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Im H, Saleh M, Khetarpal RM. Embodiment of structural vulnerability: illness experiences among Somali refugee women in urban displacement. ETHNICITY & HEALTH 2024:1-24. [PMID: 39087316 DOI: 10.1080/13557858.2024.2385112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/22/2024] [Indexed: 08/02/2024]
Abstract
OBJECTIVES Forced migration and its subsequent sequelae have caused refugees to face significant adversities throughout the displacement process, making them susceptible to significant health issues. Refugees displaced in Africa are a group especially vulnerable to poor health outcomes, experiencing a documented decline in overall physical and mental health status and rise in mortality from non-communicable diseases (NCDs). Despite the heightened health risks experienced by Somali refugees, particularly women, research into their complex illness experiences and co-/multimorbid health conditions is scarce, leaving a gap in our understanding of the multifaceted health challenges of this population. DESIGN Using structural vulnerability theory, this study explores how the broader host context shapes illness experiences for Somali refugee women in Kenya. Specifically, we describe the factors associated with illness experiences of urban Somali refugee women and how this compares with women with other similarly situated identities, such as Somali Kenyan women, other/non-Somali refugees, and Kenyan women. In-depth interviews were conducted with 43 women in Eastleigh, Kenya. RESULTS Using hybrid thematic analysis, the emergent themes were grouped into three distinct domains: (1) multimorbid, complex illness experiences, (2) embodiment of structural vulnerability, and (3) distinct/shared vulnerability among refugee/non-refugee women. Results suggest that illness experiences of displaced refugee women are inextricably linked to traumatic experiences before displacement, as well as the experiences of transmigration stressors and the hostile socio-legal dynamics encountered post-displacement. CONCLUSIONS Our findings also have implications for the need to consider intersectional identities when examining for differential exposure to structural risks and the susceptibility to poor health experiences as well as supports the need for urgent change and improvement in systems of social protection and basic care for refugees experiencing prolonged displacement.
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Affiliation(s)
- Hyojin Im
- School of Social Work, Virginia Commonwealth University, Richmond, VA, USA
| | - Muna Saleh
- School of Social Work, Virginia Commonwealth University, Richmond, VA, USA
| | - Rupa M Khetarpal
- Center for Research on Ending Violence, The State University of New Jersey, Rutgers, NJ, USA
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Yu Q, Qu Y, Zhang L, Yao X, Yang J, Chen S, Liu H, Wang Q, Wu M, Tao J, Zhou C, Alage IL, Liu S. Spatial spillovers of violent conflict amplify the impacts of climate variability on malaria risk in sub-Saharan Africa. Proc Natl Acad Sci U S A 2024; 121:e2309087121. [PMID: 38557184 PMCID: PMC11009658 DOI: 10.1073/pnas.2309087121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 02/02/2024] [Indexed: 04/04/2024] Open
Abstract
Africa carries a disproportionately high share of the global malaria burden, accounting for 94% of malaria cases and deaths worldwide in 2019. It is also a politically unstable region and the most vulnerable continent to climate change in recent decades. Knowledge about the modifying impacts of violent conflict on climate-malaria relationships remains limited. Here, we quantify the associations between violent conflict, climate variability, and malaria risk in sub-Saharan Africa using health surveys from 128,326 individuals, historical climate data, and 17,429 recorded violent conflicts from 2006 to 2017. We observe that spatial spillovers of violent conflict (SSVCs) have spatially distant effects on malaria risk. Malaria risk induced by SSVCs within 50 to 100 km from the households gradually increases from 0.1% (not significant, P>0.05) to 6.5% (95% CI: 0 to 13.0%). SSVCs significantly promote malaria risk within the average 20.1 to 26.9 °C range. At the 12-mo mean temperature of 22.5 °C, conflict deaths have the largest impact on malaria risk, with an approximately 5.8% increase (95% CI: 1.0 to 11.0%). Additionally, a pronounced association between SSVCs and malaria risk exists in the regions with 9.2 wet days per month. The results reveal that SSVCs increase population exposure to harsh environments, amplifying the effect of warm temperature and persistent precipitation on malaria transmission. Violent conflict therefore poses a substantial barrier to mosquito control and malaria elimination efforts in sub-Saharan Africa. Our findings support effective targeting of treatment programs and vector control activities in conflict-affected regions with a high malaria risk.
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Affiliation(s)
- Qiwei Yu
- Department of Geography, State Key Laboratory of Remote Sensing Science, Faculty of Geographical Science, Beijing Normal University, Beijing100875, China
| | - Ying Qu
- Department of Geography, State Key Laboratory of Remote Sensing Science, Faculty of Geographical Science, Beijing Normal University, Beijing100875, China
| | - Liqiang Zhang
- Department of Geography, State Key Laboratory of Remote Sensing Science, Faculty of Geographical Science, Beijing Normal University, Beijing100875, China
| | - Xin Yao
- Department of Geography, State Key Laboratory of Remote Sensing Science, Faculty of Geographical Science, Beijing Normal University, Beijing100875, China
| | - Jing Yang
- Department of Geography, State Key Laboratory of Remote Sensing Science, Faculty of Geographical Science, Beijing Normal University, Beijing100875, China
| | - Siyuan Chen
- Department of Geography, State Key Laboratory of Remote Sensing Science, Faculty of Geographical Science, Beijing Normal University, Beijing100875, China
| | - Hui Liu
- Department of Geography, State Key Laboratory of Remote Sensing Science, Faculty of Geographical Science, Beijing Normal University, Beijing100875, China
| | - Qihao Wang
- Department of Geography, State Key Laboratory of Remote Sensing Science, Faculty of Geographical Science, Beijing Normal University, Beijing100875, China
| | - Mengfan Wu
- Department of Geography, State Key Laboratory of Remote Sensing Science, Faculty of Geographical Science, Beijing Normal University, Beijing100875, China
| | - Junpei Tao
- Department of Geography, State Key Laboratory of Remote Sensing Science, Faculty of Geographical Science, Beijing Normal University, Beijing100875, China
| | - Chenghu Zhou
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographical Science and Natural Resources, Chinese Academy of Sciences, Beijing100101, China
| | - Isiaka Lukman Alage
- Space Research and Development Division, African Regional Centre for Space Science and Technology Education in English Ile ife, Ile ife, Osun220282, Nigeria
| | - Suhong Liu
- Department of Geography, State Key Laboratory of Remote Sensing Science, Faculty of Geographical Science, Beijing Normal University, Beijing100875, China
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Simonek T, Zahos H, Mahroof-Shaffi S, Harkensee C. Seasonal patterns of communicable disease incidence and antibiotic prescribing in Moria refugee camp, Greece. J Public Health (Oxf) 2024; 46:41-50. [PMID: 37968097 DOI: 10.1093/pubmed/fdad212] [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] [Received: 06/02/2023] [Revised: 09/27/2023] [Accepted: 10/19/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Infectious diseases remain a major risk for refugees living in camps. Limited research has been undertaken into the burden and impact of infections in the current refugee crisis around the Mediterranean.This analysis examines the frequency and incidence rates of common infections, and use of antibiotics at a healthcare facility inside Moria refugee camp on the island of Lesvos, Greece, during the winter and summer seasons of 2019. METHODS This is a retrospective analysis of routinely, prospectively collected service data from the main acute healthcare facility inside Moria camp. RESULTS Of a total of 9601 consultations, 25.16% were for infections (winter: 31.53%, summer: 19.45%). Respiratory, skin and gastrointestinal infections were the most frequent, with incidence rates up to 3.5 times, 50 times and twice as high as those in Western Europe, respectively. Antibiotic prescribing was high (27.7% of all respiratory infections) with high use of broad-spectrum antibiotics (40.2%), raising concerns about induction of antimicrobial resistance. CONCLUSIONS The burden of infectious diseases in refugee camps remains high throughout all seasons. Antimicrobial stewardship programmes should be adapted to refugee camp settings to prevent the development of unnecessary antimicrobial resistance. Improving living conditions and access to healthcare in refugee camps is likely to reduce infection rates and antimicrobial resistance among refugees.
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Affiliation(s)
- Tomas Simonek
- UNHCR Camp Lesbos Greece, St. Elizabeth University, Namestie, 1 Maja 1, 81000 Bratislava, Slovakia
| | - Helen Zahos
- School of Nursing and Midwifery, Griffith University, Parklands Drive, Southport, QLD 4222, Gold Coast, Australia
| | | | - Christian Harkensee
- Queen Elizabeth Hospital Gateshead, Queen Elizabeth Avenue, Gateshead, NE9 6SX, UK
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Logie CH, Okumu M, Admassu Z, Perez-Brumer A, Ahmed R, Luna ML, MacKenzie F, Kortenaar JL, Berry I, Hakiza R, Katisi B, Musoke DK, Nakitende A, Batte S, Kyambadde P, Taing L, Giordana G, Mbuagbaw L. HIV Vulnerabilities Associated with Water Insecurity, Food Insecurity, and Other COVID-19 Impacts Among Urban Refugee Youth in Kampala, Uganda: Multi-method Findings. AIDS Behav 2024; 28:507-523. [PMID: 38048017 DOI: 10.1007/s10461-023-04240-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 12/05/2023]
Abstract
Food insecurity (FI) and water insecurity (WI) are linked with HIV vulnerabilities, yet how these resource insecurities shape HIV prevention needs is understudied. We assessed associations between FI and WI and HIV vulnerabilities among urban refugee youth aged 16-24 in Kampala, Uganda through individual in-depth interviews (IDI) (n = 24), focus groups (n = 4), and a cross-sectional survey (n = 340) with refugee youth, and IDI with key informants (n = 15). Quantitative data was analysed via multivariable logistic and linear regression to assess associations between FI and WI with: reduced pandemic sexual and reproductive health (SRH) access; past 3-month transactional sex (TS); unplanned pandemic pregnancy; condom self-efficacy; and sexual relationship power (SRP). We applied thematic analytic approaches to qualitative data. Among survey participants, FI and WI were commonplace (65% and 47%, respectively) and significantly associated with: reduced SRH access (WI: adjusted odds ratio [aOR]: 1.92, 95% confidence interval [CI]: 1.19-3.08; FI: aOR: 2.31. 95%CI: 1.36-3.93), unplanned pregnancy (WI: aOR: 2.77, 95%CI: 1.24-6.17; FI: aOR: 2.62, 95%CI: 1.03-6.66), and TS (WI: aOR: 3.09, 95%CI: 1.22-7.89; FI: aOR: 3.51, 95%CI: 1.15-10.73). WI participants reported lower condom self-efficacy (adjusted β= -3.98, 95%CI: -5.41, -2.55) and lower SRP (adjusted β= -2.58, 95%CI= -4.79, -0.37). Thematic analyses revealed: (1) contexts of TS, including survival needs and pandemic impacts; (2) intersectional HIV vulnerabilities; (3) reduced HIV prevention/care access; and (4) water insecurity as a co-occurring socio-economic stressor. Multi-method findings reveal FI and WI are linked with HIV vulnerabilities, underscoring the need for HIV prevention to address co-occurring resource insecurities with refugee youth.
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Affiliation(s)
- Carmen H Logie
- Factor Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Room 504, Toronto, ON, M5S 1V4, Canada.
- United Nations University Institute for Water, Environment, and Health, Hamilton, ON, Canada.
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
- Centre for Gender & Sexual Health Equity, Vancouver, BC, Canada.
| | - Moses Okumu
- School of Social Work, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Zerihun Admassu
- Factor Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Room 504, Toronto, ON, M5S 1V4, Canada
| | - Amaya Perez-Brumer
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Rushdia Ahmed
- Factor Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Room 504, Toronto, ON, M5S 1V4, Canada
| | - Marianne Lahai Luna
- Department of Geography and Planning, University of Toronto, Toronto, ON, Canada
| | - Frannie MacKenzie
- Factor Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Room 504, Toronto, ON, M5S 1V4, Canada
| | - Jean-Luc Kortenaar
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Isha Berry
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Robert Hakiza
- Young African Refugees for Integral Development (YARID), Kampala, Uganda
| | - Brenda Katisi
- Young African Refugees for Integral Development (YARID), Kampala, Uganda
| | | | | | - Shamilah Batte
- Organization for Gender Empowerment and Rights Advocacy (OGERA) Uganda, Kampala, Uganda
| | - Peter Kyambadde
- National AIDS Control Program, Ministry of Health, Kampala, Uganda
- Most At Risk Population Initiative Clinic, Mulago Hospital, Kampala, Uganda
| | - Lina Taing
- United Nations University Institute for Water, Environment, and Health, Hamilton, ON, Canada
| | - Gio Giordana
- World Food Programme East Africa, Nairobi, Kenya
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, ON, Canada
- Centre for Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
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Bridi L, Kaki DA, Behnam R, Khan X, Albahsahli B, Bencheikh N, Aljenabi R, Ahmadi N, Dajani R, Al-Rousan T. Attitudes toward dementia and cognitive aging among Syrian refugees resettled in Jordan: a qualitative study. BMC Public Health 2023; 23:2307. [PMID: 37990313 PMCID: PMC10664261 DOI: 10.1186/s12889-023-17183-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 11/08/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Mounting evidence is revealing disparities in cognitive function and heightened dementia risk among refugees, yet research in this area remains scant. Despite bearing most of the world's refugee burden, limited-resource countries like Jordan are facing challenges when dealing with refugee health. There is a lack of research on the attitudes toward dementia and the cognitive healthcare gaps among refugees in Jordan. METHODS 32 older (≥ 55 years) Syrian refugees resettled in Jordan were recruited through a local community-based organization and interviewed in four focus groups (2 female and 2 male groups). Interviews were transcribed and translated, then coded using inductive thematic analysis. RESULTS Mean age of the sample was 60.1 years and 53.1% were female. Only 34.4% rated their memory as good or excellent. Themes were organized using the socioecological model: 1) At the individual level, participants believed high levels of stress, including low socioeconomic status, poor health, and traumatic history from their refugee experience increased their dementia risk. 2) Interpersonally, there is a fear of dementia due to the possible impact and burden on loved ones, particularly with the stigma surrounding dementia. 3) At the community level, participants noted that resettlement in Jordan - with a shared language, religion, and culture - offered protective effects due to facilitated access to social connection, information, and mental health self-care. 4) At the institution and policy level, participants believed older refugees faced restrictive policies for economic aid, healthcare, and employment, presenting a significant barrier to healthy aging. CONCLUSIONS Findings from this study are the first to examine the attitudes of Syrian refugees in Jordan toward dementia and cognitive aging. These results could provide essential data inclusive of refugees as Jordan develops its National Dementia Plan. Investing in dementia awareness interventions and age-friendly neighborhoods may benefit aging refugees in limited-resources settings.
