The oral health status of Syrian refugee children in Jordan: An exploratory study

Factors associated with access to dental care among refugees: A systematic review of quantitative studies

OBJECTIVES

To identify, appraise and synthesize the published evidence from quantitative studies on the individual and contextual-level factors determining access to dental care among refugees worldwide.

METHODS

A systematic literature search was conducted until the last week of February 2022 in four electronic databases - MEDLINE, Embase, Web of Science (all databases) and APA PsycINFO - without any restrictions. Quantitative studies published in English language and meeting the a priori eligibility criteria were reviewed and data extracted. Quality assessment was conducted using the National Institutes of Health tool. The identified factors were stratified according to the framework of the Behavioural Model of Health Services Use, and the evidence related to each of these factors was summarized in tables. Narrative synthesis of the findings was conducted.

RESULTS

The search retrieved 6776 unique records, of which 69 were deemed eligible for full-text screening and nine studies were included in the final data analysis and synthesis. The studies were rated to be of 'fair' quality at best. Self-reported previous dental visits was the most commonly used measure of access. Associations between individual-level factors and dental care access were most frequently examined (predisposing [n = 6], need [n = 2] and enabling [n = 1]), while the contextual-level factors were rarely examined (predisposing and enabling [n = 1, each]).

CONCLUSIONS

Individual-level predisposing factors, such as English language proficiency, education, health and dental literacy and acculturation and integration, were shown to be significantly associated with refugees' access. There is limited evidence to determine the effect of individual enabling and need and contextual factors.

Higher prevalence of dental caries and periodontal problems among refugees: A scoping review

Background

We assessed the prevalence data on oral health diseases, namely dental caries and periodontitis, among refugees and asylum seekers worldwide.

Methods

A systematic search of Scopus, Embase, and PubMed retrieved 1225 records; following title and abstract screening, 58 studies remained for full-text eligibility screening based on pre-defined inclusion criteria. Twenty-six studies were included in the review.

Results

Dental caries and tooth loss due to caries were high in refugee populations, regardless of their age, gender, or nationality. The adult population had a mean decayed, missing, and filled teeth (DMFT) index score of 9.2 (standard deviation (SD) = 2.3); children had a score of 3.1 (SD = 1.1) for deciduous teeth and 2.5 (SD = 1.1) for permanents. Caries prevalence among refugees ranged from 4.6% to 98.7%, and gingivitis from 5.7% to 100%, indicating a high heterogeneity in their oral health. Regarding oral health accessibility, 17% to 72% of refugees had never been to a dentist, showing a very low level of accessibility to dental health services.

Conclusions

Interventions and policies need to be designed to reduce oral health inequalities among refugee populations and asylum seekers, and host countries must implement strategies to increase their access to oral health care. Existing data should be used to set priorities for improving the oral health of refugees.

Registration

Open Science Framework: https://doi.org/10.17605/OSF.IO/SU59K.

Looking beyond: complex holistic care needs of Syrian and Iraqi refugee children and adolescents

OBJECTIVE

Protracted international conflict has seen escalating numbers of displaced and resettled Syrian and Iraqi refugees, raising concerns for their health and well-being. This paper describes the demographic and clinical profiles of recently resettled Syrian and Iraqi refugee children and adolescents across physical, psychosocial, developmental and educational domains using standardised multidisciplinary assessments.

DESIGN

A cross-sectional observational study was undertaken of initial specialist paediatric multidisciplinary Refugee Health Service assessments completed at the tertiary paediatric hospital (Western Australia) between June 2015 and September 2019.

RESULTS

Three hundred and twenty-seven children and adolescents (264 Syrian, 63 Iraqi) were assessed following resettlement. Witnessed trauma (86%) and disclosed adversity (median Refugee Adverse Childhood Experiences score 3, range 1-14) were universally high. Almost all patients had health issues identified across physical (99%), psychosocial (76%) and developmental/educational (75%) domains. Interrupted education (65%) and death of a family member (16%) were significantly associated with psychological morbidities. Common comorbidities included dental caries (78%), non-infectious disease (76%), vitamin D deficiency (72%), malnutrition (46%; overweight/obesity 23%), and psychological (32%; post-traumatic stress disorder 4.3%) and developmental (9.5%) concerns. Emerging and alarming child protection concerns were prevalent (17%), with females demonstrating especially high risks.

