clinics, about half of the applicants were reported to have abnormal vaginal discharge. The reported rates of sexual violence were about 8%. Only 20% of Syrian women had regular gynecological visits. CONCLUSION Overall, we conclude that early marriage, low modern contraceptive use, unmet need for contraception, sexual and gender-based violence are the major SRH issues reported. There is a need for further studies to identify the barriers limiting service uptake as well as to document successful practices. Long term strategies to improve the SRH status of Syrian refugee women should be developed with participation of all stakeholders. This review is significant in terms of that it is the first scoping review assessing the RH situation of Syrian refugees in Turkey within the framework of the MISP objectives. Based on the data of this review, relevant policy makers should consider to improve the SRH status of Syrian women refugees in Turkey.
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Affiliation(s)
- M. Çöl
- Department of Public Health, Ankara University Faculty of Medicine, Ankara, Turkey
| | - N. Bilgili Aykut
- Başkent University, Woman-Child Health and Family Planning Research and Implementation Center, Ankara, Turkey
| | - A. N. Usturalı Mut
- Department of Public Health, Ankara University Faculty of Medicine, Ankara, Turkey
| | - C. Koçak
- Department of Public Health, Ankara University Faculty of Medicine, Ankara, Turkey
| | - S. U. Uzun
- Department of Public Health, Ankara University Faculty of Medicine, Ankara, Turkey
| | - A. Akın
- Başkent University, Woman-Child Health and Family Planning Research and Implementation Center, Ankara, Turkey
| | - L. Say
- World Health Organization, Department of Reproductive Health and Research, Geneva, Switzerland
| | - L. Kobeissi
- World Health Organization, Department of Reproductive Health and Research, Geneva, Switzerland
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30
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Verschuuren AEH, Postma IR, Riksen ZM, Nott RL, Feijen-de Jong EI, Stekelenburg J. Pregnancy outcomes in asylum seekers in the North of the Netherlands: a retrospective documentary analysis. BMC Pregnancy Childbirth 2020; 20:320. [PMID: 32450845 PMCID: PMC7249627 DOI: 10.1186/s12884-020-02985-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 05/04/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND With more than 20,000 asylum seekers arriving every year, healthcare for this population has become an important issue. Pregnant asylum seekers seem to be at risk of poor pregnancy outcomes. This study aimed to assess the difference in pregnancy outcomes between asylum seekers and the local Dutch population and to identify potential substandard factors of care. METHODS Using a retrospective study design we compared pregnancy outcomes of asylum-seeking and Dutch women who gave birth in a northern region of the Netherlands between January 2012 and December 2016. The following data were compared: perinatal mortality, maternal mortality, gestational age at delivery, preterm delivery, birth weight, small for gestational age children, APGAR score, intrauterine foetal death, mode of delivery and the need for pain medication. Cases of perinatal mortality in asylum seekers were reviewed for potential substandard factors. RESULTS A total of 344 Asylum-seeking women and 2323 Dutch women were included. Asylum seekers had a higher rate of perinatal mortality (3.2% vs. 0.6%, p = 0.000) including a higher rate of intrauterine foetal death (2.3% vs. 0.2%, p = 0.000), higher gestational age at birth (39 + 4 vs. 38 + 6 weeks, p = 0.000), labour was less often induced (36.9 vs. 43.8, p = 0.016), postnatal hospitalization was longer (2.24 vs. 1.72 days p = 0.006) and they received more opioid analgesics (27.3% vs. 22%, p = 0.029). Babies born from asylum-seeking women had lower birth weights (3265 vs. 3385 g, p = 0.000) and were more often small for gestational age (13.9% vs. 8.4%, p = 0.002). Multivariate analysis showed that the increased risk of perinatal mortality in asylum-seeking women was independent of parity, birth weight and gestational age at birth. Review of the perinatal mortality cases in asylum seekers revealed possible substandard factors, such as late initiation of antenatal care, missed appointments because of transportation problems, not recognising alarm symptoms, not knowing who to contact and transfer to other locations during pregnancy. CONCLUSION Pregnant asylum seekers have an increased risk of adverse pregnancy outcomes. More research is needed to identify which specific risk factors are involved in poor perinatal outcomes in asylum seekers and to identify strategies to improve perinatal care for this group of vulnerable women.