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Affiliation(s)
- Lana Bridi
- School of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Dahlia A Kaki
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, USA
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Rawnaq Behnam
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, USA
| | - Xara Khan
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, USA
- School of Social Sciences, University of California, San Diego, San Diego, CA, USA
| | - Behnan Albahsahli
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, USA
| | - Nissma Bencheikh
- School of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Raghad Aljenabi
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, USA
- School of Social Sciences, University of California, San Diego, San Diego, CA, USA
| | - Nargis Ahmadi
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, USA
| | - Rana Dajani
- Department of Biology and Biotechnology, The Hashemite University, Zarqa, Jordan
| | - Tala Al-Rousan
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, USA.
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Jensen NK, Frøslev T, Foverskov E, Glymour M, Sørensen HT, Hamad R. The association of neighborhood socioeconomic characteristics with cardiovascular health: A quasi-experimental study of refugees to Denmark. Health Place 2023; 84:103128. [PMID: 37844523 PMCID: PMC10823536 DOI: 10.1016/j.healthplace.2023.103128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/22/2023] [Accepted: 09/22/2023] [Indexed: 10/18/2023]
Abstract
Neighborhood socioeconomic disadvantage is associated with cardiovascular health, although it is unclear which specific aspects of neighborhoods matter most. We leveraged a natural experiment in which refugees to Denmark were quasi-randomly assigned to neighborhoods across the country during 1986-1998, creating variation in exposure to various aspects of neighborhood disadvantage. The cohort was followed through December 2018. Exposures included neighborhood-level family income, educational attainment, unemployment, and welfare transfers measured in the first neighborhood after arrival to Denmark. Outcomes included cardiovascular risk factors (hyperlipidemia, hypertension, diabetes and anxiety/depression) and cardiovascular disease (acute myocardial infarction and ischemic heart disease). Neighborhood-level income and education were most consistently associated with cardiovascular risk factors, whereas welfare transfers were most consistently associated with cardiovascular disease. Addressing these specific aspects of neighborhood disadvantage could therefore lower the risk of poor cardiovascular health among refugees. Future research is warranted to examine if results are generalizable to other immigrant groups, countries or time periods.
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Affiliation(s)
- Natasja Koitzsch Jensen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark; Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Trine Frøslev
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Else Foverskov
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Maria Glymour
- Department of Epidemiology, Boston University, School of Public Health, Boston, MA, USA
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Rita Hamad
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA
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Amarasena L, Zwi K, Hu N, Lingam R, Raman S. Changing landscape of paediatric refugee health in South Western Sydney, Australia: a retrospective observational study. BMJ Open 2023; 13:e064497. [PMID: 37852766 PMCID: PMC10603544 DOI: 10.1136/bmjopen-2022-064497] [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: 09/06/2022] [Accepted: 07/04/2023] [Indexed: 10/20/2023] Open
Abstract
OBJECTIVES To examine the changing health needs of refugee children and young people (CYP) entering Australia, in relation to key government policy changes. STUDY DESIGN Retrospective analysis of health service use data over 11 years. SETTING Paediatric refugee clinics in South Western Sydney (SWS), the Australian region with the largest annual resettlement of refugees. PARTICIPANTS Refugee CYP (≤25 years) attending the SWS paediatric refugee clinics for their first visit between 2009 and 2019. MEASURES Clinician defined health conditions categorised as communicable and non-communicable disease (NCD). RESULTS Data were analysed for 359 CYP, mean age 9.3 years; 212 male (59.1%). Most CYP (n=331, 92.2%) had health problems identified; 292 (81.3%) had ≥1 NCD and 24 (6.7%) had ≥1 communicable disease. The most frequent individual NCDs were dental disease (n=128, 35.7%) and vitamin D deficiency (n=72, 20.1%). Trend analysis showed increased odds of identifying an NCD from 2013 onwards (crude OR 1.77, 95% CI 1.06 to 2.96). Neurodevelopmental problems, especially Global Developmental Delay (n=31, 8.6%), emerged as more prevalent issues in the latter half of the decade. There were significantly increased odds of identifying a neurodevelopmental problem in 2016-2019, especially in 2016-2017 (adjusted OR 2.93, 95% CI 1.34 to 6.40). Key policy changes during this period included acceptance of refugees with disabilities from 2012, additional Australian Humanitarian Programme intake from the Eastern Mediterranean region and mandatory offshore processing for those seeking asylum by boat from 2013. In response to the changing needs, local health services adopted nurse-led primary healthcare screening, early childhood services, youth and disability clinics. CONCLUSIONS Refugee CYP in Australia are presenting with a growing burden of NCDs, with neurodevelopmental problems contributing. Government policy changes affect the sociodemographics of resettled populations, influencing health profiles. Paediatric refugee health services need to be responsive to the changing needs of these populations to optimise well-being.
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Affiliation(s)
- Lahiru Amarasena
- School of Women's and Children's Health, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
| | - Karen Zwi
- School of Women's and Children's Health, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
- Department of Community Child Health, Sydney Children's Hospitals Network Randwick and Westmead, Sydney, New South Wales, Australia
| | - Nan Hu
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Raghu Lingam
- School of Women's and Children's Health, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
- Department of Community Child Health, Sydney Children's Hospitals Network Randwick and Westmead, Sydney, New South Wales, Australia
| | - Shanti Raman
- School of Women's and Children's Health, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
- Department of Community Paediatrics, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
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Albahsahli B, Bridi L, Aljenabi R, Abu-Baker D, Kaki DA, Godino JG, Al-Rousan T. Impact of United States refugee ban and discrimination on the mental health of hypertensive Arabic-speaking refugees. Front Psychiatry 2023; 14:1083353. [PMID: 37636820 PMCID: PMC10449266 DOI: 10.3389/fpsyt.2023.1083353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 07/21/2023] [Indexed: 08/29/2023] Open
Abstract
Background Hypertension is a global leading cause of death which disproportionately affects refugees. This chronic disease increases the risk of heart disease, stroke, brain, and other end-organ disease, if left uncontrolled. The 2017 United States travel or "Muslim" ban prevented immigrants and refugees from seven Muslim-majority countries from entering the United States, including Syria and Iraq; two major contributors to the global refugee population. As of 2020, the United States has admitted more than 133,000 and 22,000 Iraqi and Syrian refugees, respectively. Studies on the health effects of this policy on refugees are lacking. This study qualitatively explores the impact of the refugee ban on United States resettled Syrian and Iraqi refugees with hypertension. Methods Participants were recruited through a federally qualified health center system that is the largest healthcare provider for refugees in San Diego, CA. All participants were Arabic-speaking refugees diagnosed with hypertension from Syria and Iraq. In-depth interviews took place between April 2021 and April 2022. Inductive thematic analysis was used to analyze data from semi-structured interviews. Results Participants (N = 109) include 53 women and 56 men (23 Syrian, 86 Iraqi). The average age was 61.3 years (SD: 9.7) and stay in the United States was 9.5 years (SD 5.92). Four themes emerged linking the travel ban's impact on health, in line with the society to cells framework: (1) family factors: the refugee ban resulted in family separation; (2) physiological factors: the refugee ban worsened participants' mental health, exacerbating hypertension and perceived health outcomes; (3) community factors: perpetuation of Islamophobia, xenophobia, and perceived discrimination were structural barriers with links to poorer health; and (4) individual factors: trickle down consequences led to worsened participant self-image and self-perception within their host community. Discussion The refugee ban negatively impacted the mental and physical health of United States resettled Arabic-speaking refugees through perceived discrimination, stress, and poor social integration. It continues to have long-lasting effects years after the ban was instated. Centering family reunification within the United States Refugee Admissions Program and tailoring interventions through the healthcare and public health systems are warranted to reduce hypertension disparities in this growing and overlooked population.
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Affiliation(s)
- Behnan Albahsahli
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, United States
| | - Lana Bridi
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, United States
- School of Medicine, University of California, San Diego, San Diego, CA, United States
| | - Raghad Aljenabi
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, United States
| | - Dania Abu-Baker
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, United States
- School of Social Work, San Diego State University, San Diego, CA, United States
| | - Dahlia A Kaki
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, United States
- School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Job G Godino
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, United States
- Laura Rodriguez Research Institute, Family Health Centers of San Diego, San Diego, CA, United States
| | - Tala Al-Rousan
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, United States
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Kim JY, Kim KJ, Kim KJ, Choi J, Seo J, Lee JB, Bae JH, Kim NH, Kim HY, Lee SK, Kim SG. Effect of a Wearable Device-Based Physical Activity Intervention in North Korean Refugees: Pilot Randomized Controlled Trial. J Med Internet Res 2023; 25:e45975. [PMID: 37467013 PMCID: PMC10398363 DOI: 10.2196/45975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/17/2023] [Accepted: 06/06/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Effective health interventions for North Korean refugees vulnerable to metabolic disorders are currently unelucidated. OBJECTIVE This study aimed to evaluate the effects of digital health interventions in North Korean refugees using a wearable activity tracker (Fitbit device). METHODS We conducted a prospective, randomized, open-label study on North Korean refugees aged 19-59 years between June 2020 and October 2021 with a 12-week follow-up period. The participants were randomly assigned to either an intervention group or a control group in a 1:1 ratio. The intervention group received individualized health counseling based on Fitbit data every 4 weeks, whereas the control group wore the Fitbit device but did not receive individualized counseling. The primary and secondary outcomes were the change in the mean daily step count and changes in the metabolic parameters, respectively. RESULTS The trial was completed by 52 North Korean refugees, of whom 27 and 25 were in the intervention and control groups, respectively. The mean age was 43 (SD 10) years, and 41 (78.8%) participants were women. Most participants (44/52, 95.7%) had a low socioeconomic status. After the intervention, the daily step count in the intervention group increased, whereas that in the control group decreased. However, there were no significant differences between the 2 groups (+83 and -521 steps in the intervention and control groups, respectively; P=.500). The effects of the intervention were more prominent in the participants with a lower-than-average daily step count at baseline (<11,667 steps/day). After the 12-week study period, 85.7% (12/14) and 46.7% (7/15) of the participants in the intervention and control groups, respectively, had an increased daily step count (P=.05). The intervention prevented the worsening of the metabolic parameters, including BMI, waist circumference, fasting blood glucose level, and glycated hemoglobin level, during the study period. CONCLUSIONS The wearable device-based physical activity intervention did not significantly increase the average daily step count in the North Korean refugees in this study. However, the intervention was effective among the North Korean refugees with a lower-than-average daily step count; therefore, a large-scale, long-term study of this intervention type in an underserved population is warranted. TRIAL REGISTRATION Clinical Research Information Service KCT0007999; https://cris.nih.go.kr/cris/search/detailSearch.do/23622.
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Affiliation(s)
- Ji Yoon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyoung Jin Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kyeong Jin Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jimi Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jinhee Seo
- Department of Food and Nutrition, Inha University, Incheon, Republic of Korea
| | - Jung-Been Lee
- Division of Computer Science and Engineering, Sun Moon University, Asan, Republic of Korea
| | - Jae Hyun Bae
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Nam Hoon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hee Young Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Soo-Kyung Lee
- Department of Food and Nutrition, Inha University, Incheon, Republic of Korea
| | - Sin Gon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
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10
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Mateen FJ, Hanafi I, Birbeck GL, Saadi A, Schmutzhard E, Wilmshurst JM, Silsbee H, Jones LK. Neurologic Care of Forcibly Displaced Persons: Emerging Issues in Neurology. Neurology 2023; 100:962-969. [PMID: 36859408 PMCID: PMC10186241 DOI: 10.1212/wnl.0000000000206857] [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: 09/21/2022] [Accepted: 12/07/2022] [Indexed: 03/03/2023] Open
Abstract
There is a growing number of forcibly displaced persons (FDPs) worldwide. With more than 100 million people forcibly displaced today, there is an urgent mandate to understand the neurologic care needs of this population and how neurologists and other health care workers can most effectively provide that care. In this Emerging Issues in Neurology article, we attempt to (1) define the scope of the problem of providing neurologic care to FDPs, (2) highlight commonly encountered clinical challenges related to neurologic care of FDPs, and (3) provide useful clinical information for neurologists and other clinicians who deliver care to FDPs with neurologic needs. We address the terminology of forcible displacement and how terms may differ across a person's migration journey. Common challenges encountered by FDPs with neurologic needs across settings include loss of support systems, loss of personal health information, language barriers and differing expression of symptoms, differing belief systems, epidemiologic patterns of disease unfamiliar to the clinician, and patients' fear and perceived risks of engaging with health systems. Practical approaches are shared for clinicians who encounter an FDP with a neurologic presentation. Finally, the article discusses many unmet neurologic needs of FDPs, which require significant investment. These include addressing lapses in neurologic care during displacement and understanding the effects of forcible displacement on people with chronic neurologic conditions. Future research and educational resources should focus on improving epidemiologic intelligence for neurologic conditions across geographies, developing curricula for optimizing the neurologic care of FDPs, and evaluating the most appropriate and effective uses of health technologies in humanitarian settings.
