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Mandroiu A, Alsubahi N, Groot W, Pavlova M. Sexual and Reproductive Health Rights and Service Use among Undocumented Migrants in the EU: A Systematic Literature Review. Healthcare (Basel) 2024; 12:1771. [PMID: 39273795 PMCID: PMC11395426 DOI: 10.3390/healthcare12171771] [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: 07/06/2024] [Revised: 08/21/2024] [Accepted: 08/28/2024] [Indexed: 09/15/2024] Open
Abstract
Most EU member states fail to provide essential sexual and reproductive health services to undocumented migrants, a vulnerable population facing limited access, utilization, and worse health-related outcomes. This study systematically reviewed the literature on access to and use of these services, as well as related health, economic, and migratory outcomes for undocumented migrants in the EU-EFTA region. The systematic review is reported based on the PRISMA 2020 checklist and includes 37 studies published between 2017 and 2024. Included studies were based upon original quantitative, qualitative, or mixed-methods data; conducted in one or more European countries; and published in one or more of the following languages: English, Spanish, French, Portuguese, or Romanian. A quality assessment was conducted using the CASP checklist for qualitative studies and the NHLBI Study Quality Assessment Tools for quantitative studies. The findings revealed numerous access barriers, including refusal of care, lack of knowledge about national healthcare schemes, bureaucratic hurdles, and affordability issues. Even when care was available, stigma, fear of deportation, socio-economic precarity, and abuse further hindered utilization. These barriers contributed to generally worse reproductive health outcomes for undocumented migrants in Europe, though the findings may not generalize to all EU-EFTA countries.
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Affiliation(s)
- Alexandra Mandroiu
- Department of Health Services Research, Care and Public Health Research Institute-CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), 1349-008 Lisbon, Portugal
| | - Nizar Alsubahi
- Department of Health Services Research, Care and Public Health Research Institute-CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Department of Health Service and Hospital Administration, Faculty of Economics and Administration, King Abdul Aziz University, Jeddah 21589, Saudi Arabia
| | - Wim Groot
- Department of Health Services Research, Care and Public Health Research Institute-CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Maastricht Economic and Social Research Institute on Innovation and Technology, United Nations University, 6211 LK Maastricht, The Netherlands
| | - Milena Pavlova
- Department of Health Services Research, Care and Public Health Research Institute-CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
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Hobart C, Pescarini JM, Evans L, Adil HS, Adil ST, Deal A, Carter J, Matthews PC, Hargreaves S, Sanchez Clemente N. Hepatitis B infection and immunity in migrant children and pregnant persons in Europe: a systematic review and meta-analysis. J Travel Med 2024; 31:taae094. [PMID: 38990201 PMCID: PMC11298050 DOI: 10.1093/jtm/taae094] [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: 03/28/2024] [Revised: 06/24/2024] [Accepted: 07/10/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND The WHO's global hepatitis strategy aims to achieve viral hepatitis elimination by 2030. Migrant children and pregnant persons represent an important target group for prevention strategies. However, evidence on the burden of chronic hepatitis B (CHB) infection and the factors affecting its incidence is lacking. METHODS EMBASE, Global Health, Global Index Medicus, Web of Science and Medline were searched for articles in any language from 1 January 2012 to 8 June 2022. Studies reporting CHB prevalence, disease severity, complications and/or prevention strategies, including vaccination, prevention of vertical transmission and access to care/treatment for migrant children and pregnant migrants, were included. Pooled estimates of CHB prevalence and hepatitis B vaccination (HBV) coverage among migrant children were calculated using random effects meta-analysis. FINDINGS 42 studies were included, 27 relating to migrant children and 15 to pregnant migrants across 12 European countries, involving data from 64 773 migrants. Migrants had a higher incidence of CHB than host populations. Among children, the pooled prevalence of CHB was higher for unaccompanied minors (UAM) (5%, [95% CI: 3-7%]) compared to other child migrants, including internationally adopted children (IAC) and refugees (1%, [95% CI: 1-2%]). Region of origin was identified as a risk factor for CHB, with children from Africa and pregnant migrants from Africa, Eastern Europe and China at the highest risk. Pooled estimates of HBV vaccine coverage were lower among UAM (12%, [95% CI: 3-21%]) compared to other child migrants (50%, [95% CI: 37-63%]). CONCLUSION A range of modifiable determinants of HBV prevalence in migrant children and pregnant persons were identified, including sub-optimal screening, prevention and continuum of care. There is a need to develop evidence-based approaches in hepatitis care for these groups, thereby contributing towards global viral hepatitis elimination goals.