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Affiliation(s)
- A E H Verschuuren
- Department of Obstetrics and Gynaecology and Department of Health Sciences, Global Health, University Medical Center Groningen/University of Groningen, Hanzeplein, 19713 GZ, Groningen, the Netherlands.
| | - I R Postma
- Department of Obstetrics and Gynaecology and Department of Health Sciences, Global Health, University Medical Center Groningen/University of Groningen, Hanzeplein, 19713 GZ, Groningen, the Netherlands
| | - Z M Riksen
- Refaja ziekenhuis Stadskanaal, Boerhaavestraat, 19501 HE, Stadskanaal, the Netherlands
| | - R L Nott
- New Life, Sperwerlaan, 179561 BG, Ter Apel, the Netherlands
| | - E I Feijen-de Jong
- Department of General Practice & Elderly Medicine, University Medical Center Groningen, University of Groningen, Dirk Huizingastraat 3, 59713 GL, Groningen, the Netherlands
| | - J Stekelenburg
- Department of Obstetrics and Gynaecology and Department of Health Sciences, Global Health, University Medical Center Groningen/University of Groningen, Hanzeplein, 19713 GZ, Groningen, the Netherlands.,Department Obstetrics and Gynaecology, Medical center Leeuwarden, Henri Dunantweg 2, AD, 8934, Leeuwarden, the Netherlands
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Paquier L, Barlow P, Paesmans M, Rozenberg S. Do recent immigrants have similar obstetrical care and perinatal complications as long-term residents? A retrospective exploratory cohort study in Brussels. BMJ Open 2020; 10:e029683. [PMID: 32156759 PMCID: PMC7064068 DOI: 10.1136/bmjopen-2019-029683] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 01/30/2020] [Accepted: 02/12/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Recent immigrants (RIs) face various barriers affecting quality of care. The main research question assessed whether perinatal complications (during pregnancy, labour, delivery and neonatal period) were similar in RIs to those in long-term residents (LTRs). The secondary question assessed whether prenatal and perinatal care was similar in the two groups. METHODS This is a monocentric observational study, carried out in Brussels between November 2016 and March 2017 (n=1365). We surveyed 892 pregnant women during prenatal consultations and immediate postpartum period in order to identify RIs of less than 3 years (n=230, 25%) and compared them with LTRs (n=662). Sociodemographic data, baseline health status, prenatal care, obstetrical and neonatal complications were compared between these two groups. Multivariable binary logistic regression was conducted to examine the occurrence of perinatal complications (during pregnancy, labour and delivery, and neonatal period) between RIs and LTRs after adjustment for potential confounders. RESULTS RIs were living more frequently in precarious conditions. RIs were younger (p<0.001) and had a lower body mass index (p<0.001) than LTRs. Prenatal care was often delayed in RIs, resulting in fewer evaluations during the first trimester (p<0.001). They had a lower prevalence of gestational diabetes mellitus (p<0.05) and less complications during the pregnancy even after adjustment for confounding factors. Similar obstetrical care during labour and delivery occurred. After adjustment for confounding factors, no differences in labour and delivery complications were observed. Although RIs' newborns had a lower umbilical cord blood pH (<0.05), a lower 1 min of life Apgar score (p<0.01) and more frequently required respiratory assistance (p<0.05), no differences in the composite endpoint of neonatal complications were observed. No increase in complications in the RI group was detected whatever the considered period. CONCLUSION RIs had less optimal prenatal care but this did not result in more obstetrical and perinatal complications.