CONCLUSION

This is the largest comprehensive study demonstrating the complex and cross-dimensional health needs and specific vulnerabilities of resettled Syrian and Iraqi refugee children and adolescents. Early comprehensive standardised multidisciplinary paediatric assessments, and culturally safe, trauma-informed interventions and follow-up are required to optimise resettlement outcomes and promote well-being.

Eritrean Refugees' and Asylum-Seekers' Attitude towards and Access to Oral Healthcare in Heidelberg, Germany: A Qualitative Study

Oral health concerns in Eritrean refugees have been an overlooked subject. This qualitative study explored the access of Eritrean refugees and asylum-seekers (ERNRAS) to oral health care services in Heidelberg, Germany, as well as their perceptions and attitudes towards oral health care. It involved 25 participants. We employed online semi-structured interviews (n = 15) and focus group discussions (n = 2). The data was recorded, transcribed, and analysed, using thematic analysis. The study found out that most of the participants have a relatively realistic perception and understanding of oral health. However, they have poor dental care practices, whilst a few have certain misconceptions of the conventional oral hygiene tools. Along with the majority's concerns regarding psychosocial attributes of poor oral health, some participants are routinely consuming Berbere (a traditional spice-blended pepper) to prevent bad breath. Structural or supply-side barriers to oral healthcare services included: communication hurdles; difficulty in identifying and navigating the German health system; gaps in transculturally, professionally, and communicationally competent oral health professionals; cost of dental treatment; entitlement issues (asylum-seekers); and appointment mechanisms. Individual or demand-side barriers comprised: lack of self-sufficiency; issue related to dental care beliefs, trust, and expectation from dentists; negligence and lack of adherence to dental treatment follow-up; and fear or apprehension of dental treatment. To address the oral health burdens of ERNRAS, it is advised to consider oral health education, language-specific, inclusive, and culturally and professionally appropriate healthcare services.

Oral health assessment in a sample of displaced people as a result of the war in Syria in Damascus city: results of non-profit initiative

BACKGROUND

War on Syria extended for a long time and resulted in significant impacts on various aspects, one of these aspects was displaced people crisis, and thus its impact on complete neglecting of oral health despite of its importance and impacts on the general health. This study aims to assess the oral health of the displaced Syria sample as a result of the war on Syria.

METHODS

The sample included 118 patients of displaced families from different regions and cities to shelters in Damascus city, and the study included 118 control samples from the Faculty of Dentistry, Damascus University. The non-profit initiative team included 20 dentists of all dental specialties. Oral health was assessed using DMFT index. Data were analyzed using SPSS V.22 in comparison with the gender of the patients, age groups, and socioeconomic status. Finally, the number of the treatment provided by the non-profit initiative was collected and presented in the study.

RESULTS

No significant differences found in the DMFT index between children and adults (P = 0.750), DMFT value ranged between (0 and 11) with a mean value (2.4). The total DMFT value for adults was (2.77), while for children (2.12). Also, no statistical difference was found between males and females (P = 0.688). While the control group had an average DMFT value of (2.37), the difference between the displaced and control samples was not significant. Over 200 dental treatments were provided by the team.

CONCLUSION

This study concluded that the DMFT value is high among the displaced people as one of the consequences of the war on Syria, however, no significant difference was found when the results of the displaced sample was compared to a control sample.

Design, implementation, and evaluation of a PRECEDE-PROCEED model-based intervention for oral and dental health among primary school students of Rafsanjan city: a mixed method study

Background

Oral and dental health has a significant impact on public health as well as the quality of life among individuals and families. This study aims to design, implement, and evaluate an intervention based on the PRECEDE-PROCEED model for oral and dental health among primary school students in Rafsanjan city, Southern Iran.

Methods

According to the nature of the model and with the focus group discussion and interview methods, in phases 1 to 4 (PRECEDE), predisposing, enabling, and reinforcing factors related to oral health were identified. The training program was designed and consisted of six sessions for students (250 students) with a brushing session, three sessions for parents, and two sessions for teachers. Process evaluation and the effect of the program on behavioral and factors affecting oral health were evaluated (PROCEED).