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Affiliation(s)
- Carla Hobart
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, WC1E 7HT, London, UK
| | - Julia M Pescarini
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, WC1E 7HT, London, UK
- Centre of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Rua Waldemar Falcão, 121, Candeal - Salvador/BA CEP: 40296-710, Bahia, Brazil
| | - Laith Evans
- Centre for Neonatal and Paediatric Infection, St. George’s University of London, Cranmer Terrace, London SW17 0RE, UK
| | - Haleema S Adil
- University College London Medical School, 74 Huntley St, London WC1E 6DE, UK
| | - Shehzhore T Adil
- University College London Medical School, 74 Huntley St, London WC1E 6DE, UK
| | - Anna Deal
- Migrant Health Research Group, Institute for Infection and Immunity, St. George’s University London, Cranmer Terrace, London SW17 0RE, UK
| | - Jessica Carter
- Migrant Health Research Group, Institute for Infection and Immunity, St. George’s University London, Cranmer Terrace, London SW17 0RE, UK
| | - Philippa C Matthews
- The Francis Crick Institute, HBV Elimination Laboratory, 1 Midland Road, London NW1 1AT, UK
- Division of Infection and Immunity, University College London, Gower Street, London WC1E 6BT, UK
- Department of Infectious Diseases, University College London Hospital, Euston Road, London NW1 2BU, UK
| | - Sally Hargreaves
- Migrant Health Research Group, Institute for Infection and Immunity, St. George’s University London, Cranmer Terrace, London SW17 0RE, UK
| | - Nuria Sanchez Clemente
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, WC1E 7HT, London, UK
- Centre for Neonatal and Paediatric Infection, St. George’s University of London, Cranmer Terrace, London SW17 0RE, UK
- Migrant Health Research Group, Institute for Infection and Immunity, St. George’s University London, Cranmer Terrace, London SW17 0RE, UK
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Eick F, Vallersnes OM, Fjeld HE, Sørbye IK, Valberg M, Dahl C. Perinatal mortality among pregnant undocumented migrants in Norway 1999-2020: A register-based population study. Soc Sci Med 2024; 353:117055. [PMID: 38897075 DOI: 10.1016/j.socscimed.2024.117055] [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: 12/22/2023] [Revised: 04/11/2024] [Accepted: 06/13/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Irregular legal status is a recognized health risk factor in the context of migration. However, undocumented migrants are rarely included in health surveys and register studies. Adverse perinatal outcomes are especially important because they have long-term consequences and societal risk factors are modifiable. In this study, we compare perinatal outcomes in undocumented migrants to foreign-born and Norwegian-born residents, using a population-based register. METHODS We included women 18-49 years old giving birth to singletons as registered in the Medical Birth Registry of Norway from 1999 to 2020. Women were categorized as 'undocumented migrants' (without an identity number), 'documented migrants' (with an identity number and born abroad), and 'non-migrants' (with an identity number and born in Norway). The main outcome was perinatal mortality, i.e., death of a foetus ≥ gestational week 22, or neonate up to seven days after birth. We used log-binominal regression to estimate the association between legal status and perinatal mortality, adjusting for several maternal pre-gestational and gestational factors. Direct standardization was used to adjust for maternal region of origin. ETHICAL APPROVAL Regional Ethical Committee (REK South East, case number 68329). RESULTS We retrieved information on 5856 undocumented migrant women who gave birth during the study period representing 0.5% of the 1 247 537 births in Norway. Undocumented migrants had a relative risk of 6.17 (95% confidence interval 5.29 ̶7.20) of perinatal mortality compared to non-migrants and a relative risk of 4.17 (95% confidence interval 3.51 ̶4.93) compared to documented migrants. Adjusting for maternal region of origin attenuated the results slightly. CONCLUSION Being undocumented is strongly associated with perinatal mortality in the offspring. Disparities were not explained by maternal origin or maternal health factors, indicating that social determinants of health through delays in receiving adequate care and factors negatively influencing gestational length may be of importance.