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Affiliation(s)
- Leila Paquier
- Obstetrics and Gynecology, CHU St Pierre Université Libre de Bruxelles, Brussels, Belgium
| | - Patricia Barlow
- Obstetrics and Gynecology, CHU St Pierre Université Libre de Bruxelles, Brussels, Belgium
| | | | - Serge Rozenberg
- Obstetrics and Gynecology, CHU St Pierre Université Libre de Bruxelles, Brussels, Belgium
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Turkay Ü, Aydın Ü, Salıcı M, Çalışkan E, Terzi H, Astepe BS, Varlıklı O. Comparison of pregnant Turkish women and Syrian refugees: Does living as a refugee have an unfavorable effect on pregnancy outcomes? Int J Gynaecol Obstet 2020; 149:160-165. [DOI: 10.1002/ijgo.13117] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 10/14/2019] [Accepted: 02/07/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Ünal Turkay
- Department of Obstetrics and Gynecology University of Health Sciences Derince Training and Research Hospital Derince Kocaeli Turkey
| | - Ümit Aydın
- Department of Obstetrics and Gynecology Medikal Park Hospital İzmit Kocaeli Turkey
| | - Mehmet Salıcı
- Department of Obstetrics and Gynecology University of Health Sciences Derince Training and Research Hospital Derince Kocaeli Turkey
| | - Ebru Çalışkan
- Kocaeli Provincial Health Directorate, quality coordinator and productivity İzmit Kocaeli Turkey
| | - Hasan Terzi
- Department of Obstetrics and Gynecology University of Health Sciences Derince Training and Research Hospital Derince Kocaeli Turkey
| | - Bahar S. Astepe
- Department of Obstetrics and Gynecology University of Health Sciences Derince Training and Research Hospital Derince Kocaeli Turkey
| | - Onursal Varlıklı
- Department of Pediatric Surgery University of Health Sciences Derince Training and Research Hospital Derince Kocaeli Turkey
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Yücel A, Alataş N, Yücel H, Güllüev M, Özsöz E, Uğur C. Newborn hearing screening results of refugees living in our city and the factors affecting the results. Int J Pediatr Otorhinolaryngol 2019; 123:187-190. [PMID: 31129457 DOI: 10.1016/j.ijporl.2019.05.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 05/15/2019] [Accepted: 05/15/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To investigate the changes in the risk factors affecting the results of the Newborn Hearing Screening (NHS) and the hearing test results of the Syrian refugees in our city. METHODS Syrian and Turkish newborns, born in our hospital between 01.01.2016 and 31.12.2017 and referred to our hospital from environmental hospitals for NHS, were included in this study. NHS results and risk factors were analyzed. RESULTS 786 Syrian and 7230 Turkish newborns were included in this study. 53 (6,74%) infants referred in both ears, 26 (3,30%) infants in the one ear. There was a significant relationship between the presence of hearing loss and the history of intensive care unit admittance, presence and absence of low birth weight and neonatal icterus at Syrian newborns. In the same period, 20 (0,3%) Turkish infants referred bilaterally and 45 (0,6%) newborns unilaterally (25 right ear, 20 left ear). There was a significant difference between Turkish and Syrian newborns in terms of very low and low birth weight and intensive care unit admittance. CONCLUSIONS The rate of hearing loss in Syrian refugee patients is quite high. Pregnant refugee women who are forced to migrate because of war face many risk factors and these people need to be included into the newborn hearing screening programs in the country where they took refuge in.
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Affiliation(s)
- Abitter Yücel
- Department of Otorhinolaryngology Head and Neck Surgery, University of Health Sciences, Konya Health Application Research Center, Konya, Turkey.
| | - Necat Alataş
- Department of Otorhinolaryngology Head and Neck Surgery, Usak University, Uşak, Turkey.
| | - Hilal Yücel
- Department of Otorhinolaryngology Head and Neck Surgery, University of Health Sciences, Konya Education Research Hospital, Turkey.
| | - Mustafa Güllüev
- Department of Otorhinolaryngology Head and Neck Surgery, University of Health Sciences, Konya Education Research Hospital, Turkey.
| | - Ekrem Özsöz
- Department of Otorhinolaryngology Head and Neck Surgery, University of Health Sciences, Konya Education Research Hospital, Turkey.
| | - Cüneyt Uğur
- Department of Pediatry, University of Health Sciences, Konya Health Application Research Center, Turkey.