Results

In the qualitative section, seven predisposing factors, five enabling factors, and two reinforcing factors were identified. A training program based on the PRECEDE-PROCEED model was found to be effective in increasing the mean scores of the above constructs and the students’ brushing behavior (P < 0.001).

Conclusion

Based on the model planning phases, the factors affecting the brushing behavior of children aged 6–12 years were identified. The educational program has had a significant effect on improving the scores of predisposing, enabling and reinforcing factors and children’s brushing behavior.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11585-z.

Dental services provided to Syrian refugee children in Jordan: A retrospective study

BACKGROUND

Little is known about oral health care in Syrian refugee children in host countries. We describe the pattern and nature of oral healthcare service provided to Syrian refugee children in Jordan METHOD: The clinical records of 3 to 7-year-old children who attended dental clinics at Zaatari refugee camp over a period of 8 months were retrieved and analyzed.

RESULTS

Records of 259 children were analyzed. The mean age of the study sample was 5.6 years, and all included children were born in Zaatari refugee camp. Most children (66%; n = 171) presented because of dental pain and/or dental infection. Dental extraction was the most common procedure (55%), followed by dental fillings (25%), pulpotomy (10.6%), and stainless steel crown (9.2%). Most patients (75.3%; n = 195) received only one dental procedure during their stay in the camp, and no significant correlation between age and number of dental procedures was found.

CONCLUSIONS

Oral health care is not a priority in this population, and the available capacity for dental services is insufficient. Dental health programs should be implemented to improve refugee dental care.

Pediatric Healthcare Utilization in a Large Cohort of Refugee Children Entering Western Europe During the Migrant Crisis

: Background: Currently, half of the population displaced worldwide is children and adolescents. Little is known on healthcare demand in underage migrants.

MATERIALS AND METHODS

We analyzed healthcare utilization in n = 1.411 children and adolescents living in a large German refugee reception in 2015-2016.

RESULTS

The mean age of all included refugees was 9 years (60.8% male). The majority came from the eastern Mediterranean region. During a mean camp inhabitance of 34 days, 57.6% needed primary healthcare, with a significant inverse correlation of healthcare seeking frequency with age and duration of camp inhabitance. Infants and unaccompanied minors displayed particular high demands for medical help.

DISCUSSION

Our analysis showed that pediatric primary healthcare in pediatric and adolescent refugees are most sought during the first period upon arrival with particular demand in infants, toddlers, and unaccompanied minors. Based on this data, future care taking strategies should be adapted accordingly.

Syria Profile of the Epidemiology and Management of Early Childhood Caries Before and During the Time of Crisis

Syria has witnessed the greatest humanitarian crisis of forcibly displaced population since World War II. The present review aimed to outline Syria's profile of the epidemiology and management of early childhood caries (ECC). Before the crisis, the burden of ECC amongst Syrian pre-schoolers had been growing in prevalence and severity. Comparable data showed an increase in the burden of ECC amongst Syrian children aged five years, rising from 74% in 1991 to 81% in 2011, with a dmft value of 8.6. A similar increase was observed in the burden of ECC amongst Syrian children aged three years, rising from 50% in 1991 to 56% in 2011, with a dmft value of 6.1. Whilst there are no data on the burden of ECC during the current crisis, estimates could be extrapolated from data on the current burden of dental caries amongst Syrian primary school children living inside Syria or in informal settlements outside Syria. Such data suggested that the burden of ECC might have further increased amongst Syrian pre-schoolers during the crisis time. This is due to the crisis exacerbating effect on ECC risk factors, in terms of increasing the existing high sugar intake amongst Syrian pre-schoolers as well as increasing different barriers Syrian families face to fresh foods, sugar-free medicines, oral hygiene and fluoride products and accessing essential preventative dental care. Tackling the growing burden of ECC amongst Syrian pre-schoolers should not be postponed till post-crisis time. The seed work for relevant public health interventions could start and be embedded in different health and social initiatives taking place during the time of crisis. A number of public health interventions informed by relevant international and local (Syrian) studies conducted during the time of crisis have been suggested to tackle the burden of ECC amongst Syrian young children. They include a mix of upstream, midstream, and downstream interventions that aim to reduce sugar intake, improve feeding and oral hygiene practices, increase access to an appropriate source of fluoride and build the capacity of the Syrian dental and wider workforce to tackle the growing burden of ECC in Syrian pre-schoolers.