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Affiliation(s)
- Frode Eick
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Postboks 1130 Blindern, 0318, Oslo, Norway.
| | - Odd Martin Vallersnes
- Department of General Practice, Institute of Health and Society, University of Oslo, Norway; Oslo Accident and Emergency Outpatient Clinic, Department of Emergency General Practice, City of Oslo Health Agency, Norway
| | - Heidi E Fjeld
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Postboks 1130 Blindern, 0318, Oslo, Norway
| | - Ingvil K Sørbye
- Department of Obstetrics, Division of Obstetrics and Gynaecology, Oslo University Hospital, Norway
| | - Morten Valberg
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Postboks 1130 Blindern, 0318, Oslo, Norway; Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Norway
| | - Cecilie Dahl
- Department of Public Health Science, Institute of Health and Society, University of Oslo, Norway
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Stevenson K, Antia K, Burns R, Mosca D, Gencianos G, Rechel B, Norredam M, LeVoy M, Blanchet K. Universal health coverage for undocumented migrants in the WHO European region: a long way to go. THE LANCET REGIONAL HEALTH. EUROPE 2024; 41:100803. [PMID: 39119095 PMCID: PMC11306210 DOI: 10.1016/j.lanepe.2023.100803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 11/09/2023] [Accepted: 11/16/2023] [Indexed: 08/10/2024]
Abstract
The number of people on the move internationally is increasing, and a sizable number of these individuals are migrating through and to the WHO European Region. The UN Sustainable Development Goals demand that we leave no one behind and ensure equitable implementation of Universal Health Coverage (UHC), regardless of immigration status. In the WHO European region, some of the migrants in the most precarious situations are undocumented; defined as those who may have been unsuccessful in asylum applications, born to undocumented parents, continued their residence in a country after their permit or other means of stay expired, as well as those who have entered the country irregularly. These undocumented migrants face some of the biggest challenges to accessing UHC and are often left behind by systems that exclude and stigmatise them. This paper examines the literature on access to healthcare for undocumented migrants in the WHO European Region and calls for urgent action towards ensuring UHC for all migrants regardless of immigration status by 2030.
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Affiliation(s)
- Kerrie Stevenson
- Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA, United Kingdom
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, Keppel Street London, WC1E 7HT, United Kingdom
| | - Khatia Antia
- Heidelberg Institute of Global Health, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Rachel Burns
- Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA, United Kingdom
| | - Davide Mosca
- Realizing SDGs for Migrants, Displaced, and Communities, Italy
| | | | - Bernd Rechel
- European Observatory on Health Systems and Policies, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Marie Norredam
- Department of Public Health, Danish Research Center for Migration, Ethnicity and Health, Section of Health Services, University of Copenhagen, Denmark
| | - Michele LeVoy
- Platform for International Cooperation on Undocumented Migrants (PICUM), Brussels, Belgium
| | - Karl Blanchet
- Geneva Centre of Humanitarian Studies, Faculty of Medicine, University of Geneva, Switzerland
- Lancet Migration European Region Hub, Switzerland
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Wierenga H, Målqvist M. Differences in Antenatal Care Policies in England, Finland, and the Netherlands: A Framing analysis. Matern Child Health J 2024; 28:738-745. [PMID: 38334865 DOI: 10.1007/s10995-023-03882-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 02/10/2024]
Abstract
BACKGROUND AND PURPOSE The World Health Organization (WHO) states that good quality antenatal care should strive for both mother and child achieving their best possible health. On a policy level, in Europe these goals are reached with varying approaches. This research offers a fresh look on the underlying assumptions embedded in the ANC policies in three European countries. METHODS A framing analysis was conducted to publicly available ANC policies on uncomplicated pregnancies in Finland, England, and the Netherlands. Analysis was guided by van Hulst and Yanowa and included the following phases: a) Sense-making, b) Selecting, naming, and categorizing and c) Storytelling. MAIN FINDINGS Findings of this study demonstrate how ANC is organized with distinct frames. The Finnish ANC policies emphasized equity in care and instead of focusing on women, the ANC focused on the family. In England the pregnant woman was central, and it is seen as her responsibility to understand the ANC protocols. The ANC in the Netherlands focused on the pregnant woman's pregnancy experience and freedom. CONCLUSION The three studied countries had individual priorities and values guiding ANC provision. Despite each country being in line with the WHO ANC recommendations, areas requiring improvement should not be overlooked.