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Affiliation(s)
- Tuğba Adalı
- Hacettepe University Institute of Population Studies Ankara
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User IR, Ozokutan BH. Common pediatric surgical diseases of refugee children: health around warzone. Pediatr Surg Int 2019; 35:803-806. [PMID: 31037325 DOI: 10.1007/s00383-019-04479-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/23/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE We aim to evaluate the sociodemographic and medical features of child-aged refugee patients and identify their health-related problems. METHODS Refugee children admitted to pediatric surgery department of a teaching hospital during the years 2012-2017 were included. Patients' files were reviewed retrospectively for sociodemographic and medical features. RESULTS A total of 254 patients with the mean age of 4.6 ± 4.15 years (0-16 years) were treated. Male-to-female ratio was 1.7. Most common diagnosis were inguino-scrotal pathologies (n = 50, 19.7%) followed by foreign body ingestion (n = 37, 14.6%) and corrosive esophagitis (n = 22, 8.7%). The cause of admission was a potentially preventable trauma in 24.4% of cases. Comorbid medical conditions were present in 49 patients (19.3%). Anemia was detected in 23.2% of cases. Weight according to age and gender were < 3 percentile in 29.1% of patients. Difficulties in communication, lack of former medical history and advanced presentation of disease were the challenges faced by caregivers. CONCLUSION The primary diagnoses for admission of refugee children were different from the routine practice and a significant part were from preventable causes. Comorbidities were common potentially having a negative influence on treatment processes. This can be a result of unfavorable living conditions and lack of medical care during migration.
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Affiliation(s)
- Idil Rana User
- Department of Pediatric Surgery, Faculty of Medicine, Gaziantep University, Sahinbey, Turkey.
- Sahinbey Arastirma Uygulama Hast., Cocuk Cerrahisi AD, Sahinbey, Gaziantep, Turkey.
| | - Bulent Hayri Ozokutan
- Department of Pediatric Surgery, Faculty of Medicine, Gaziantep University, Sahinbey, Turkey
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El Arnaout N, Rutherford S, Zreik T, Nabulsi D, Yassin N, Saleh S. Assessment of the health needs of Syrian refugees in Lebanon and Syria's neighboring countries. Confl Health 2019; 13:31. [PMID: 31297141 PMCID: PMC6598365 DOI: 10.1186/s13031-019-0211-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 06/10/2019] [Indexed: 11/10/2022] Open
Abstract
Background Health needs of displaced Syrians in refugee hosting countries have become increasingly complex in light of the protracted Syrian conflict. The primary aim of this study was to identify the primary health needs of displaced Syrians in Iraq, Jordan, Lebanon, Turkey, and Syria. Methods A systematic review was performed using 6 electronic databases, and multiple grey literature sources. Title, abstract, and full text screening were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The target population was Syrian individuals displaced due to conflict in Syria and its neighboring countries. The outcomes of interest were health needs (i.e. health problems that can be addressed by health services), gaps in health services, training, and workforce. Studies on mixed refugee populations and Syrians displaced prior to the conflict were excluded. Results The Lebanon-specific results of the review were validated through two stakeholder roundtable discussions conducted with representatives from primary healthcare centers, non-governmental organizations and humanitarian aid agencies. A total of 63 articles were included in the analysis. Mental health and women's health were identified as the greatest health needs in the region. The most common health problems were Non-communicable diseases in Jordan, women's health in Lebanon and mental health in Turkey. Studies addressing gaps in services found the highest gap in general healthcare services, followed by women's health, mental health, and vaccinations. Sub-optimal training and availability of health workers was also noted particularly in Syria.Results from the stakeholders' discussions in Lebanon showed communicable diseases, women's health and mental health as the main health needs of Syrian refugees in Lebanon. Reported barriers to accessing health services included geographical barriers and lack of necessary awareness and education. Conclusion There is a need for an enhanced synchronized approach in Syria's refugee hosting neighboring countries to reduce the existing gaps in responding to the needs of Syrian refugees, especially in regards to women's health, mental health, and communicable diseases. This mainly includes training of healthcare workers to ensure a skilled workforce and community-based efforts to overcome barriers to access, including lack of knowledge and awareness about highly prevalent health conditions.