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Affiliation(s)
- Farrah J Mateen
- From the Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Department of Neurology (I.H.), University Hospital of Würzburg, Germany; Department of Neurology (G.L.B.), University of Rochester Medical Center, NY; Department of Neurology (A.S.), Massachusetts General Hospital, Boston; Department of Neurology (E.S.), Medical University Innsbruck, Austria; Department of Paediatric Neurology (J.M.W.), University of Cape Town, South Africa; American Academy of Neurology (H.S.), Minneapolis, MN; and Department of Neurology (L.K.J.), Mayo Clinic, Rochester, MN
| | - Ibrahem Hanafi
- From the Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Department of Neurology (I.H.), University Hospital of Würzburg, Germany; Department of Neurology (G.L.B.), University of Rochester Medical Center, NY; Department of Neurology (A.S.), Massachusetts General Hospital, Boston; Department of Neurology (E.S.), Medical University Innsbruck, Austria; Department of Paediatric Neurology (J.M.W.), University of Cape Town, South Africa; American Academy of Neurology (H.S.), Minneapolis, MN; and Department of Neurology (L.K.J.), Mayo Clinic, Rochester, MN
| | - Gretchen L Birbeck
- From the Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Department of Neurology (I.H.), University Hospital of Würzburg, Germany; Department of Neurology (G.L.B.), University of Rochester Medical Center, NY; Department of Neurology (A.S.), Massachusetts General Hospital, Boston; Department of Neurology (E.S.), Medical University Innsbruck, Austria; Department of Paediatric Neurology (J.M.W.), University of Cape Town, South Africa; American Academy of Neurology (H.S.), Minneapolis, MN; and Department of Neurology (L.K.J.), Mayo Clinic, Rochester, MN
| | - Altaf Saadi
- From the Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Department of Neurology (I.H.), University Hospital of Würzburg, Germany; Department of Neurology (G.L.B.), University of Rochester Medical Center, NY; Department of Neurology (A.S.), Massachusetts General Hospital, Boston; Department of Neurology (E.S.), Medical University Innsbruck, Austria; Department of Paediatric Neurology (J.M.W.), University of Cape Town, South Africa; American Academy of Neurology (H.S.), Minneapolis, MN; and Department of Neurology (L.K.J.), Mayo Clinic, Rochester, MN
| | - Erich Schmutzhard
- From the Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Department of Neurology (I.H.), University Hospital of Würzburg, Germany; Department of Neurology (G.L.B.), University of Rochester Medical Center, NY; Department of Neurology (A.S.), Massachusetts General Hospital, Boston; Department of Neurology (E.S.), Medical University Innsbruck, Austria; Department of Paediatric Neurology (J.M.W.), University of Cape Town, South Africa; American Academy of Neurology (H.S.), Minneapolis, MN; and Department of Neurology (L.K.J.), Mayo Clinic, Rochester, MN
| | - Jo M Wilmshurst
- From the Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Department of Neurology (I.H.), University Hospital of Würzburg, Germany; Department of Neurology (G.L.B.), University of Rochester Medical Center, NY; Department of Neurology (A.S.), Massachusetts General Hospital, Boston; Department of Neurology (E.S.), Medical University Innsbruck, Austria; Department of Paediatric Neurology (J.M.W.), University of Cape Town, South Africa; American Academy of Neurology (H.S.), Minneapolis, MN; and Department of Neurology (L.K.J.), Mayo Clinic, Rochester, MN
| | - Heather Silsbee
- From the Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Department of Neurology (I.H.), University Hospital of Würzburg, Germany; Department of Neurology (G.L.B.), University of Rochester Medical Center, NY; Department of Neurology (A.S.), Massachusetts General Hospital, Boston; Department of Neurology (E.S.), Medical University Innsbruck, Austria; Department of Paediatric Neurology (J.M.W.), University of Cape Town, South Africa; American Academy of Neurology (H.S.), Minneapolis, MN; and Department of Neurology (L.K.J.), Mayo Clinic, Rochester, MN.
| | - Lyell K Jones
- From the Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Department of Neurology (I.H.), University Hospital of Würzburg, Germany; Department of Neurology (G.L.B.), University of Rochester Medical Center, NY; Department of Neurology (A.S.), Massachusetts General Hospital, Boston; Department of Neurology (E.S.), Medical University Innsbruck, Austria; Department of Paediatric Neurology (J.M.W.), University of Cape Town, South Africa; American Academy of Neurology (H.S.), Minneapolis, MN; and Department of Neurology (L.K.J.), Mayo Clinic, Rochester, MN
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11
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Longstreth GF, Attix C, Kuck J. Torture Survivors and Asylum: Legal, Medical, and Psychological Perspectives. Am J Med 2023; 136:244-251. [PMID: 36370801 DOI: 10.1016/j.amjmed.2022.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 11/10/2022]
Abstract
Torture occurs worldwide. Survivors seeking asylum are detained and must complete a complicated legal process to prove a "well-founded fear of persecution" if returned to their home countries. Forensic evaluations guided by the United Nations Istanbul Protocol increase asylum grant rates. Medical evaluation emphasizes skin examination, which can provide strong evidence of torture. Female genital mutilation and cutting, a basis for asylum, is classified according to the World Health Organization. Many resettled refugees and foreign-born immigrants at urban health care facilities have been tortured, but few report it to physicians due to factors affecting both survivors and physicians. Specific torture methods can cause characteristic long-term sequelae. Painful somatic disorders of mind-body interaction and psychological disorders are common. Practices derived from cultural factors and traumatized individuals' feedback enhance management of survivors. Individual and group psychotherapy provide modest proven benefit, but assessment is limited. Physicians and psychotherapists should coordinate care.
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Affiliation(s)
- George F Longstreth
- Survivors of Torture International, San Diego, Calif; Veterans Administration San Diego Healthcare System, San Diego, Calif.
| | | | - Julie Kuck
- Survivors of Torture International, San Diego, Calif
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12
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Hart PL, Zahos H, Salt N, Schofield R, Mahroof-Shaffi S, Simonek T, Harkensee C. Lessons to learn from the analysis of routine health data from Moria Refugee Camp on Lesvos, Greece. J Public Health (Oxf) 2022:6840101. [DOI: 10.1093/pubmed/fdac127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 06/04/2022] [Accepted: 10/11/2022] [Indexed: 11/24/2022] Open
Abstract
Abstract
Background
Refugees in humanitarian settings commonly experience many health needs and barriers to access healthcare; health data from these settings are infrequently reported, preventing effective healthcare provision. This report describes health needs of refugees in Moria Camp on Lesvos, Greece—Europe’s largest refugee camp.
Methods
A set of routinely collected service data of 18 131 consultations of 11 938 patients, attending a primary care clinic in the camp over 6 months in 2019–20, was analysed retrospectively, focusing on chronic health conditions.
Results
The most frequent chronic conditions were musculoskeletal pain (25.1%), mental health (15.9%), cardiac (12.7%) and endocrine conditions (8.9%). In all, 70.4% of consultations were for acute health problems, with high rates of injuries and wounds (20.8%), respiratory infections (12.5%), gastroenteritis (10.7%) and skin problems (9.7%), particularly scabies.
Conclusions
The prevalence of acute and chronic health problems is high in this setting, with some likely attributable to the deplorable living conditions in the camp. Despite its magnitude, the interpretability of routine health data is limited. A research agenda is identified, and a framework for chronic disease management in refugee camps is proposed.
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Affiliation(s)
- Paul L Hart
- 22603 Esplanada Circle W, Boca Raton , FL 33433 , USA
| | - Helen Zahos
- Griffith University School of Nursing and Midwifery, , Gold Coast, 1 Hospital Boulevard, Southport, QLD 4215 , Australia
| | - Nicola Salt
- Wandsworth Care Commissioning Group Balham Park Surgery, , 236 Balham High Road, London, SW17 7AW , UK
| | - Roger Schofield
- Shalom House Palliative Care Centre , St David’s, Pembrokeshire, SA62 6BP , UK
| | | | | | - Christian Harkensee
- Gateshead Health NHS Foundation Trust , Queen Elizabeth Avenue, Gateshead, NE9 6SX , UK
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13
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Achiri E, Ibrahim MD. Efficiency Analysis of Syrian Refugees' Healthcare Services in Turkey and Other 3RP States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14986. [PMID: 36429703 PMCID: PMC9691198 DOI: 10.3390/ijerph192214986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/07/2022] [Accepted: 11/09/2022] [Indexed: 06/16/2023]
Abstract
Access to healthcare for refugees is often contextually and conceptually diverse. This study set out to evaluate the efficiency of the healthcare services provided for Syrian refugees in Turkey and other refugee response and resilience plan (3RP) states. Data envelopment analysis is utilized for efficiency analysis using primary healthcare system indicators. Efficiency is broken down into pure technical efficiency and scale efficiency to identify causes of inefficiency. Normative analysis is used to employ a teleological approach to better understand current refugee healthcare policies. The findings show a decline in the overall efficiency for Turkey and other 3RP states. However, Turkey's operational practices could be a model for other 3RP states due to its relatively high pure technical efficiency. Scale inefficiency negatively impacts the overall efficiency of Turkey's service, while other 3RP states exhibit a rather consistent performance. The study concludes that Turkey's healthcare system for refugees is inefficient, resulting in inadequate access for Syrian refugees. As such, operational and scale efficiency must be synergized for Turkey to fulfill its obligation to provide adequate healthcare for Syrian refugees. Additionally, COVID-19 was found to have exacerbated the challenges Syrian refugees face accessing healthcare. Policy recommendations have been made in line with the findings of the study.
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Affiliation(s)
- Emmanuel Achiri
- Department of Political Science and International Relations, Faculty of Business and Economics, Eastern Mediterranean University, Famagusta 99628, Turkey
| | - Mustapha D. Ibrahim
- Industrial Engineering Technology, Higher Colleges of Technology, Sharjah P.O. Box 7947, United Arab Emirates
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14
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Khouani J, Blatrix L, Tinland A, Jego M, Gentile G, Fond G, Loundou A, Fromentin M, Auquier P. Health status of recently arrived asylum seekers in their host country: results of a cross-sectional observational study. BMC Public Health 2022; 22:1688. [PMID: 36068557 PMCID: PMC9450400 DOI: 10.1186/s12889-022-14095-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/24/2022] [Indexed: 11/11/2022] Open
Abstract
Background The World Health Organization (WHO) considers that the heterogeneity of concepts and definitions of migrants is an obstacle to obtaining evidence to inform public health policies. There is no recent data on the health status of only asylum seekers who have recently arrived in their Western host country. The purpose of this study was to determine the health status of asylum seekers and search for explanatory factors for this health status. Methods This cross-sectional observational study screened the mental and somatic health of adult asylum seekers who had arrived in France within the past 21 days and went to the Marseille single center between March 1 and August 31, 2021. In order to study the explanatory factors of the asylum seekers' health status, a multivariate analysis was performed using a logistic regression model to predict the health status. Factors taken into account were those significantly associated with outcome (level < 0.05) in univariate analysis. Results In total, 419 asylum seekers were included and 96% CI95%[93;97.3] had at least one health disorder. Concerning mental health, 89% CI95% [85.1;91.4] had a mental disorder and in terms of somatic health exclusively, 66% CI95% [61.4;70.6] had at least one somatic disorder. Women were more likely to have a somatic disease OR = 1.80 [1.07; 3.05]. We found a statistically significant association between the presence of at least one disorder and sleeping in a public space OR = 3.4 [1.02;11.28] p = 0.046. This association is also found for mental disorders OR = 2.36 [1.16;4.84], p = 0.018. Conclusions Due to the high prevalence of health disorders our study found, asylum seekers are a population with many care needs when they arrive in their host country. The main factors linked to a poor health status seem to be related to a person’s sex, geographical origin and sleeping in a public space.
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Affiliation(s)
- Jérémy Khouani
- Aix-Marseille Univ, - CEReSS UR3279-Health Service Research and Quality of Life Center, Marseille, France. .,Department of General Practice, Aix-Marseille Univ, Marseille, France.
| | - Léo Blatrix
- Department of General Practice, Aix-Marseille Univ, Marseille, France
| | - Aurélie Tinland
- Aix-Marseille Univ, - CEReSS UR3279-Health Service Research and Quality of Life Center, Marseille, France.,Department of Psychiatry, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Maeva Jego
- Aix-Marseille Univ, - CEReSS UR3279-Health Service Research and Quality of Life Center, Marseille, France.,Department of General Practice, Aix-Marseille Univ, Marseille, France
| | - Gaëtan Gentile
- Department of General Practice, Aix-Marseille Univ, Marseille, France
| | - Guillaume Fond
- Aix-Marseille Univ, - CEReSS UR3279-Health Service Research and Quality of Life Center, Marseille, France.,Department of Psychiatry, Assistance Publique - Hôpitaux de Marseille, Marseille, France.,Department of Public Health, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Anderson Loundou
- Aix-Marseille Univ, - CEReSS UR3279-Health Service Research and Quality of Life Center, Marseille, France.,Department of Public Health, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Marilou Fromentin
- Department of General Practice, Aix-Marseille Univ, Marseille, France
| | - Pascal Auquier
- Aix-Marseille Univ, - CEReSS UR3279-Health Service Research and Quality of Life Center, Marseille, France.,Department of Public Health, Assistance Publique - Hôpitaux de Marseille, Marseille, France
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15
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A systematic review of effective strategies for chronic disease management in humanitarian settings; opportunities and challenges. Prev Med 2022; 161:107154. [PMID: 35817161 DOI: 10.1016/j.ypmed.2022.107154] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/29/2022] [Accepted: 07/05/2022] [Indexed: 11/22/2022]
Abstract
Large number of people with non-communicable diseases (NCDs) face barriers to adequate healthcare in humanitarian settings. We conducted a systematic literature review in MEDLINE/PubMed, Web of Science, EMBASE/DARE, Cochrane, and grey literature from 1990 to 2021 to evaluate effective strategies in addressing NCDs (diabetes, cardiovascular diseases, COPD, cancer) in humanitarian settings. From 2793 articles, 2652 were eliminated through title/abstract screening; 141 articles were reviewed in full; 93 were eliminated for not meeting full criteria. Remaining 48 articles were reviewed qualitatively to assess populations, settings, interventions, outcome, and efficacy and effectiveness; 38 studies addressed treatments, 9 prevention, and 7 epidemiology. Prevention studies broadly addressed capacity-building. Treatment and epidemiology studies largely addressed hypertension and diabetes. Interventions included web-based/mobile health strategies, pharmacy-level interventions, portable imaging, and capacity building including physical clinics, staff training, forging collaborations, guideline development, point-of-care labs, health promotion activities, EMR, and monitoring interventions. Collaboration between academia and implementing agencies was limited. Models of care were largely not well-described and varied between studies due to contextual constraints. Barriers to interventions included financial, logistical, organizational, sociocultural, and security. Cancer care is significantly understudied. Simplified care models adapted to contexts and program evaluations of implemented strategies could address gaps in applied research. Inherent challenges in humanitarian settings pose unavoidable perils to evidence generation which requires a shift in research mindset to match aspirations with practicality, research collaborations at the inception of projects, reworking of desired conventional level of research evidence considering resource-intense constraints (HR, time, cost), and adapted research tools, methods, and procedures.