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Affiliation(s)
- Hanna Wierenga
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Mats Målqvist
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
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Osuide JO, Parsa AD, Mahmud I, Kabir R. The effect of limited access to antenatal care on pregnancy experiences and outcomes among undocumented migrant women in Europe: a systematic review. Front Glob Womens Health 2024; 5:1289784. [PMID: 38379839 PMCID: PMC10876992 DOI: 10.3389/fgwh.2024.1289784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/23/2024] [Indexed: 02/22/2024] Open
Abstract
Women who are undocumented migrants in Europe encounter a variety of challenges while trying to access health services, including restricted access to antenatal care (ANC) despite the importance of ANC to the well-being of mothers and their infants. This study's aim was to examine the effect that limited access to antenatal care has on the pregnancy experiences and outcomes of undocumented migrant (UM) women in Europe. Systematic searches were done on PubMed, Ovid MEDLINE, Ovid EMBASE, EBSCO CINAHL Plus, and BioMed Central. From the search results, only primary research articles that reported on the pregnancy outcomes and experiences of undocumented migrants were selected. A meta-analysis was not possible because this review included information from both qualitative and quantitative studies. The data that was taken from the included publications was organised, analysed, using the Microsoft Excel programme, and then meta-synthesised. Twelve papers from seven different European nations-Belgium, France, Sweden, Denmark, Norway, Finland, and England-were included in this systematic review. Eight of the studies aimed to explore the access to and utilization of ANC by undocumented migrant women and the related pregnancy outcomes. Two of the included studies examined the pregnancy experiences of UMs and two examined the perinatal risks associated with living as a migrant with no legal status. Although heterogeneous in their specific findings most of the studies showed undocumented immigrants are more likely to experience unfavourable pregnancy outcomes and experience greater anxiety and worries due to a variety of factors than documented migrants and registered citizens. This review's conclusions demonstrate the pressing need for policy modifications and healthcare reforms in Europe to address the problems associated with undocumented migrants' restricted access to antenatal care. It also highlights the urgent need for structural changes that will give this vulnerable population's health and well-being a higher priority. It is not just an issue of health equality but also a humanitarian obligation to address the many obstacles and difficulties undocumented migrant women endure during pregnancy.
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Affiliation(s)
- Jennifer Okhianosen Osuide
- School of Allied Health, Faculty of Health, Medicine and Social Care, Anglia Ruskin University, Essex, Chelmsford, United Kingdom
| | - Ali Davod Parsa
- School of Allied Health, Faculty of Health, Medicine and Social Care, Anglia Ruskin University, Essex, Chelmsford, United Kingdom
| | - Ilias Mahmud
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- School of Health, University of New England, Armidale, NSW, Australia
| | - Russell Kabir
- School of Allied Health, Faculty of Health, Medicine and Social Care, Anglia Ruskin University, Essex, Chelmsford, United Kingdom
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Cadman V, Soltani H, Spencer R, Marvin-Dowle K, Harrop D. Cesarean birth rates among migrants in Europe: A systematic review. Birth 2023; 50:657-671. [PMID: 36939837 DOI: 10.1111/birt.12718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 01/27/2023] [Accepted: 02/07/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND Cesarean birth (CB) rates have increased over recent years with concerns over differences between these rates in migrant communities compared with the rates among women in their receiving country. This review aimed at summarizing the available literature regarding the incidence of CB among migrants in Europe. METHODS A systematic search of four electronic databases was carried out, including CINAHL, MEDLINE, Scopus, and Maternity and Infant Care. Identified studies were screened and their quality assessed. Meta-analysis was undertaken using Rev Man 5.4 where sufficient data were available. Otherwise, data were synthesized narratively. RESULTS From the 435 records identified in searches, 21 papers were included. Analysis shows that overall CB rates were significantly lower for Syrian refugee women compared with women in their receiving country (Turkey) and higher for Iranian migrants than women in their host country. Emergency CB rates were significantly higher for migrant women from "Sub Saharan Africa" and the "South East Asia, Asia and Pacific" region than rates in the receiving country. Statistical significance was not found between other populations. CONCLUSIONS This review highlights differences between CB rates in certain migrant groups in comparison with women native to their host country, which merits further investigation for potential explanations. We also identified a need to standardize definitions and population groupings to enable more meaningful analysis. This review also highlights a substantial lack of data on CB rates between different population groups that could negatively impact the provision of care.