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Affiliation(s)
- Nour El Arnaout
- 1Global Health Institute, American University of Beirut, Riad El Solh, Beirut, 1107 2020 Lebanon
| | - Spencer Rutherford
- 1Global Health Institute, American University of Beirut, Riad El Solh, Beirut, 1107 2020 Lebanon
| | - Thurayya Zreik
- 1Global Health Institute, American University of Beirut, Riad El Solh, Beirut, 1107 2020 Lebanon
| | - Dana Nabulsi
- 1Global Health Institute, American University of Beirut, Riad El Solh, Beirut, 1107 2020 Lebanon
| | - Nasser Yassin
- 2Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Riad El Solh, Beirut, 1107 2020 Lebanon.,3Issam Fares Institute for Public Policy and International Affairs, American University of Beirut, Riad El Solh, Beirut, 1107 2020 Lebanon
| | - Shadi Saleh
- 1Global Health Institute, American University of Beirut, Riad El Solh, Beirut, 1107 2020 Lebanon.,2Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Riad El Solh, Beirut, 1107 2020 Lebanon
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Çelik İH, Arslan Z, Ulubaş Işık D, Tapısız ÖL, Mollamahmutoğlu L, Baş AY, Demirel N. Neonatal outcomes in Syrian and other refugees treated in a tertiary hospital in Turkey. Turk J Med Sci 2019; 49:815-820. [PMID: 31195786 PMCID: PMC7018309 DOI: 10.3906/sag-1806-86] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background/aim Turkey accepts refugees from many countries, principally Syria. More than 2.7 million refugees live in Turkey.We evaluated the neonatal outcomes of refugees. Materials and methods We retrospectively reviewed the clinical and demographic characteristics of refugee infants born in our hospital between August 2013 and September 2016. Results Refugees (718 Syrian, 136 Iraqi, 32 Afghani, and 21 of other nationalities) accounted for 907 of 49,413 births. The mean refugee maternal age was lower than that of Turkish women, whereas the gestational age (GA) and birthweight were similar. Refugees required fewer cesarean sections but exhibited greater small- and large-for-GA rates (P < 0.05). Refugee and Turkish infant mortality rates did not differ significantly (0.8 vs. 0.4%). Eighty-nine (12.3%) refugee neonates and 6682 (13.5%) Turkish neonates were admitted to our neonatal intensive care unit (NICU). Jaundice and perinatal asphyxia were significantly more common in refugees, whereas respiratory distress syndrome, GA ≤32 weeks, and infant birthweight <2000 g were more common in Turkish infants. The total NICU admission cost of approximately 450,000 USD was paid by the Turkish government. Conclusion The numbers of refugees and refugee births continue to grow. The Turkish people and government have provided medical, social, and economic support to date; international assistance is needed.
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Affiliation(s)
- İstemi Han Çelik
- Division of Neonatology, Department of Pediatrics, University of Health Sciences,Etlik Zübeyde Hanım Women’s Health Teaching and Research Hospital, Ankara, Turkey
| | - Zehra Arslan
- Division of Neonatology, Department of Pediatrics, University of Health Sciences,Etlik Zübeyde Hanım Women’s Health Teaching and Research Hospital, Ankara, Turkey
| | - Dilek Ulubaş Işık
- Division of Neonatology, Department of Pediatrics, University of Health Sciences,Etlik Zübeyde Hanım Women’s Health Teaching and Research Hospital, Ankara, Turkey
| | - Ömer Lütfi Tapısız
- Department of Obstetrics and Gynecology, University of Health Sciences,Etlik Zübeyde Hanım Women’s Health Teaching and Research Hospital, Ankara, Turkey
| | - Leyla Mollamahmutoğlu
- Department of Obstetrics and Gynecology, University of Health Sciences,Etlik Zübeyde Hanım Women’s Health Teaching and Research Hospital, Ankara, Turkey
| | - Ahmet Yağmur Baş
- Division of Neonatology, Department of Pediatrics, University of Health Sciences,Etlik Zübeyde Hanım Women’s Health Teaching and Research Hospital, Ankara, Turkey,Division of Neonatology, Department of Pediatrics, School of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