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16
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Ngaruiya C, Bernstein R, Leff R, Wallace L, Agrawal P, Selvam A, Hersey D, Hayward A. Systematic review on chronic non-communicable disease in disaster settings. BMC Public Health 2022; 22:1234. [PMID: 35729507 PMCID: PMC9210736 DOI: 10.1186/s12889-022-13399-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 05/11/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs) constitute the leading cause of mortality globally. Low and middle-income countries (LMICs) not only experience the largest burden of humanitarian emergencies but are also disproportionately affected by NCDs, yet primary focus on the topic is lagging. We conducted a systematic review on the effect of humanitarian disasters on NCDs in LMICs assessing epidemiology, interventions, and treatment. METHODS A systematic search in MEDLINE, MEDLINE (PubMed, for in-process and non-indexed citations), Social Science Citation Index, and Global Health (EBSCO) for indexed articles published before December 11, 2017 was conducted, and publications reporting on NCDs and humanitarian emergencies in LMICs were included. We extracted and synthesized results using a thematic analysis approach and present the results by disease type. The study is registered at PROSPERO (CRD42018088769). RESULTS Of the 85 included publications, most reported on observational research studies and almost half (48.9%) reported on studies in the Eastern Mediterranean Region (EMRO), with scant studies reporting on the African and Americas regions. NCDs represented a significant burden for populations affected by humanitarian crises in our findings, despite a dearth of data from particular regions and disease categories. The majority of studies included in our review presented epidemiologic evidence for the burden of disease, while few studies addressed clinical management or intervention delivery. Commonly cited barriers to healthcare access in all phases of disaster and major disease diagnoses studied included: low levels of education, financial difficulties, displacement, illiteracy, lack of access to medications, affordability of treatment and monitoring devices, and centralized healthcare infrastructure for NCDs. Screening and prevention for NCDs in disaster-prone settings was supported. Refugee status was independently identified both as a risk factor for diagnosis with an NCD and conferring worse morbidity. CONCLUSIONS An increased focus on the effects of, and mitigating factors for, NCDs occurring in disaster-afflicted LMICs is needed. While the majority of studies included in our review presented epidemiologic evidence for the burden of disease, research is needed to address contributing factors, interventions, and means of managing disease during humanitarian emergencies in LMICs.
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Affiliation(s)
- Christine Ngaruiya
- Department of Emergency Medicine, Yale University, 464 Congress Avenue, Suite #260, New Haven, CT, 06519, USA.
| | - Robyn Bernstein
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Rebecca Leff
- Department of Emergency Medicine, Yale University, 464 Congress Avenue, Suite #260, New Haven, CT, 06519, USA
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Lydia Wallace
- Department of Emergency Medicine, Yale University, 464 Congress Avenue, Suite #260, New Haven, CT, 06519, USA
| | - Pooja Agrawal
- Department of Emergency Medicine, Yale University, 464 Congress Avenue, Suite #260, New Haven, CT, 06519, USA
| | - Anand Selvam
- Department of Emergency Medicine, Yale University, 464 Congress Avenue, Suite #260, New Haven, CT, 06519, USA
| | - Denise Hersey
- Director, Dana Medical Library, University of Vermont, Burlington, VT, USA
| | - Alison Hayward
- Division of Global Emergency Medicine, Department of Emergency Medicine, The Warren Alpert Medical School of Brown University, Providence, USA
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17
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Clark E, Steel N, Gillam TB, Sharman M, Webb A, Bucataru AM, Hanson S. Scarred survivors: gate keepers and gate openers to healthcare for migrants in vulnerable circumstances. J Res Nurs 2022; 27:245-255. [PMID: 35813168 PMCID: PMC9264407 DOI: 10.1177/17449871211043754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The main barriers to ‘vulnerable migrants’ receiving good quality primary care are language and administration barriers. Little is known about the experiences of healthcare discrimination faced by migrants from different cultural groups. The aim was to explore vulnerable migrants’ perspectives on primary healthcare in a UK city. Methods Three focus groups and two semi-structured interviews were aided by interpreters. These were analysed against a pre-developed framework based on national standards of care for vulnerable migrants. Recruitment was facilitated via a community organisation. Results In total, 13 participants took part, six women and seven men. There were five Arabic speakers, four Farsi speakers and four English speakers. Themes included access to primary care, mental health, use of interpreters, post-migration stressors and cultural competency. Conclusion Vulnerable migrants perceived high levels of discrimination and reported the value of a respectful attitude from health professionals. Appointment booking systems and re-ordering medication are key areas where language barriers cause the most disruption to patient care. Medication-only treatment plans have limitations for mental distress for this population. Community-based therapies which manage post-migration stressors are likely to enhance recovery.
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Affiliation(s)
- Emily Clark
- GP and Honorary Research Fellow, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Nicholas Steel
- Professor of Public Health, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Tara B Gillam
- Academic Public Health Trainee, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Monica Sharman
- Foundation Doctor, Yorkshire and the Humber Postgraduate Deanery
| | - Anne Webb
- Community Volunteer, Postdoctoral Researcher, Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Sarah Hanson
- Lecturer in Health Sciences, School of Health Sciences, University of East Anglia, Norwich, UK
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Audi MN, Mwenda KM, Wei G, Lurie MN. Healthcare accessibility in preconflict Syria: a comparative spatial analysis. BMJ Open 2022; 12:e059210. [PMID: 35508340 PMCID: PMC9073410 DOI: 10.1136/bmjopen-2021-059210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION There is scarce information about the allocation of health resources in Syria. Pre-existing inequalities were further intensified after the 2011 conflict which displaced over 50% of the population. This study provides an analysis of health inequalities in Syria focusing on spatial access to public hospitals and employs data from 2010, just prior to the outbreak of conflict. Establishing a preconflict snapshot of the health system could serve as a helpful baseline assessment for future studies to measure the impact of the conflict on the health system. Such information could also offer systematic data to guide postconflict reconstruction efforts. METHODS We compared two methods to quantify the inpatient bed access: provider to population ratio (PPR) and two-step floating catchment area (2SFCA) method. We compared PPR calculated at the governorate level with population weighted 2SFCA score calculated at a resolution of 2 km by 2 km. We then aggregated at the governorate level, tested multiple catchment sizes and calculated Gini coefficient for each governorate. RESULTS We found high inequality in access to public hospitals across and within governorates, especially in the north and eastern regions, where all governorates ranked in the lowest two quintiles using both PPR and 2SFCA. Relatively small governorates in the west and the south had higher spatial access and less inequality. Testing variability in catchment size showed that even at 125 km catchment, 65% of the country had accessibility below national average. CONCLUSION Methodologically, the use of 2SFCA provided more nuanced insights about hospital bed allocation than PPR. 2SFCA was able to account for the cross-boundary effect and road network quality. Realistic representation of health accessibility is possible in data-scarce settings such as Syria and could be adapted to assess health access inequalities in conflict and postconflict settings.
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Affiliation(s)
- Mhd Nour Audi
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Kevin M Mwenda
- Spatial Structures in the Social Sciences (S4), Population Studies and Training Center (PSTC), Brown University, Providence, Rhode Island, USA
| | - Guixing Wei
- Spatial Structures in the Social Sciences (S4), Population Studies and Training Center (PSTC), Brown University, Providence, Rhode Island, USA
| | - Mark N Lurie
- Brown University, School of Public Health, International Health Institute, Providence, Rhode Island, USA
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Al-Rousan T, AlHeresh R, Saadi A, El-Sabrout H, Young M, Benmarhnia T, Han BH, Alshawabkeh L. Epidemiology of cardiovascular disease and its risk factors among refugees and asylum seekers: Systematic review and meta-analysis. INTERNATIONAL JOURNAL OF CARDIOLOGY CARDIOVASCULAR RISK AND PREVENTION 2022; 12:200126. [PMID: 35199106 PMCID: PMC8851152 DOI: 10.1016/j.ijcrp.2022.200126] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/31/2021] [Accepted: 01/28/2022] [Indexed: 01/10/2023]
Abstract
Background Methods and results Conclusions
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Affiliation(s)
- Tala Al-Rousan
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
- Corresponding author. Herbert Wertheim School of Public Health, 9500 Gilman Dr., La Jolla, CA, 92093, USA.
| | - Rawan AlHeresh
- Department of Occupational Therapy, Massachusetts General Hospital Institute of Health Professions, Boston, MA, USA
| | - Altaf Saadi
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Hannah El-Sabrout
- University of California San Francisco Medical School, San Francisco, CA, USA
| | - Megan Young
- Department of Occupational Therapy, Massachusetts General Hospital Institute of Health Professions, Boston, MA, USA
| | - Tarik Benmarhnia
- Scripps Institution of Oceanography, University of California San Diego, La Jolla, CA, USA
| | - Benjamin H. Han
- Division of Geriatrics, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Laith Alshawabkeh
- Division of Cardiovascular Medicine, Department of Medicine, University of California San Diego, La Jolla, CA, USA
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20
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Health Inequalities amongst Refugees and Migrant Workers in the Midst of the COVID-19 Pandemic: a Report of Two Cases. Asian Bioeth Rev 2022; 14:107-114. [PMID: 35069882 PMCID: PMC8760588 DOI: 10.1007/s41649-021-00198-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/26/2021] [Accepted: 12/03/2021] [Indexed: 12/02/2022] Open
Abstract
Malaysia hosts a significant number of refugees, asylum-seekers and migrant workers. Healthcare access for these individuals has always proved a challenge: language barriers, financial constraints and mobility restrictions are some of the frequently cited hurdles. The COVID-19 pandemic has exacerbated these existing inequalities, with migrants and refugees bearing the brunt of chronic systemic injustices. Providing equitable healthcare access for all, regardless of their citizenship and social status remains an ethical challenge for healthcare providers, particularly within the framework of a resource-limited healthcare system. Inclusive healthcare and socio-economic policies are necessary to ensure every individual’s equal opportunity to attain good health. The collective experiences of refugees and migrants in the pursuit of healthcare, as highlighted by the two cases described, showcases the importance of equity in healthcare access and the detrimental implications of non-inclusive healthcare and socio-economic policies.
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21
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Tan ST, Low PTA, Howard N, Yi H. Social capital in the prevention and management of non-communicable diseases among migrants and refugees: a systematic review and meta-ethnography. BMJ Glob Health 2021; 6:bmjgh-2021-006828. [PMID: 34952855 PMCID: PMC8710856 DOI: 10.1136/bmjgh-2021-006828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 12/05/2021] [Indexed: 12/31/2022] Open
Abstract
Globally, the burden of non-communicable diseases (NCDs) falls disproportionately on underserved populations. Migrants and refugees are particularly vulnerable due to economic instability and systemic poverty. Despite the myriad of health risks faced by migrants and refugees, access to appropriate healthcare is hindered by structural, cultural and socioeconomic barriers. We conducted a systematic review and meta-ethnography to obtain critical insight into how the interplay of social capital and structural factors (eg, state policies and socioeconomic disadvantage) influences the prevention and treatment of NCDs in migrant and refugee populations. We included 26 studies of 14 794 identified articles, which reported qualitative findings on the structure and functions of social capital in NCD prevention and management among migrants and refugees. We synthesised findings, using the process outlined by Noblit and Hare, which indicated that migrants and refugees experienced weakened social networks in postmigration settings. They faced multiple barriers in healthcare access and difficulty navigating healthcare systems perceived as complex. Family as the core of social capital appeared of mixed value in their NCD prevention and management, interacting with cultural dissonance and economic stress. Community organisations were integral in brokering healthcare access, especially for information diffusion and logistics. Healthcare providers, especially general practitioners, were important bridges providing service-user education and ensuring a full continuum of quality care. While social capital reduced immediate barriers in healthcare access for NCD prevention and management, it was insufficient to address structural barriers. System-level interventions appear necessary to achieve equitable healthcare access in host countries. PROSPERO registration number: CCRD42020167846.
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Affiliation(s)
- Sok Teng Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Pei Ting Amanda Low
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Natasha Howard
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.,Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Huso Yi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
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22
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Backlund M, Olausson S. Nurses' Experiences as Care Providers for Refugees in Emergency and Critical Care in Jordan: A Qualitative Interview Study. Glob Qual Nurs Res 2021; 8:23333936211056932. [PMID: 34790839 PMCID: PMC8591209 DOI: 10.1177/23333936211056932] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 10/12/2021] [Accepted: 10/14/2021] [Indexed: 11/25/2022] Open
Abstract
During the global refugee crisis of the 2010s, hundreds of thousands of Syrians fled to
Jordan. As displaced Palestinians have had refugee status for several decades in Jordan
already, this study aimed to explore nurses’ perceptions of caring for Palestinian and
Syrian refugees within the context of critical and emergency care. The qualitative design
was executed through twelve semi-structured interviews with nurses working in refugee
camps and public hospitals. Three main themes were identified describing the nurses’
empathetic understanding of the refugees’ situation, various challenging factors, as well
as different aspects of the opportunities that they perceived in critical care and
emergency care. The experiences of publicly employed nurses generally differed from those
working in the camps. In addition, the findings indicate the importance of further
research conducted locally, as it suggests several elements that have a negative impact on
the quality of advanced healthcare for refugees.
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Affiliation(s)
- Maja Backlund
- Sahlgrenska Academy, Institution for Nursing Science and Health at Gothenburg University, Gothenburg, Sweden
| | - Sepideh Olausson
- Sahlgrenska Academy, Institution for Nursing Science and Health at Gothenburg University, Gothenburg, Sweden
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23
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Mohd Hanapi IR, Sahimin N, Maackara MJB, Annisa AS, Abdul Mutalib RNS, Lewis JW, Behnke JM, Lau YL, Mohd Zain SN. Prevalence of anti-Leptospira antibodies and associated risk factors in the Malaysian refugee communities. BMC Infect Dis 2021; 21:1128. [PMID: 34724919 PMCID: PMC8561983 DOI: 10.1186/s12879-021-06830-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 10/28/2021] [Indexed: 12/03/2022] Open
Abstract
Background Refugees in Malaysia, who are afflicted by poverty, conflict and poor health, are vulnerable to a range of zoonotic infections in the deprived environmental and social conditions under which they live. Exposure to infections such as leptospirosis, for which rodents are primary hosts, is of particular concern. Methods A wellness program was conducted to determine the presence of antibodies against Leptospira (seroprevalence) in 11 refugee community schools and centers in the Klang Valley, Malaysia. A total of 433 samples were assessed for IgG and IgM antibodies against Leptospira, using enzyme-linked immunosorbent assays (ELISA). Results Overall Leptospira seroprevalence was 24.7%, with 3.0% being seropositive for anti-Leptospira IgG and 21.7% for anti-Leptospira IgM. Factors significantly associated with overall Leptospira seroprevalence included: age, ethnicity, pet ownership, knowledge of disease and awareness of disease fatality. For IgM seroprevalence, significant risk factors included sex, ethnicity, eating habits with hands, pet ownership, the presence of rats, walking in bare feet and water recreation visits. Conclusions These findings highlight the need for improvements in health and well-being among the refugee community through disease awareness programs and provision of healthy behavior programs, particularly in hygiene and sanitation through community engagement activities.