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Affiliation(s)
- Victoria Cadman
- Department of Allied Health Professions, College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, UK
| | - Hora Soltani
- College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, UK
| | - Rachael Spencer
- Department of Nursing and Midwifery College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, UK
| | - Katie Marvin-Dowle
- College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, UK
| | - Deborah Harrop
- College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, UK
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Atak M, Sezerol MA, Değer MS, Kurubal H. Factors Associated with the Prevalence of Postpartum Anxiety Disorder and Depression in Syrian Migrant Women Living in Turkey: A Cross-Sectional Study. Healthcare (Basel) 2023; 11:2517. [PMID: 37761714 PMCID: PMC10530885 DOI: 10.3390/healthcare11182517] [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: 07/31/2023] [Revised: 08/22/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
The global migration trend has brought attention to the mental health of immigrant populations, especially postpartum women. The prevalence of postpartum anxiety and depression among these populations remains a growing concern. This study aimed to explore the factors associated with postpartum anxiety and depression among immigrant women, with a special emphasis on Syrian migrants in Turkey. A cross-sectional design was employed, enrolling postpartum women who visited the Strengthened Migrant Health Center in Istanbul between July and December 2022. Data were collected using a three-part questionnaire comprising sociodemographic details and scores from the Edinburgh Postpartum Depression Scale (EPDS) and Beck Anxiety Scale (BAI). The average age of participants was 25.73 years. The mean EPDS and BAI scores were low at 1.27 and 3.85, respectively. Notably, 97.1% of women scored below the EPDS cut-off point of 13. EPDS scores showed a significant relationship between income levels and COVID-19 vaccination status, while BAI scores were significantly associated with educational levels. There was an inverse correlation between EPDS scores and the number of cohabitants in a household. The observed low rates of postpartum depression and anxiety could be attributed to the accessible health services and psychosocial support for immigrants in Turkey. It would be useful to conduct multicenter and comprehensive epidemiological studies on migrant puerperas.
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Affiliation(s)
- Muhammed Atak
- Department of Public Health, Istanbul Medical Faculty, Istanbul University, Istanbul 34093, Türkiye
- Epidemiology Program, Institute of Health Sciences, İstanbul Medipol University, Istanbul 34810, Türkiye;
| | - Mehmet Akif Sezerol
- Epidemiology Program, Institute of Health Sciences, İstanbul Medipol University, Istanbul 34810, Türkiye;
- Health Management Program, Graduate Education Institute, Maltepe University, Istanbul 34857, Türkiye
- Department of Public Health, School of Medicine, Istanbul Medipol University, Istanbul 34810, Türkiye
- Sultanbeyli District Health Directorate, Istanbul 34935, Türkiye
| | - Mehmet Sait Değer
- Department of Public Health, Medical Faculty, Hitit University, Corum 19030, Türkiye;
| | - Hamza Kurubal
- Klinik Porta Westfalica GmbH & Co. KG, Steinstrasse 65, 32547 Bad Oeynhausen, Germany;
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Montagnoli C, Wanner P. Are pregnancy outcomes affected by the lack of legal status? A demographic study based on 850,288 live births in Switzerland. BMC Pregnancy Childbirth 2023; 23:567. [PMID: 37543619 PMCID: PMC10403826 DOI: 10.1186/s12884-023-05870-5] [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: 07/05/2022] [Accepted: 07/24/2023] [Indexed: 08/07/2023] Open
Abstract