| | - Nihal Demirel
- Division of Neonatology, Department of Pediatrics, University of Health Sciences,Etlik Zübeyde Hanım Women’s Health Teaching and Research Hospital, Ankara, Turkey,Division of Neonatology, Department of Pediatrics, School of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
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Ozcan PY. Retinopathy of Prematurity among Syrian Refugees: Incidence and Severity. Middle East Afr J Ophthalmol 2019; 26:7-10. [PMID: 31114117 PMCID: PMC6507370 DOI: 10.4103/meajo.meajo_50_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
PURPOSE: The aim of this study is to compare the incidence and severity of retinopathy of prematurity (ROP) in premature newborns of Syrian refugees and those of Turkish origin. METHODS: This retrospective, the single-center study included 1545 premature infants assigned to two groups based on maternal origin. Group 1 comprised 1366 premature infants of Turkish origin, and Group II comprised 179 premature infants born to Syrian refugees. All the premature infants were screened for ROP by the same ophthalmologist who is experienced in the screening and treatment of ROP. All data including gestational age (GA), birth weight (BW), the presence of ROP, and severe ROP collected from 2014 to 2017 were recorded for each group. The outcomes were compared between the two groups. RESULTS: The mean GA at birth was 30.6 ± 2 weeks and was significantly lower in Group II (P = 0.03). The overall incidence of ROP was similar in both groups. The incidence of severe ROP in Group II was nearly seven times higher than in Group I (1.5% and 10%, respectively). The incidence of severe ROP seen in Group II evaluated according to different ranges of GA and BW was higher than in Group I. CONCLUSION: The higher incidence of severe ROP in the premature newborns of Syrian refugees could play an important role in identifying ongoing health problems of refugees.
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Affiliation(s)
- Pehmen Yasin Ozcan
- Ophthalmology Department, Sanliurfa Education and Research Hospital, Sanliurfa, Turkey
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Abbasi-Kangevari M, Amin K, Kolahi AA. Antenatal care utilisation among Syrian refugees in Tehran: A respondent driven sampling method. Women Birth 2019; 33:e117-e121. [PMID: 30777740 DOI: 10.1016/j.wombi.2019.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/25/2019] [Accepted: 02/02/2019] [Indexed: 11/17/2022]
Abstract
AIM To assess the antenatal care utilisation among Syrian refugees in Tehran. METHODS This cross-sectional study was performed in 2016 in Tehran. As the refugees live in the city, we used Respondent Driven Sampling method for finding participants. Data were collected from interviews by a newly graduated Syrian general practitioner. FINDINGS In total, 231 women participated in the study. The mean (standard deviation) number of antenatal care visits was 3.73 (1.41) and 131(56.7%) women received at least four visits. The mean (standard deviation) number of antenatal care visits was higher among women with four or more living children compared with those with four or more: 3.47 (1.35); 95% confidence interval 3.28 to 3.66 vs. 2.82 (1.64); 95% confidence interval 2.25 to 3.40, p=0.01. The mean (standard deviation) number of antenatal care visits was higher among women whose spouses had academic degrees compared with those with lower education: 4.13 (1.37); 95% confidence interval 3.86-4.40 vs. 3.28 (1.31); 95% confidence interval 3.05-3.52, p<0.001. CONCLUSIONS Antenatal care utilisation of Syrian women in Tehran complied with neither national guidelines of Iran nor the recommendations of World Health Organization. However, antenatal care utilisation of Syrian women in Tehran was higher than the main destinations of Syrian refugees. Syrian women kept their own cultural behaviour in terms of antenatal care utilisation.