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Affiliation(s)
- Izzah Ruzana Mohd Hanapi
- Institute of Biological Sciences, Faculty of Science, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Norhidayu Sahimin
- Tropical Infectious Diseases Research and Education Centre (TIDREC), Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | | | - Aufa Shofia Annisa
- Institute of Biological Sciences, Faculty of Science, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Raisya Nur Syazmeen Abdul Mutalib
- Department of Biomedical Science, Kulliyah of Allied Health Science, International Islamic University Malaysia, 25200, Kuantan, Pahang, Malaysia
| | - John W Lewis
- School of Biological Sciences, Royal Holloway, University of London, Egham, Surrey, TW20 OEX, UK
| | - Jerzy M Behnke
- School of Life Sciences, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Yee Ling Lau
- Department of Parasitology, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Siti Nursheena Mohd Zain
- Institute of Biological Sciences, Faculty of Science, Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
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24
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Aljadeeah S, Wirtz VJ, Nagel E. Cross-sectional survey to describe medicine use among Syrian asylum seekers and refugees in a German federal state: looking beyond infectious diseases. BMJ Open 2021; 11:e053044. [PMID: 34588262 PMCID: PMC8479972 DOI: 10.1136/bmjopen-2021-053044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES The aim of our study was to describe medicine use and document self-reported diseases or conditions for which medicines were used among Syrian asylum seekers and refugees (AS&Rs) in the German state of North Rhine-Westphalia (NRW). We examined in this study differences in the use of medicines among different age and sex groups of the study participants. SETTING Fifteen different refugee shared accommodation centres in the greater Cologne area, a community centre with a language school and consultation office, and other places frequented by the Syrian community. PARTICIPANTS Syrian AS&Rs registered in NRW and residing in the city of Cologne or surrounding areas. PRIMARY OUTCOME MEASURES The prevalence of using at least one medicine in the 7 days preceding data collection, and the use of prescribed medicines and self-medication. RESULTS Of the 1641 Syrian AS&Rs who took part in our study, the overall 7-day prevalence of medicine use was 34.9%. Among adults, headache and hypertension were the most common indications that led to medicine use. By dose, hypertension (954 doses) and diabetes (595 doses) were the first and second most frequent indication. Among children, fever and cough were the most common indication; ibuprofen and hederae helicis folium preparations were the most used medicines. Low prevalence was found of medicine use for the treatment of either infectious diseases or mental disorders. CONCLUSION Among the Syrian AS&Rs in NRW who participated in the study, non-communicable diseases (NCDs) were common presumed causes of use of medication among adults. We encourage future studies to pay more attention to NCDs medicine use among AS&Rs. Researchers should also consider reaching AS&Rs who live in private housing and not limit studies only to newly arrived AS&Rs who live in shared accommodation centres.
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Affiliation(s)
- Saleh Aljadeeah
- Institute of Medical Management and Health Science, University of Bayreuth, Bayreuth, Germany
| | - Veronika J Wirtz
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Eckhard Nagel
- Institute of Medical Management and Health Science, University of Bayreuth, Bayreuth, Germany
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25
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Phaiyarom M, Kosiyaporn H, Pudpong N, Sinam P, Suphanchaimat R, Julchoo S, Kunpeuk W. Access to Non-Communicable Disease (NCD) Services Among Urban Refugees and Asylum Seekers, Relative to the Thai Population, 2019: A Case Study in Bangkok, Thailand. Risk Manag Healthc Policy 2021; 14:3423-3433. [PMID: 34429673 PMCID: PMC8380139 DOI: 10.2147/rmhp.s314090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/10/2021] [Indexed: 11/23/2022] Open
Abstract
Background The health of urban refugees and asylum seekers (URAS) in Thailand has been under-researched compared with other groups of non-Thai populations, especially in the area of chronic non-communicable diseases (NCD). The objectives of this study were to i) examine NCD prevalence; ii) access to NCD services; and iii) factors associated with access to NCD services among urban refugees and asylum seekers (URAS) in comparison with the Thai population. Methods A cross-sectional study, using a self-administrative questionnaire adapted from the Thai Health and Welfare Survey (HWS), was conducted in 2019. URAS were randomly selected from the register of the Bangkok Refugee Center. One hundred and eighty-one URAS participated in the survey. The data were combined with 2941 Thai records from the HWS. The population scope was confined to Bangkok. Bivariate analysis by Chi-square, Fisher's exact, and Mann-Whitney U-tests was conducted to examine difference in demographic and access to NCD services between URAS and Thais. Multivariable logistic regression was performed to identify factors associated with access to NCD services. Results Overall, URAS were young, less educated, and poorer than Thais. The trend of NCDs was similar to the Thai population, except mental health disorders appeared to be more prevalent in URAS. Almost half of the URAS did not receive any formal treatment. Being insured, abiding with Buddhism, and living in more affluent households were factors associated with better access to NCD services. URAS from Asian countries had greater access to NCD care than those from non-Asian countries. Conclusion Policymakers should consider expanding the insurance coverage to URAS, similar to coverage for Thai populations. Additional studies on refugees' health status and service utilization in other settings outside Bangkok are strongly recommended.
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Affiliation(s)
- Mathudara Phaiyarom
- International Health Policy Program, Ministry of Public Health, Nonthaburi, 11000, Thailand
| | - Hathairat Kosiyaporn
- International Health Policy Program, Ministry of Public Health, Nonthaburi, 11000, Thailand
| | - Nareerut Pudpong
- International Health Policy Program, Ministry of Public Health, Nonthaburi, 11000, Thailand.,Sirindron College of Public Health, Chonburi, Thailand
| | - Pigunkaew Sinam
- International Health Policy Program, Ministry of Public Health, Nonthaburi, 11000, Thailand
| | - Rapeepong Suphanchaimat
- International Health Policy Program, Ministry of Public Health, Nonthaburi, 11000, Thailand.,Division of Epidemiology, Department of Disease Control, Ministry of Public Health, Nonthaburi, 11000, Thailand
| | - Sataporn Julchoo
- International Health Policy Program, Ministry of Public Health, Nonthaburi, 11000, Thailand
| | - Watinee Kunpeuk
- International Health Policy Program, Ministry of Public Health, Nonthaburi, 11000, Thailand
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Moustafa MK, Al-Hajj S, El-Hechi M, El Moheb M, Chamseddine Z, Kaafarani HMA. The Burden of Surgical Disease and Access to Care in a Vulnerable Syrian Refugee Population in Lebanon. World J Surg 2021; 45:3019-3026. [PMID: 34312694 PMCID: PMC8313117 DOI: 10.1007/s00268-021-06242-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2021] [Indexed: 11/27/2022]
Abstract
Background The Syrian conflict has produced one of the largest refugee crises in modern times. Lebanon has taken in more Syrian refugees per capita than any other nation. We aimed to study the burden of surgical disease and access to surgical care among Syrian refugees in Lebanon. Methods This study was designed as a convenient cross-sectional cluster-based population survey of all refugee camps throughout the Bekaa region of Lebanon. We used a modified version of the Surgeons OverSeas Assessment of Surgical Need to identify surgical conditions and barriers to care access. The head of household of each informal tented settlement provided demographic information after which two household members were randomly chosen and administered the survey. Results A total of 1,500 individuals from 750 households representing 21 camps were surveyed. Respondents had a mean age of 36.6 (15.0) years, 54.6% were female, and 59% were illiterate. Nearly 25% of respondents reported at least one surgical condition within the past year, most commonly involving the face, head, and neck region (32%) and extremities (22%). Less than 20% of patients with a surgical condition reported seeing any healthcare provider, > 75% due to financial hardship. Conclusions The prevalence of surgical disease among Syrian refugees is very high with a fourth of refugees suffering from one or more surgical conditions over the past year. The surgical needs of this vulnerable population are largely unmet as financial reasons prevent patients from seeking care. Local and humanitarian efforts need to include increased access to surgical care.
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Affiliation(s)
| | - Samar Al-Hajj
- Faculty of Health Sciences, Health Management and Policy Department, American University in Beirut, Bliss Street, Beirut, Lebanon.
| | - Majed El-Hechi
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA
| | - Mohamad El Moheb
- Department of Surgery, University of Virginia, Charlottesville, VA, USA
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA
| | - Zahraa Chamseddine
- Faculty of Health Sciences, Health Management and Policy Department, American University in Beirut, Bliss Street, Beirut, Lebanon
| | - Haytham M A Kaafarani
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA.
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Pudpong N, Kosiyaporn H, Phaiyarom M, Kunpeuk W, Sinam P, Julchoo S, Suphanchaimat R. Situation of Self-Reported Anxiety and Depression among Urban Refugees and Asylum Seekers in Thailand, 2019. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7269. [PMID: 34299727 PMCID: PMC8307443 DOI: 10.3390/ijerph18147269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/26/2021] [Accepted: 07/01/2021] [Indexed: 11/17/2022]
Abstract
Academic evidence on the health of urban refugees and asylum seekers (URAS) in Thailand is extremely sparse, especially for neglected problems such as mental health disorders. This study aimed to investigate the prevalence of anxiety and depression and factors associated with these problems among URAS in Bangkok. A cross-sectional study was conducted in 2019. The URAS were randomly selected from the roster of the Bangkok Refugee Centre (BRC). A self-administered questionnaire was used and 180 samples were recruited. Descriptive statistics and multivariable logistic regression were used for the analysis. We found a prevalence of 70.0% for anxiety and 39.5% for depression. Compared to Southeast Asia and China, URAS from other regions were 3.4 times (95% CI 1.5-7.5, p < 0.05) and 4.0 times (95% CI 1.1-14.0, p < 0.05) more likely to experience anxiety and depression, respectively. URAS with chronic co-morbidities (OR = 3.4, 95% CI 1.2-9.4, p < 0.05) and being divorced or widowed (OR = 11.1, 95% CI 2.1-57.2, p < 0.05) faced greater odds of depression than those without co-morbidities and being single. Related health authorities should play a proactive role in providing mental healthcare services for URAS, with greater consideration for those of certain nationalities and with chronic diseases.
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Affiliation(s)
- Nareerut Pudpong
- International Health Policy Program, Ministry of Public Health, Nonthaburi 11000, Thailand; (H.K.); (M.P.); (W.K.); (P.S.); (S.J.); (R.S.)
- Sirindron College of Public Health, Chonburi 20000, Thailand
| | - Hathairat Kosiyaporn
- International Health Policy Program, Ministry of Public Health, Nonthaburi 11000, Thailand; (H.K.); (M.P.); (W.K.); (P.S.); (S.J.); (R.S.)
| | - Mathudara Phaiyarom
- International Health Policy Program, Ministry of Public Health, Nonthaburi 11000, Thailand; (H.K.); (M.P.); (W.K.); (P.S.); (S.J.); (R.S.)
| | - Watinee Kunpeuk
- International Health Policy Program, Ministry of Public Health, Nonthaburi 11000, Thailand; (H.K.); (M.P.); (W.K.); (P.S.); (S.J.); (R.S.)
| | - Pigunkaew Sinam
- International Health Policy Program, Ministry of Public Health, Nonthaburi 11000, Thailand; (H.K.); (M.P.); (W.K.); (P.S.); (S.J.); (R.S.)
| | - Sataporn Julchoo
- International Health Policy Program, Ministry of Public Health, Nonthaburi 11000, Thailand; (H.K.); (M.P.); (W.K.); (P.S.); (S.J.); (R.S.)
| | - Rapeepong Suphanchaimat
- International Health Policy Program, Ministry of Public Health, Nonthaburi 11000, Thailand; (H.K.); (M.P.); (W.K.); (P.S.); (S.J.); (R.S.)
- Division of Epidemiology, Department of Disease Control, Nonthaburi 11000, Thailand
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Alawa J, Al-Ali S, Walz L, Wiles E, Harle N, Awale MA, Mohamed D, Khoshnood K. Knowledge and perceptions of COVID-19, prevalence of pre-existing conditions and access to essential resources in Somali IDP camps: a cross-sectional study. BMJ Open 2021; 11:e044411. [PMID: 34187818 PMCID: PMC8245279 DOI: 10.1136/bmjopen-2020-044411] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This study examined knowledge and perceptions of COVID-19, prevalence of pre-existing conditions and access to essential resources among residents of internally displaced person (IDP) camps in Somalia, where overcrowded settlements with weakened infrastructure, inadequate water, sanitation, and hygiene facilities, and limited access to health services make this vulnerable population particularly susceptible to a COVID-19 outbreak. DESIGN A descriptive, cross-sectional survey. SETTING Twelve IDP camps across six areas of the Lower Shabelle region in Somalia. PARTICIPANTS 401 adult Somali IDP camp residents. RESULTS The majority of participants were female (86%) and had received no formal education (89%). While 58% reported being in 'good' health, half of the participants reported having one or more pre-existing conditions. Though 77% of respondents reported taking at least one COVID-19 preventative public health measure, respondents reported a lack of access to adequate sanitation, an inability to practice social distancing and nearly universal inability to receive a COVID-19 screening exam. Questions assessing knowledge surrounding COVID-19 prevention and treatment yielded answers of 'I don't know' for roughly 50% of responses. The majority of participants were not familiar with basic information about the virus or confident that they could receive medical services if infected. 185 (47%) respondents indicated that camp living conditions needed to change to prevent the spread of COVID-19. CONCLUSION This study highlights low levels of COVID-19 knowledge and limited access to essential prevention and treatment resources among individuals living in Somali IDP camps. A massive influx of additional resources is required to adequately address COVID-19 in Somalia, starting with codesigning interventions to educate those individuals most vulnerable to infection.