BACKGROUND In the context of increased global mobility, it is fundamental to understand migrants' needs and how governments can ensure equal health opportunities for both regular and irregular migrants simply by applying low-cost primary health care measures. To identify health issues in which to intervene, this study analysed the impact of a mother's lack of legal status, together with available biological and socioeconomic characteristics, on four indicators of adverse perinatal outcomes in Switzerland. METHODS Based on the exhaustive records of the Swiss Federal Statistical Office (FSO) for its Vital Statistics (BEVNAT), different indicators of birth outcomes, including preterm birth (PTB), low and very low birth weight (LBW and VLBW), and small for gestational age (SGA), were analysed using logistic regressions on live births occurring from 2005 to 2018. These four adverse outcomes were defined as dependent variables. Statistical analysis was performed using the statistical package STATA, version 17. RESULTS Selected pregnancy outcomes were conversely affected by an irregular legal status. Analysis run on the final sample showed that, compared to the neonates of mothers who are non-migrant legal residents in Switzerland, newborns of irregular migrants have higher risks of PTB (aOR 1.18 95% CI [1.05-1.32], p<0.01) and VLBW (aOR 1.43 [1.13-1.81], p < 0.01]). In contrast, we observed that in both irregular and regular migrant groups, the odds of SGA were lowered (aOR .76 [.68-.85] p<0.01) and aOR .93 [.91-.94], p< 0.01, respectively). A similar effect was observed when controlling for any adverse outcome (any AOs) (aOR .90 [.83-.99] p 0.022; and aOR .93 [.91-.94] p< 0.01, respectively). CONCLUSIONS Our results, together with those from the available literature, call for a more comprehensive assessment of all pregnancy outcomes as well as of the social determinants of health for which the analysis was adjusted. Given the complexity of the migration phenomenon, future studies should account for local structural restrictions in the organization of care, the extension of a person's network as a means of health care accessibility, diverse backgrounds and cultures and the recent arrival status of migrants. This would allow researchers to understand the long-term impact of social determinants of health on the wellbeing of a mother and child and take them into account in the adoption of health policies.
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Affiliation(s)
- Caterina Montagnoli
- Institute of Demography and Socioeconomics, University of Geneva, Geneva, Switzerland.
- Midwifery Degree Programme, Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland, Geneva, Switzerland.
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland.
| | - Philippe Wanner
- Institute of Demography and Socioeconomics, University of Geneva, Geneva, Switzerland
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Martyn E, Eisen S, Longley N, Harris P, Surey J, Norman J, Brown M, Sultan B, Maponga TG, Iwuji C, Flanagan S, Ghosh I, Story A, Matthews PC. The forgotten people: Hepatitis B virus (HBV) infection as a priority for the inclusion health agenda. eLife 2023; 12:e81070. [PMID: 36757862 PMCID: PMC9910830 DOI: 10.7554/elife.81070] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 01/19/2023] [Indexed: 02/10/2023] Open
Abstract
Hepatitis B virus (HBV) infection represents a significant global health threat, accounting for 300 million chronic infections and up to 1 million deaths each year. HBV disproportionately affects people who are under-served by health systems due to social exclusion, and can further amplify inequities through its impact on physical and mental health, relationship with stigma and discrimination, and economic costs. The 'inclusion health' agenda focuses on excluded and vulnerable populations, who often experience barriers to accessing healthcare, and are under-represented by research, resources, interventions, advocacy, and policy. In this article, we assimilate evidence to establish HBV on the inclusion health agenda, and consider how this view can inform provision of better approaches to diagnosis, treatment, and prevention. We suggest approaches to redress the unmet need for HBV interventions among excluded populations as an imperative to progress the global goal for the elimination of viral hepatitis as a public health threat.