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Affiliation(s)
- Mohsen Abbasi-Kangevari
- Social Determinants of Health Research Center, Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kamal Amin
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali-Asghar Kolahi
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Bulut O, Sevuk S, Ustun N, Arslanoglu S, Ovali F. Retrospective Evaluation of Perinatal and Early Neonatal Outcomes in Infants of Migrant Mothers: A Case-Controlled Study. Medeni Med J 2019; 34:368-373. [PMID: 32821463 PMCID: PMC7433720 DOI: 10.5222/mmj.2019.86658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 11/09/2019] [Indexed: 11/28/2022] Open
Abstract
Objective: To investigate the incidence of perinatal features and neonatal morbidities in migrant mothers in comparison with native Turkish mothers. Method: A retrospective analysis was conducted using the medical records of 89 infants born to Syrian immigrants and 89 infants born to native Turkish mothers who were consecutively admitted to the neonatal intensive care unit of our hospital between 2015 and 2019. Statistical analyses were used to compare demographic data and perinatal and neonatal outcomes between the two groups. Results: Compared to Turkish mothers, Syrian mothers were significantly younger and adolescent pregnancy rate was significantly higher (p<0.01). The rates of multiple pregnancy, consanguineous marriage, and prolonged premature membrane rupture were also significantly higher in Syrian mothers (p<0.05). The incidence rates of congenital anomalies, respiratory distress syndrome, transient tachypnea of newborn pneumonia/bronchiolitis, sepsis, jaundice, and feeding problems were the same for infants born to Syrian and Turkish mothers (p>0.05). In addition, the two groups did not differ with respect to gestational week at birth, birth weight, sex, types of delivery, Apgar score, duration of hospital stay, and incidence of infant mortality (p>0.05). Conclusion: The immigrant status negatively affects perinatal and neonatal outcomes. However, the incidence rates of infant mortality and neonatal morbidity did not differ between infants born to Syrian and those born to Turkish mothers. This may be due to the recent improvements in the of overall health status of migrant women or of those migrants living in Turkey being able to have access to increased prenatal and postnatal period policies of mother-child health services which have been successfully implemented.
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Affiliation(s)
- Ozgul Bulut
- Istanbul Medeniyet University Goztepe Training and Research Hospital, Department of Pediatrics, Division of Neonatology, Istanbul, Turkey
| | - Sibel Sevuk
- Istanbul Medeniyet University Goztepe Training and Research Hospital, Department of Pediatrics, Division of Neonatology, Istanbul, Turkey
| | - Nuran Ustun
- Istanbul Medeniyet University Goztepe Training and Research Hospital, Department of Pediatrics, Division of Neonatology, Istanbul, Turkey
| | - Sertac Arslanoglu
- Istanbul Medeniyet University Goztepe Training and Research Hospital, Department of Pediatrics, Division of Neonatology, Istanbul, Turkey
| | - Fahri Ovali
- Istanbul Medeniyet University Goztepe Training and Research Hospital, Department of Pediatrics, Division of Neonatology, Istanbul, Turkey
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Dopfer C, Vakilzadeh A, Happle C, Kleinert E, Müller F, Ernst D, Schmidt RE, Behrens GMN, Merkesdal S, Wetzke M, Jablonka A. Pregnancy Related Health Care Needs in Refugees-A Current Three Center Experience in Europe. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1934. [PMID: 30189649 PMCID: PMC6165089 DOI: 10.3390/ijerph15091934] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 08/21/2018] [Accepted: 08/28/2018] [Indexed: 11/30/2022]
Abstract
Background: Immigration into Europe has reached an all-time high. Provision of coordinated healthcare, especially to refugee women that are at increased risk for adverse pregnancy outcomes, is a challenge for receiving health care systems. Methods: We assessed pregnancy rates and associated primary healthcare needs in three refugee cohorts in Northern Germany during the current crisis. Results: Out of n = 2911 refugees, 18.0% were women of reproductive age, and 9.1% of these were pregnant. Pregnancy was associated with a significant, 3.7-fold increase in primary health care utilization. Language barrier and cultural customs impeded healthcare to some refugee pregnant women. The most common complaints were demand for pregnancy checkup without specific symptoms (48.6%), followed by abdominal pain or urinary tract infections (in 11.4% of cases each). In 4.2% of pregnancies, severe complications such as syphilis or suicide attempts occurred. Discussion: We present data on pregnancy rates and pregnancy associated medical need in three current refugee cohorts upon arrival in Germany. Healthcare providers should be particularly aware of the requirements of pregnant migrants and should adapt primary caretaking strategies accordingly.
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Affiliation(s)
- Christian Dopfer
- Department of Pediatric Pneumology, Allergology, and Neonatology, Hannover Medical School, 30625 Hannover, Germany.
- German Center for Lung Research, Biomedical Research in End Stage and Obstructive Lung Disease/BREATH Hannover, 30625 Hannover, Germany.
| | | | - Christine Happle
- Department of Pediatric Pneumology, Allergology, and Neonatology, Hannover Medical School, 30625 Hannover, Germany.