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Affiliation(s)
- Jude Alawa
- Stanford University School of Medicine, Stanford, California, USA
| | | | - Lucas Walz
- Yale University School of Public Health, New Haven, Connecticut, USA
| | - Eleanor Wiles
- Milken Institute of Public Health, The George Washington University, Washington, DC, USA
| | | | | | | | - Kaveh Khoshnood
- Yale University School of Public Health, New Haven, Connecticut, USA
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Sibai AM, Najem Kteily M, Barazi R, Chartouni M, Ghanem M, Afifi RA. Lessons learned in the provision NCD primary care to Syrian refugee and host communities in Lebanon: the need to 'act locally and think globally'. J Public Health (Oxf) 2021; 42:e361-e368. [PMID: 31763670 DOI: 10.1093/pubmed/fdz096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/15/2019] [Accepted: 07/21/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Prevention and control of non-communicable diseases (NCDs) remain inadequate in resource-scarce countries, particularly in conflict situations. This paper describes a multicomponent intervention for management of hypertension and diabetes among older adult Syrian refugees and the Lebanese host community and reflects on challenges for scaling up NCD integration into primary care in humanitarian situations. METHODS Using a mixed method approach, the study focused on monitoring and evaluation of the three components of the intervention: healthcare physical facilities and documentation processes, provider knowledge and guideline-concordant performance, and refugee and host community awareness. RESULTS Findings revealed overall high compliance of healthcare workers with completing data collection forms. Their knowledge of basic aspects of hypertension/diabetes management was adequate, but diagnosis knowledge was low. Patients and healthcare providers voiced satisfaction with the program. Yet, interruptions in medicines' supplies and lapses in care were perceived by all study groups alike as the most problematic aspect of the program. CONCLUSIONS Our intervention program was aligned with internationally agreed-upon practices, yet, our experiences in the field point to the need for more 'local testing' of modified interventions within such contexts. This can then inform 'thinking globally' on guidelines for the delivery of NCD care in crisis settings.
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Affiliation(s)
- Abla M Sibai
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Martine Najem Kteily
- Center for Public Health Practice, Faculty of Health Sciences, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Rana Barazi
- Center for Public Health Practice, Faculty of Health Sciences, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Mia Chartouni
- Center for Public Health Practice, Faculty of Health Sciences, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Maguy Ghanem
- HelpAge International, Lebanon Office, Beirut 1107 2020, Lebanon
| | - Rima A Afifi
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, IA 52242, USA
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Lyles BE, Chua S, Barham Y, Pfieffer-Mundt K, Spiegel P, Burton A, Doocy S. Improving diabetes control for Syrian refugees in Jordan: a longitudinal cohort study comparing the effects of cash transfers and health education interventions. Confl Health 2021; 15:41. [PMID: 34034780 PMCID: PMC8145855 DOI: 10.1186/s13031-021-00380-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 05/12/2021] [Indexed: 12/15/2022] Open
Abstract
Background Cash transfers are an increasingly common intervention in the Syrian refugee response to meet basic needs, though there is little known of their potential secondary impact on health outcomes in humanitarian settings. Methods A quasi-experimental prospective cohort study was implemented from October 2018 through January 2020 to assess the effectiveness of multi-purpose cash (MPC), community health volunteer (CHV)-led education, combined with conditional cash transfers (CCT) with respect to health measures among Syrian refugees with type II diabetes in Jordan. Results CHV + CCT participants had the highest expenditures at endline and were the only group with statistically significant increases in payments for outpatient diabetes care (25.3%, P < 0.001) and monthly medication costs (13.6%, P < 0.001). Conversely, monthly spending on diabetes medication decreased significantly in the CHV only group (− 18.7%, P = 0.001) yet increased in the MPC and CHV + CCT groups. Expenditures on glucose monitoring increased in all groups but significantly more in the CHV + CCT group (39.2%, P < 0.001). The proportion of participants reporting regular diabetes care visits increased significantly only in the CHV + CCT group (15.1%, P = 0.002). Specialist visits also increased among CHV + CCT participants (16.8%, P = 0.001), but decreased in CHV only participants (− 27.8%, P < 0.001). Decreases in cost-motivated provider selection (− 22.8%, P < 0.001) and not receiving all needed care because of cost (− 26.2%, P < 0.001) were significant only in the CHV + CCT group. A small significant decrease in BMI was observed in the CHV + CCT group (− 1.0, P = 0.005). Decreases in HbA1C were significant in all groups with magnitudes ranging from − 0.2 to − 0.7%. The proportion of CHV + CCT participants with normal blood pressure increased significantly from baseline to endline by 11.3% (P = 0.007). Conclusions Combined conditional cash and health education were effective in improving expenditures, health service utilization, medication adherence, blood pressure, and diabetes control. The lower cost health education intervention was similarly effective in improving diabetes control, whereas unconditional cash transfers alone were least effective. Study findings suggest that conditional cash or combined cash and health education are promising strategies to support diabetes control among refugees and that where the purpose of MPC is to improve health outcomes, this alone is insufficient to achieve improvements in the health of refugees with diabetes. Supplementary Information The online version contains supplementary material available at 10.1186/s13031-021-00380-7.
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Affiliation(s)
- By Emily Lyles
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8132, Baltimore, MD, 21205, USA
| | | | | | - Kayla Pfieffer-Mundt
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8132, Baltimore, MD, 21205, USA
| | - Paul Spiegel
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8132, Baltimore, MD, 21205, USA
| | - Ann Burton
- United Nations High Commissioner for Refugees, Geneva, Switzerland
| | - Shannon Doocy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8132, Baltimore, MD, 21205, USA.
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Jaung MS, Willis R, Sharma P, Aebischer Perone S, Frederiksen S, Truppa C, Roberts B, Perel P, Blanchet K, Ansbro É. Models of care for patients with hypertension and diabetes in humanitarian crises: a systematic review. Health Policy Plan 2021; 36:509-532. [PMID: 33693657 PMCID: PMC8128021 DOI: 10.1093/heapol/czab007] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2021] [Indexed: 01/02/2023] Open
Abstract
Care for non-communicable diseases, including hypertension and diabetes (HTN/DM), is recognized as a growing challenge in humanitarian crises, particularly in low- and middle-income countries (LMICs) where most crises occur. There is little evidence to support humanitarian actors and governments in designing efficient, effective, and context-adapted models of care for HTN/DM in such settings. This article aimed to systematically review the evidence on models of care targeting people with HTN/DM affected by humanitarian crises in LMICs. A search of the MEDLINE, Embase, Global Health, Global Indexus Medicus, Web of Science, and EconLit bibliographic databases and grey literature sources was performed. Studies were selected that described models of care for HTN/DM in humanitarian crises in LMICs. We descriptively analysed and compared models of care using a conceptual framework and evaluated study quality using the Mixed Methods Appraisal Tool. We report our findings according to PRISMA guidelines. The search yielded 10 645 citations, of which 45 were eligible for this review. Quantitative methods were most commonly used (n = 34), with four qualitative, three mixed methods, and four descriptive reviews of specific care models were also included. Most studies detailed primary care facility-based services for HTN/DM, focusing on health system inputs. More limited references were made to community-based services. Health care workforce and treatment protocols were commonly described framework components, whereas few studies described patient centredness, quality of care, financing and governance, broader health policy, and sociocultural contexts. There were few programme evaluations or effectiveness studies, and only one study reported costs. Most studies were of low quality. We concluded that an increasing body of literature describing models of care for patients with HTN/DM in humanitarian crises demonstrated the development of context-adapted services but showed little evidence of impact. Our conceptual framework could be used for further research and development of NCD models of care.
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Affiliation(s)
- Michael S Jaung
- Department of Health Services Research & Policy and Centre for Global Chronic Conditions, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
- Department of Emergency Medicine, Baylor College of Medicine, 1504 Ben Taub Loop, Houston, 77030, TX, USA
| | - Ruth Willis
- Department of Health Services Research & Policy and Centre for Global Chronic Conditions, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Piyu Sharma
- Department of Health Services Research & Policy and Centre for Global Chronic Conditions, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Sigiriya Aebischer Perone
- Health Unit, international Committee of the Red Cross, Avenue de la Paix 19, 1202 Geneva, Switzerland
| | | | - Claudia Truppa
- Health Unit, international Committee of the Red Cross, Avenue de la Paix 19, 1202 Geneva, Switzerland
| | - Bayard Roberts
- Department of Health Services Research & Policy and Centre for Global Chronic Conditions, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Pablo Perel
- Department of Non-Communicable Disease Epidemiology and Centre for Global Chronic Conditions, Faculty of Epidemiology and Population Health, Keppel Street, London WC1E 7HT, UK
| | - Karl Blanchet
- Geneva Centre of Humanitarian Studies, University of Geneva, 24 rue du Général-Dufour, Geneva, Switzerland
| | - Éimhín Ansbro
- Department of Health Services Research & Policy and Centre for Global Chronic Conditions, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
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Yunus RM, Azme N, Chen XW, Badlishah-Sham SF, Miptah HN, Azraai AM. The need to map existing health care services for refugees in Malaysia. J Glob Health 2021; 11:03024. [PMID: 33692879 PMCID: PMC7917370 DOI: 10.7189/jogh.11.03024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Raudah Mohd Yunus
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh Campus, Malaysia
| | - Nasibah Azme
- Department of Physiology, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh Campus, Malaysia
| | - Xin Wee Chen
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh Campus, Malaysia
| | - Siti Fatimah Badlishah-Sham
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh Campus, Malaysia
| | - Hayatul Najaa Miptah
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh Campus, Malaysia
| | - Awla Mohd Azraai
- Department of Pathology, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh Campus, Malaysia
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Adoch W, Garimoi CO, Scott SE, Okeny GG, Moodley J, Komakech H, Walter FM, Mwaka AD. Knowledge of cervical cancer risk factors and symptoms among women in a refugee settlement: a cross-sectional study in northern Uganda. Confl Health 2020; 14:85. [PMID: 33292345 PMCID: PMC7713037 DOI: 10.1186/s13031-020-00328-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 11/24/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND There are limited data on awareness of cervical cancer risk factors and symptoms among refugee populations living in Uganda. In this study, we sought to determine the awareness and knowledge of cervical cancer risk factors and symptoms among women in Palabek refugee settlement, northern Uganda. METHODS We conducted a cross-sectional study. 815 women (aged 18-60 years) were randomly selected using multistage sampling in Palabek refugee settlement. Data were collected using pre-tested, structured questionnaires. Logistic regression models were used to determine magnitudes of association between socio-demographic and health system factors, and knowledge on cervical cancer risk factors and symptoms. RESULTS The majority of participants (53%, n = 433) were young (18-29 years), married (68%, n = 553), and did not have formal employment (93%, n = 759). Less than half (40%, n = 325) had heard of cervical cancer. Of those who had heard, most recognized multiple male sexual partners, early onset of sexual intercourse and HPV infections as risk factors for cervical cancer (93%, n = 295; 89%, n = 283; and 86%, n = 271 respectively). Median knowledge score for risk factor recognition = 7 (IQR: 3-9). Median knowledge score for symptoms recognition = 7 (IQR: 1-10). Half of women (50%, n = 409) correctly recognized 7 to 11 symptoms of cervical cancer, with vaginal bleeding between menstrual periods, pelvic pain, and vaginal bleeding during/after sexual intercourse recognized by 58, 52 and 54% respectively. Single women (OR = 0.59 (95%CI: 0.38-0.94), and women that lived farther than 1 kilo meter from nearest health facility in South Sudan (OR = 0.36-0.49 (95%CI: 0.26-0.84) were less likely to be knowledgeable of symptoms of cervical cancer. CONCLUSION A significant proportion of women in Palabek refugee settlement had not heard about cervical cancer. Refugee health services providers could increase awareness of cervical cancer risk factors and symptoms through health education in order to promote risk reduction behaviours and guide women during symptoms appraisal. Single women and those who lived more than one kilo metre from nearest health facility in home country could be a priority group for awareness intervention in the settlement.
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Affiliation(s)
- Winnie Adoch
- School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Christopher Orach Garimoi
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Suzanne E. Scott
- Centre for Oral, Clinical & Translational Sciences, Faculty of Dentistry, Oral & Craniofacical Sciences, King’s College London, London, UK
| | - Geoffrey Goddie Okeny
- School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Jennifer Moodley
- Women’s Health Research Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road. Observatory, Cape Town, 7925 South Africa
- Cancer Research Initiative, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925 South Africa
| | - Henry Komakech
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Fiona M. Walter
- The Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Amos Deogratius Mwaka
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
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Shahin W, Kennedy GA, Cockshaw W, Stupans I. The Role of Medication Beliefs on Medication Adherence in Middle Eastern Refugees and Migrants Diagnosed with Hypertension in Australia. Patient Prefer Adherence 2020; 14:2163-2173. [PMID: 33173283 PMCID: PMC7648560 DOI: 10.2147/ppa.s274323] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/06/2020] [Indexed: 12/12/2022] Open
Abstract
PURPOSE The study assessed the association between medication beliefs and adherence in Middle Eastern refugees and migrants in Australia, and also examined differences between the two groups regarding beliefs and adherence to medication. PATIENTS AND METHODS A total of 319 Middle Eastern refugees and migrants with hypertension were approached via various social groups in Australia and asked to complete Arabic versions of the Beliefs about Medicine Questionnaire (BMQ) and the Medication Adherence Questionnaire. BMQ scores (necessity and concerns scales) were classified as "accepting", "indifferent", "ambivalent" or "skeptical". Multiple mediation modelling was applied to examine the role of necessity and concerns scales as mediators between migration status and medication adherence. RESULTS There were significant associations between medication adherence and medication beliefs scores (necessity and concerns scales) (p=0.0001). Necessity and concern were mediators in the relationship between migration status and medication adherence. Significant differences were found between refugees and migrants for medication adherence and medication beliefs. Refugees were likely to have less necessity, and more concern beliefs than migrants, and were also less likely to adhere to medications. Almost 30% of refugees could be classified as skeptical and 40% as ambivalent. In contrast, 50% of migrants had accepting beliefs, and around 35% held ambivalent beliefs. Refugees and migrants with "accepting" beliefs reported the highest adherence to medication and those holding "skeptical" beliefs reported the lowest adherence. CONCLUSION Medication beliefs are potentially modifiable and are reasonable targets for clinical interventions designed to improve medication adherence. Understanding these beliefs and the likely differences between refugees and migrants is crucial to provide specific and targeted advice to each group independently in order to improve medication adherence and overall health.