- German Center for Lung Research, Biomedical Research in End Stage and Obstructive Lung Disease/BREATH Hannover, 30625 Hannover, Germany.
| | - Evelyn Kleinert
- Department of General Practice, University Medical Center Göttingen, 37073 Göttingen, Germany.
| | - Frank Müller
- Department of General Practice, University Medical Center Göttingen, 37073 Göttingen, Germany.
| | - Diana Ernst
- Department of Clinical Immunology and Rheumatology, Hannover Medical School, 30625 Hannover, Germany.
- German Center for Infection Research (DZIF), Partner Site Hannover-Braunschweig, 38124 Braunschweig, Germany.
| | - Reinhold E Schmidt
- Department of Clinical Immunology and Rheumatology, Hannover Medical School, 30625 Hannover, Germany.
- German Center for Infection Research (DZIF), Partner Site Hannover-Braunschweig, 38124 Braunschweig, Germany.
| | - Georg M N Behrens
- Department of Clinical Immunology and Rheumatology, Hannover Medical School, 30625 Hannover, Germany.
- German Center for Infection Research (DZIF), Partner Site Hannover-Braunschweig, 38124 Braunschweig, Germany.
| | - Sonja Merkesdal
- Department of Clinical Immunology and Rheumatology, Hannover Medical School, 30625 Hannover, Germany.
| | - Martin Wetzke
- Department of Pediatric Pneumology, Allergology, and Neonatology, Hannover Medical School, 30625 Hannover, Germany.
- German Center for Infection Research (DZIF), Partner Site Hannover-Braunschweig, 38124 Braunschweig, Germany.
| | - Alexandra Jablonka
- Department of Clinical Immunology and Rheumatology, Hannover Medical School, 30625 Hannover, Germany.
- German Center for Infection Research (DZIF), Partner Site Hannover-Braunschweig, 38124 Braunschweig, Germany.
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Güngör ES, Seval O, İlhan G, Verit FF. Do Syrian refugees have increased risk for worser pregnancy outcomes? Results of a tertiary center in İstanbul. Turk J Obstet Gynecol 2018; 15:23-27. [PMID: 29662712 PMCID: PMC5894532 DOI: 10.4274/tjod.64022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 01/24/2018] [Indexed: 12/01/2022] Open
Abstract
Objective: To compare obstetric and perinatal outcomes of Syrian refugee pregnants and Turkish counterparts who gave birth at a tertiary center in İstanbul. Materials and Methods: A retrospective study including the birth records of 704 Syrian refugees and 744 Turkish pregnant women between January 2016 and May 2017 were analyzed. Demographic data, obstetric and neonatal outcomes were compared. The primary aims of this study were to evaluate the pregnancy outcomes and cesarean rates between the groups. The secondary outcomes were the use of antenatal vitamin supplementation, hemoglobin-hematocrit values, and maternal complications. Results: Our results showed that the use of folic acid and iron supplementation rates during pregnancy were similar between the groups (folic acid supplementation 8.1% vs 6.5%, p=0.264; iron supplementation 20.7% vs 19.6%, p=0.125; respectively for Turkish women and Syrian refugees). Cesarean rates were significantly higher for Turkish patients than in Syrian refugees (42.7% vs 32.7%; p<0.05). Gestational age at delivery was significantly higher among Turkish women when compared with Syrian refugees (37.7±2.3 vs 36.4±2.3 weeks, p<0.05), but there was no significant difference regarding the birtweights’ of the newborns (3134 g vs 3066 g for Turkish women and Syrian refugees, respectively, p=0.105). Although obstetric complications were seen more often in Syrian refugees, it did not reach statistical difference (9.7% vs 8.1%, respectively, p=0.285). Conclusion: Syrian refugees use antenatal vitamin supplementations at similar rates to Turkish citizens and obstetric and perinatal outcomes are similar between the groups.
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Affiliation(s)
- Emre Sinan Güngör
- Süleymaniye Maternity Research and Training Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Olcay Seval
- Süleymaniye Maternity Research and Training Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Gülşah İlhan
- Süleymaniye Maternity Research and Training Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Fatma Ferda Verit
- Süleymaniye Maternity Research and Training Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
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