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Affiliation(s)
- Wejdan Shahin
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria3083, Australia
| | - Gerard A Kennedy
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria3083, Australia
- School of Science, Psychology and Sport, Federation University, Ballarat, Melbourne, Australia
- Institute for Breathing and Sleep, Austin Health, Melbourne, Australia
| | - Wendell Cockshaw
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria3083, Australia
| | - Ieva Stupans
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria3083, Australia
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Ferguson A, Swan LET, Im H. A Domains Approach to Perceived Problems and Solutions for Community Empowerment in an Urban Refugee Community in Kenya. GLOBAL SOCIAL WELFARE 2020; 7:263-274. [DOI: https:/doi.org/10.1007/s40609-019-00150-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
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Alawa J, Hamade O, Alayleh A, Fayad L, Khoshnood K. Cancer Awareness and Barriers to Medical Treatment Among Syrian Refugees and Lebanese Citizens in Lebanon. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:709-717. [PMID: 30924080 DOI: 10.1007/s13187-019-01516-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The Syrian conflict has forced over a million refugees into Lebanon, which now faces the challenge of providing healthcare for this large, vulnerable population. Syrian refugees and Lebanese citizens suffer from an immense burden of cancer and encounter many barriers to obtaining healthcare. An increase in cancer awareness could prompt earlier diagnosis and treatment. This study aims to evaluate the level of cancer awareness and barriers to medical treatment among Syrian refugees and Lebanese citizens in Lebanon. A descriptive cross-sectional survey design was used. Four hundred seventeen Syrian refugees and 319 Lebanese citizens seeking healthcare in Lebanon completed the Cancer Awareness Measure. The mean age of Syrian refugees and Lebanese citizens was 33.8 years (SD 11.9) and 41.7 years (SD 16.3), respectively. Syrian refugees and Lebanese citizens were only able to recognize a low number of cancer symptoms (mean 4.2 (out of 9), SD 2.4 and 3.9, SD 2.3, respectively) and risk factors (mean 5.1 (out of 11), SD 2.6 and 5.2, SD 2.9, respectively). Barriers to seeking medical care were prevalent. The most commonly reported barrier among both samples was having no medical insurance or funds to cover the cost of treatment (78.9% and 67.7%, respectively). A comprehensive restructuring of the Lebanese healthcare system and a massive influx of resources are required for Syrian refugees and Lebanese citizens to obtain adequate access to cancer treatment. To encourage early diagnosis and treatment, much more work is needed to overcome barriers and enhance knowledge of cancer.
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Affiliation(s)
| | - Omar Hamade
- Santa Clara University, Santa Clara, CA, USA
| | - Amin Alayleh
- University of California San Diego, San Diego, CA, USA
| | - Luna Fayad
- University of Miami, Coral Gables, FL, USA
| | - Kaveh Khoshnood
- Yale School of Public Health, 60 College Street, Ste 405, New Haven, CT, 06510, USA.
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Greene-Cramer B, Summers A, Lopes-Cardozo B, Husain F, Couture A, Bilukha O. Noncommunicable disease burden among conflict-affected adults in Ukraine: A cross-sectional study of prevalence, risk factors, and effect of conflict on severity of disease and access to care. PLoS One 2020; 15:e0231899. [PMID: 32315357 PMCID: PMC7173772 DOI: 10.1371/journal.pone.0231899] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 04/02/2020] [Indexed: 12/14/2022] Open
Abstract
Background There is limited research on noncommunicable diseases (NCDs) in humanitarian settings despite the overall global burden and disproportionate growth in many conflicts and disaster-prone settings. This study aimed to determine the prevalence of NCDs and assess the perceived effect of conflict on NCD severity and access to treatment among conflict-affected adults (≥ 30 years) in Ukraine. Methods and findings We conducted two population-representative, stratified, cross-sectional household surveys: one among adult internally displaced people (IDPs) throughout Ukraine and one among adults living in Donbas in eastern Ukraine. One randomly selected adult per household answered questions about their demographics, height and weight, diagnosed NCDs, access to medications and healthcare since the conflict began, as well as questions assessing psychological distress, trauma exposure, and posttraumatic stress disorder. More than half of participants reported having at least one NCD (55.7% Donbas; 59.8% IDPs) A higher proportion of IDPs compared to adults in Donbas experienced serious psychological distress (29.9% vs. 18.7%), interruptions in care (9.7–14.3% vs. 23.1–51.3%), and interruptions in medication than adults in Donbas (14.9–45.6% vs. 30.2–77.5%). Factors associated with perceived worsening of disease included psychological distress (p: 0.002–0.043), displacement status (IDP vs. Donbas) (p: <0.001–0.011), interruptions in medication (p: 0.002–0.004), and inability to see a doctor at some point since the start of the conflict (p: <0.001–0.008). Conclusions Our study found a high burden of NCDs among two conflict-affected populations in Ukraine and identified obstacles to accessing care and medication. Psychological distress, interruptions to care, and interruptions in medication were all reported by a higher proportion of IDPs than adults in Donbas. There is a need for targeted policies and programs to support the unique needs of displaced conflict-affected individuals in Ukraine that address the economic and perceived barriers to NCD treatment and care.
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Affiliation(s)
- Blanche Greene-Cramer
- Emergency Response and Recovery Branch, Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Aimee Summers
- Emergency Response and Recovery Branch, Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Barbara Lopes-Cardozo
- Emergency Response and Recovery Branch, Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Farah Husain
- Emergency Response and Recovery Branch, Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Alexia Couture
- Emergency Response and Recovery Branch, Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Oleg Bilukha
- Emergency Response and Recovery Branch, Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Ahmed M, Whitestone N, Patnaik JL, Hossain MA, Husain L, Alauddin M, Rahaman M, Cherwek DH, Congdon N, Haddad D. Burden of eye disease and demand for care in the Bangladesh Rohingya displaced population and host community: A cohort study. PLoS Med 2020; 17:e1003096. [PMID: 32231365 PMCID: PMC7108691 DOI: 10.1371/journal.pmed.1003096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 02/28/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There is a growing awareness that addressing chronic as well as acute health conditions may contribute importantly to the well-being of displaced populations, but eye care service has generally not been prioritized in crisis situations. We describe a replicable model of eye care provision as delivered by Orbis International and local partners to the Rohingya and host population in Cox's Bazar, Bangladesh, and characterize the burden of vision impairment and demand for sight-restoring services in this setting. METHODS AND FINDINGS Orbis International and local secondary facility Cox's Bazar Baitush Sharaf Hospital (CBBSH) provide eye care support to the Rohingya population and the host community of all ages in Cox's Bazar, Bangladesh, with fixed vision screening locations established in Camps 4 and 11 of the Kutupalong refugee settlement. Structured outreach targets these camps and four surrounding local subdistricts, with referrals made as needed for refraction (glasses measurement) and cataract surgery to CBBSH. Between February 2018 and March 2019, 48,105 displaced Rohingya (70.3%, among whom 71.6% were children and 46.5% women) and 20,357 local residents (29.7%, 88.5% children, 54.4% women) underwent vision screening. Displaced Rohingya sought services from a total of 12 surrounding camps, within which coverage was 17.3%, including 43.3% (27,027/62,424) of children aged 5-11 years and 60.0% (5,315/8,857) of adults ≥ 60 years old. The prevalence of blindness (presenting acuity < 3/60) among Rohingya patients exceeded that among local residents by 3- to 6-fold in each 10-year age group between 18 and 59 years (P < 0.001 comparing vision between the two groups in this age range), and the prevalence of cataract requiring surgery was also higher in Rohingya patients (18-29 years: 4.67% versus 1.80%, P = 0.0019; 30-39: 7.61% versus 2.39%, P < 0.001; and 40-49 years: 7.91% versus 3.77%, P = 0.0014). A limitation of the study is lack of data on population prevalence of eye disease. CONCLUSIONS The burden of untreated eye disease is very high among the Rohingya, particularly those in their peak working years who could contribute most to the resiliency of their community. Demand for eye care service is also great among children and adults in this population with many competing healthcare priorities. Research is needed, building on strong evidence of benefit in settled populations, to explore the specific impact of vision care on the well-being of displaced populations.
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Affiliation(s)
| | - Noelle Whitestone
- Independent consultant, Orbis International, New York, New York, United States of America
| | - Jennifer L. Patnaik
- Orbis International, New York, New York, United States of America
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | | | | | | | | | | | - Nathan Congdon
- Orbis International, New York, New York, United States of America
| | - Danny Haddad
- Orbis International, New York, New York, United States of America
- * E-mail:
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McNatt ZZ. Addressing noncommunicable diseases among urban refugees in the Middle East and North Africa - a scoping review. Confl Health 2020; 14:9. [PMID: 32099579 PMCID: PMC7029555 DOI: 10.1186/s13031-020-0255-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 01/29/2020] [Indexed: 12/02/2022] Open
Abstract
Background More than 5.5 million Syrian refugees have fled violence and settled in mostly urban environments in neighboring countries. The Middle East and North Africa (MENA) region accounts for 6% of the global population but 25% of the population are ‘of concern’ to the UN Refugee Agency. In addition to large amounts of forced migration, the region is also undergoing an epidemiologic transition towards a heavier burden of noncommunicable diseases (NCDs), which in 2018 accounted for 74% of all deaths in the region. To address NCD needs globally, a myriad of policies and interventions have been implemented in low-income stable country settings. However, little is known about which policies and interventions are currently being implemented or are best suited for refugee hosting countries across the Middle East and North Africa. Methods A scoping review of peer-reviewed literature was conducted to identify policies and interventions implemented in the Middle East and North Africa to address the needs of urban refugees with noncommunicable diseases. Results This scoping review identified 11 studies from Jordan, Lebanon, Iran, West Bank, Gaza and Syria. These studies addressed three foci of extant work, (1) innovative financing for expensive treatments, (2) improvements to access and quality of treatment and, (3) efforts to prevent new diagnoses and secondary complications. All interventions targeted refugee populations including Palestinians, Sudanese, Syrians, Afghans and Iraqis. Discussion The scoping review highlighted five key findings. First, very few studies focused on the prevention of noncommunicable diseases among displaced populations. Second, several interventions made use of health information technologies, including electronic medical records and mHealth applications for patients. Third, the vast majority of publications were solely focused on tackling NCDs through primary care efforts. Fourth, the literature was very sparse in regard to national policy development, and instead favored interventions by NGOs and UN agencies. Last, the perspectives of refugees were notably absent. Conclusion Opportunities exist to prioritize prevention efforts, scale up eHealth interventions, expand access to secondary and tertiary services, address the scarcity of research on national policy, and incorporate the perspectives of affected persons in the broader discourse.
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Affiliation(s)
- Zahirah Z McNatt
- Department of Community Health and Social Medicine, University of Global Health Equity, Kigali Heights, Plot 772, KG 7 Ave., 5th floor, P.O. Box 6955, Kigali, Rwanda.,2Mailman School of Public Health, Department of Population and Family Health, Columbia University, 60 Haven Avenue B3, New York, 10032 USA
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Carruth L, Ateye MJ, Nassir A, Hosh FM, Mendenhall E. Diabetes in a humanitarian crisis: Atypical clinical presentations and challenges to clinical- and community-based management among Somalis in Ethiopia. Glob Public Health 2020; 15:828-839. [PMID: 31994445 DOI: 10.1080/17441692.2020.1718735] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
This study was designed to better understand the clinical presentations and challenges of managing type-2 diabetes mellitus (T2DM) in a humanitarian crisis-affected population. Findings are based on a long-term ethnographic study of humanitarian response in eastern Ethiopia by the first author from 2008 to 2018, and in addition, a mixed-method case study of T2DM in July-August 2018. For the case study, the authors collected anthropometric, demographic, and biological data from 85 persons with T2DM diagnosis and 23 of their adult siblings. The team then conducted participant-observation and 28 ethnographic interviews with a purposive sample of patients, their siblings, and local health providers, policymakers, and aid workers. T2DM was characterised in this sample by progressive weight loss, weakness, lethargy, loss of teeth, and persistently high average blood glucose levels (HbA1c), at initial clinical presentation, and then in subsequent years, even while taking prescribed medications and/or insulin. Patients struggled to access medical care, refrigerate insulin, and follow dietary recommendations due to chronic food insecurity and long-term dependence on limited food aid rations. Local health providers who are trained and supplied mostly through humanitarian relief funding lack the education and resources to effectively help patients manage non-communicable chronic conditions.
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Affiliation(s)
- Lauren Carruth
- School of International Service, American University, Washington, DC, USA
| | - Mohamed Jama Ateye
- School of International Service, Norwegian Refugee Council, American University, Jigjiga, Ethiopia
| | - Ahmed Nassir
- Elahelay Health Post, Aysha Woreda Health Bureau, Aysha, Ethiopia
| | - Farah Mussa Hosh
- School of International Service, American University, Dire Dawa, Ethiopia
| | - Emily Mendenhall
- School of Foreign Service, Georgetown University, Washington, DC, USA
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Adverse Childhood Experiences in Non-Westernized Nations: Implications for Immigrant and Refugee Health. J Immigr Minor Health 2019; 22:145-155. [DOI: 10.1007/s10903-019-00953-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Piwowarczyk LA, Ona F. BeWell: quality assurance health promotion pilot. Int J Health Care Qual Assur 2019; 32:321-331. [PMID: 31017063 DOI: 10.1108/ijhcqa-08-2017-0152] [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] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to determine the experience participating in a health promotion program for refugee and asylum seekers and torture survivors in a safety net clinical setting. DESIGN/METHODOLOGY/APPROACH Refugee and asylum seeker torture survivors participated in a seven-week health promotion program at a safety-net clinic. Participants interviewed before, during and after the program was designed to improve and maintain health promotion program quality. FINDINGS Six major themes emerged: social networks; tools/techniques/skills; wellness planning; spiritualism; health maintenance; and social/group interaction. Preliminary results suggest that this multi-pronged approach is feasible and acceptable to foreign-born torture survivors. RESEARCH LIMITATIONS/IMPLICATIONS Torture impacts many facets of one's life. A program which addresses health from a multidisciplinary perspective has promise to facilitate healing. PRACTICAL IMPLICATIONS The impact of torture and human rights violations significantly affects many facets of peoples' lives including emotional, social, physical and spiritual dimensions. Therefore a program which utilizes a multidisciplinary integrated bio-psychosocial and spiritual approach has the potential to simultaneously address many domains facilitating healing. ORIGINALITY/VALUE BeWell, a bio-psychosocio-spiritual health promotion strategy aimed at improving health service quality and increasing patient satisfaction to support positive health outcomes by implementing in-classroom/person modules for patients, to the authors' knowledge is unique in its efforts to encompass multiple domains simultaneously and fully integrate an approach to wellbeing.
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Affiliation(s)
- Linda A Piwowarczyk
- Boston Center for Refugee Health and Human Rights, Boston Medical Center, Boston, Massachusetts, USA
| | - Fernando Ona
- Tufts University School of Medicine , Boston, Massachusetts, USA
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Saleh S, Farah A, El Arnaout N, Dimassi H, El Morr C, Muntaner C, Ammar W, Hamadeh R, Alameddine M. mHealth use for non-communicable diseases care in primary health: patients' perspective from rural settings and refugee camps. J Public Health (Oxf) 2019; 40:ii52-ii63. [PMID: 30307516 PMCID: PMC6294037 DOI: 10.1093/pubmed/fdy172] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 09/11/2018] [Indexed: 12/20/2022] Open
Abstract
Background Non-communicable diseases (NCDs) account for 85% of deaths in Lebanon and contribute to remarkable morbidity and mortality among refugees and underserved populations. This study assesses the perspectives of individuals with hypertension and/or diabetes in rural areas and Palestinian refugee camps towards a population based mHealth intervention called 'eSahha'. Methods The study employs a mixed-methods design to evaluate the effectiveness of SMSs on self-reported perceptions of lifestyle modifications. Quantitative data was collected through phone surveys, and qualitative data through focus group discussions. Descriptive statistics and bivariate analysis were performed. Results About 93.9% (n = 1000) of respondents perceived the SMSs as useful and easy to read and understand. About 76.9% reported compliance with SMSs through daily behavioral modifications. Women (P = 0.007), people aged ≥76 years (P < 0.001), unemployed individuals (P < 0.001), individuals who only read and write (P < 0.001) or those who are illiterate (P < 0.001) were significantly more likely to receive and not read the SMSs. Behavior change across settings was statistically significant (P < 0.001). Conclusion While SMS-based interventions targeting individuals with hypertension and/or diabetes were generally satisfactory among those living in rural areas and Palestinian refugee camps in Lebanon, a more tailored approach for older, illiterate and unemployed individuals is needed. Keywords e-health, refugees.
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Affiliation(s)
- Shadi Saleh
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Riad El Solh, Beirut, Lebanon.,Global Health Institute, American University of Beirut, Riad El Solh, Beirut, Lebanon
| | - Angie Farah
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Riad El Solh, Beirut, Lebanon
| | - Nour El Arnaout
- Global Health Institute, American University of Beirut, Riad El Solh, Beirut, Lebanon
| | - Hani Dimassi
- Department of Pharmaceutical Sciences, School of Pharmacy, Lebanese American University, Beirut, Lebanon
| | - Christo El Morr
- School of Health Policy & Management, Faculty of Health, School of Health Policy and Management, York University, 4700 Keele St., Toronto ON, Canada
| | - Carles Muntaner
- Social & Behavioural Health Sciences Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Walid Ammar
- Ministry of Public Health, Ministry of Public Health, Beirut, Lebanon
| | - Randa Hamadeh
- Ministry of Public Health, Ministry of Public Health, Beirut, Lebanon
| | - Mohamad Alameddine
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Riad El Solh, Beirut, Lebanon.,Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Healthcare City, Dubai, United Arab Emirates
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Trends in Chronic Diseases Reported by Refugees Originating from Burma Resettling to the United States from Camps Versus Urban Areas During 2009-2016. J Immigr Minor Health 2019; 21:246-256. [PMID: 29761353 DOI: 10.1007/s10903-018-0749-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
We examined changes in the prevalence of chronic health conditions among US-bound refugees originating from Burma resettling over 8 years by the type of living arrangement before resettlement, either in camps (Thailand) or in urban areas (Malaysia). Using data from the required overseas medical exam for 73,251 adult (≥ 18 years) refugees originating from Burma resettling to the United States during 2009-2016, we assessed average annual percent change (AAPC) in proportion ≥ 45 years and age- and sex-standardized prevalence of obesity, diabetes, hypertension, chronic obstructive pulmonary disease (COPD), and musculoskeletal disease, by camps versus urban areas. Compared with refugees resettling from camps, those coming from urban settings had higher prevalence of obesity (mean 18.0 vs. 5.9%), diabetes (mean 6.5 vs. 0.8%), and hypertension (mean 12.7 vs. 8.1%). Compared with those resettling from camps, those from urban areas saw greater increases in the proportion with COPD (AAPC: 109.4 vs. 9.9) and musculoskeletal disease (AAPC: 34.6 vs. 1.6). Chronic conditions and their related risk factors increased among refugees originating from Burma resettling to the United States whether they had lived in camps or in urban areas, though the prevalence of such conditions was higher among refugees who had lived in urban settings.
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Chaudhary A, Dosto N, Hill R, Lehmijoki-Gardner M, Sharp P, Daniel Hale W, Galiatsatos P. Community Intervention for Syrian Refugees in Baltimore City: The Lay Health Educator Program at a Local Mosque. JOURNAL OF RELIGION AND HEALTH 2019; 58:1687-1697. [PMID: 31414337 DOI: 10.1007/s10943-019-00893-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
This study focused on a partnership with a mosque in Baltimore, MD, and its impact on the local Syrian refugee population through a peer-to-peer healthcare training program. We implemented the Lay Health Educator Program over a 6-week period in an effort to teach members of the mosque about healthcare-related topics that they could then disseminate to the Syrian refugee population that attends the mosque. Physicians and nurses instructed community members on health, healthcare resources, and healthcare information during 2-h long sessions once a week. A total of 18 community members took part in the program, and their participation highlighted that the most significant health issues for the Syrian refugees are "access to healthcare," "mental health," and insight into certain noncommunicable disease. Finally, the community program graduates implemented several health-related campaigns over 2 years in an effort to disseminate information taught to them. In doing so, they significantly impacted the ability of the refugees to assimilate to the US healthcare system.
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Affiliation(s)
- Anila Chaudhary
- Medicine for the Greater Good, Johns Hopkins School of Medicine, 4940 Eastern Avenue, Asthma & Allergy Building, 4th Floor, Baltimore, MD, 21224, USA
- Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Niccolo Dosto
- Medicine for the Greater Good, Johns Hopkins School of Medicine, 4940 Eastern Avenue, Asthma & Allergy Building, 4th Floor, Baltimore, MD, 21224, USA
| | - Rachel Hill
- Medicine for the Greater Good, Johns Hopkins School of Medicine, 4940 Eastern Avenue, Asthma & Allergy Building, 4th Floor, Baltimore, MD, 21224, USA
| | | | - Phyllis Sharp
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - W Daniel Hale
- Medicine for the Greater Good, Johns Hopkins School of Medicine, 4940 Eastern Avenue, Asthma & Allergy Building, 4th Floor, Baltimore, MD, 21224, USA
- Division of Geriatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Panagis Galiatsatos
- Medicine for the Greater Good, Johns Hopkins School of Medicine, 4940 Eastern Avenue, Asthma & Allergy Building, 4th Floor, Baltimore, MD, 21224, USA.
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
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Evaluating the Provision of Health Services and Barriers to Treatment for Chronic Diseases among Syrian Refugees in Turkey: A Review of Literature and Stakeholder Interviews. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16152660. [PMID: 31349639 PMCID: PMC6696441 DOI: 10.3390/ijerph16152660] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 07/16/2019] [Accepted: 07/23/2019] [Indexed: 01/02/2023]
Abstract
Background: While Turkey hosts the largest number of Syrian refugees, the provision of health services for chronic disease among Syrian refugees in Turkey has been inadequate and understudied. This paper explores Turkish healthcare policies surrounding Syrian refugees’ access to health services for chronic diseases. Methods: We conducted a literature review and supplementary stakeholder interviews to evaluate the provision of chronic health services and the most common barriers to healthcare access among Syrian refugees in Turkey. Results: Though access to treatment for displaced Syrians has improved throughout the past five years, five primary barriers persist: registration procedure regulations, navigation of a new health system, language barriers, fear of adverse treatment, and cost. Conclusions: To drive improvements in healthcare for chronic diseases among Syrian refugees in Turkey, we recommend making registration procedures more accessible, developing more healthcare options in patients’ native language, increasing human resources, and advocating for more research surrounding chronic health conditions among refugees.
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Alawa J, Alhalabi F, Khoshnood K. Breast Cancer Management Among Refugees and Forcibly Displaced Populations: a Call to Action. CURRENT BREAST CANCER REPORTS 2019. [DOI: 10.1007/s12609-019-00314-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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McNatt ZZ, Freels PE, Chandler H, Fawad M, Qarmout S, Al-Oraibi AS, Boothby N. "What's happening in Syria even affects the rocks": a qualitative study of the Syrian refugee experience accessing noncommunicable disease services in Jordan. Confl Health 2019; 13:26. [PMID: 31210780 PMCID: PMC6567402 DOI: 10.1186/s13031-019-0209-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 05/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Humanitarian actors and host-countries in the Middle East and North Africa region are challenged with meeting the health needs of Syrian refugees and adjusting the response to contemporary humanitarian conditions - urban-based refugees, stressed host-country health systems and high NCD prevalence. Although several studies have explored NCD prevalence, utilization of services and barriers to access, these analyses took place prior to dramatic shifts in Jordanian health policy and did not account for nuances in health seeking and utilization behaviors or operational barriers. Accordingly, we aimed to understand the depth and nuances of Syrian refugees' experiences accessing NCD services in urban and semi-urban settings in Jordan. METHODS A qualitative study was conducted to explore the healthcare experiences of Syrian refugees in Jordan. The study team conducted 68 in-depth interviews with Syrian refugees in urban and semi-urban locations in central and northern Jordan. RESULTS The findings indicated four themes key to understanding the healthcare experience: (1) emotional distress is a central concern and is frequently highlighted as the trigger for a non-communicable disease or its exacerbation; (2) service provision across all sectors - government, NGO, private - is complex, inadequate, expensive and fragmented, making engagement with the health sector physically and financially burdensome; (3) given financial constraints, participants make harmful decisions that further damage their health in order to reduce financial burdens, and (4) host-community members actively exhibit solidarity with their refugee neighbors and specifically do so during emergency health episodes. The findings from this study can be used to inform program design for forcibly displaced persons with NCDs and identify points of entry for effective interventions. CONCLUSIONS Opportunities exist for humanitarian and host-country actors to provide more comprehensive NCD services and to improve the relevance and the quality of care provided to Syrian refugees in Jordan. Global and national funding will need to align with front-line realities and foster better coordination of services between host-country health systems, private actors and non-governmental organizations.
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Affiliation(s)
- Zahirah Zahrah McNatt
- Columbia University Mailman School of Public Health, 60 Haven Avenue, B4, New York, NY 10032 USA
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Burden of non-communicable diseases among Syrian refugees: a scoping review. BMC Public Health 2019; 19:637. [PMID: 31126261 PMCID: PMC6534897 DOI: 10.1186/s12889-019-6977-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 05/14/2019] [Indexed: 11/18/2022] Open
Abstract
Background The scarcity of evidence-based research on non-communicable diseases (NCDs) among Syrian refugees has hampered efforts to address the high burden of these diseases in host countries. The objective of this study is to examine published research on NCDs among Syrian refugees in order to inform future research, practice, programs, and policy. . Methods Using the scoping review framework proposed by Arksey et al., 17 different databases were searched to identify studies reporting on NCDs among Syrian refugees. The number of relevant documents found was 34, with the earliest going back to 2013—2 years after the beginning of the Syrian conflict. Results The majority of these documents were descriptive in nature and only two studies addressed the effectiveness of interventions in the management of NCDs. No studies investigated the prevention of these diseases. Furthermore, only 7 studies addressed the host community and only one research article, conducted in Lebanon, included subjects from the host community. The increasing number of documents over the past 5 years illustrates a growing interest in studying NCDs among Syrian refugees. Examination of the papers showed high prevalence of NCDs among Syrian refugees as well as unmet healthcare needs. Conclusion The findings of this review highlighted the dire need for further research on the burden of NCDs among Syrian refugees. Future studies should diversify research design to include interventions, address the host community in addition to the refugees, tackle prevention as well as treatment of NCDs, and explore strategies to enhance the resilience of the host country’s health system while ensuring quality of care for NCDs. The increasing momentum for research found in this review presents an opportunity to fill current knowledge gaps, which could result in preventing, controlling and ultimately reducing the burden of NCDs among Syrian refugees and their host communities. Electronic supplementary material The online version of this article (10.1186/s12889-019-6977-9) contains supplementary material, which is available to authorized users.
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El Arab R, Sagbakken M. Healthcare services for Syrian refugees in Jordan: a systematic review. Eur J Public Health 2019; 28:1079-1087. [PMID: 29905785 DOI: 10.1093/eurpub/cky103] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background This review aims to explore the healthcare needs and access to healthcare services among Syrian refugees in Jordan. Furthermore, it identifies possible ways of responding to such needs within the framework of the structural challenges faced in this particular context. Methods Through qualitative techniques, this study systematically reviewed nine articles identified in academic and international organizations' databases. Six articles are from scholarly sources, while three are published reports or commentary articles; thus, there are variations in methodological rigour. An analysis of the articles was performed based on the Critical Appraisal Skills Programme check tool to systematically assess the trustworthiness, relevance and results of the included papers. Results The overall access to healthcare is relatively good for most registered Syrian refugees. However, some groups lack access due to financial and structural barriers, such as not possessing the appropriate civil documentation and/or not having the means to pay out-of-pocket expenses to access adequate services. A key challenge relates to access of inpatient care. Accessing care for non-communicable/chronic diseases requires not only legal documentation but also long-term access and continuity of care in an already overburdened health care system. Conclusion The healthcare needs of the refugee, as well as the host population in Jordan, cannot be adequately met without the international society acknowledging a collective responsibility, including a financial commitment. One effort that could solve a major structural problem for those not able to access healthcare is increased flexibility in regards to documentation.
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Affiliation(s)
- R El Arab
- Preparatory year department, Al-Ghad International Colleges for Health Sciences, Riyadh, Saudi Arabia
| | - M Sagbakken
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Norway
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