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Affiliation(s)
- Emily Martyn
- The Francis Crick InstituteLondonUnited Kingdom
- London School of Hygiene & Tropical MedicineLondonUnited Kingdom
- Hospital for Tropical Diseases, Division of Infection, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
| | - Sarah Eisen
- Hospital for Tropical Diseases, Division of Infection, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
| | - Nicky Longley
- London School of Hygiene & Tropical MedicineLondonUnited Kingdom
- Hospital for Tropical Diseases, Division of Infection, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
- Department of Infectious Diseases, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
| | - Philippa Harris
- Find & Treat Service, Division of Infection, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
| | - Julian Surey
- Find & Treat Service, Division of Infection, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
- Institute of Global Health, University College LondonLondonUnited Kingdom
- Universidad Autonoma de Madrid, Ciudad Universitaria de CantoblancoMadridSpain
| | - James Norman
- Find & Treat Service, Division of Infection, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
| | - Michael Brown
- London School of Hygiene & Tropical MedicineLondonUnited Kingdom
- Department of Infectious Diseases, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
- Find & Treat Service, Division of Infection, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
| | - Binta Sultan
- Find & Treat Service, Division of Infection, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
- Mortimer Market Centre, Central and North London NHS Foundation TrustLondonUnited Kingdom
| | - Tongai G Maponga
- Stellenbosch University, Faculty of Medicine and Health SciencesTygerbergSouth Africa
| | - Collins Iwuji
- Department of Global Health, Brighton and Sussex Medical School, University of SussexBrightonUnited Kingdom
- Africa Health Research InstituteDurban, KwaZulu-NatalSouth Africa
| | - Stuart Flanagan
- Mortimer Market Centre, Central and North London NHS Foundation TrustLondonUnited Kingdom
| | - Indrajit Ghosh
- Find & Treat Service, Division of Infection, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
- Mortimer Market Centre, Central and North London NHS Foundation TrustLondonUnited Kingdom
| | - Alistair Story
- Find & Treat Service, Division of Infection, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
- Collaborative Centre for Inclusion Health, University College LondonLondonUnited Kingdom
| | - Philippa C Matthews
- The Francis Crick InstituteLondonUnited Kingdom
- Department of Infectious Diseases, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
- Mortimer Market Centre, Central and North London NHS Foundation TrustLondonUnited Kingdom
- Division of Infection and Immunity, University College LondonLondonUnited Kingdom
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11
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Vaccine Uptake and COVID-19 Frequency in Pregnant Syrian Immigrant Women. Vaccines (Basel) 2023; 11:vaccines11020257. [PMID: 36851135 PMCID: PMC9966866 DOI: 10.3390/vaccines11020257] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/16/2023] [Accepted: 01/21/2023] [Indexed: 01/27/2023] Open
Abstract
Immigrants have difficulties in the use of essential health services such as vaccinations. Vaccine uptake among pregnant immigrant women is very low. The aim of the study was to examine the vaccination status of pregnant immigrant women who received health services in an immigrant health center (IHC) affiliated to primary health care institutions. The research is a retrospective-designed cross-sectional type of study. The study sample consists of pregnant Syrian women who received health care from the strengthened IHC of a District Health Directorate in Istanbul between August 2020 and 2022. Age, trimesters, number of pregnancies, high-risk pregnancy status, vaccination dates and status against influenza, COVID-19 and tetanus, and vaccine types of COVID-19 were evaluated. The statistical significance level was determined as p < 0.05. None of the pregnant women had received the influenza vaccine. Of the women whose tetanus vaccine data were evaluated, 29.7% had received at least two doses of the tetanus vaccine. Of the pregnant women, 19.4% were vaccinated against COVID-19 with a minimum two doses and 4.2% had a COVID-19 infection during their pregnancy. None of the women with the COVID-19 infection were fully vaccinated against COVID-19. The vaccine uptake of pregnant immigrant women is very low. Public health interventions are needed to improve vaccination coverage among disadvantaged groups.
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12
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Pereira A, Biscaia A, Calado I, Freitas A, Costa A, Coelho A. Healthcare Equity and Commissioning: A Four-Year National Analysis of Portuguese Primary Healthcare Units. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14819. [PMID: 36429538 PMCID: PMC9690059 DOI: 10.3390/ijerph192214819] [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: 10/13/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 06/16/2023]
Abstract
Equal and adequate access to healthcare is one of the pillars of Portuguese health policy. Despite the controversy over commissioning processes' contribution to equity in health, this article aims to clarify the relationship between socio-economic factors and the results of primary healthcare (PHC) commissioning indicators through an analysis of four years of data from all PHC units in Portugal. The factor that presents a statistically significant relationship with a greater number of indicators is the organizational model. Since the reform of PHC services in 2005, a new type of unit was introduced: the family health unit (USF). At the time of the study, these units covered 58.1% of the population and achieved better indicator results. In most cases, the evolution of the results achieved by commissioning seems to be similar in different analyzed contexts. Nevertheless, the percentage of patients of a non-Portuguese nationality and the population density were analyzed, and a widening of discrepancies was observed in 23.3% of the cases. The commissioning indicators were statistically related to the studied context factors, and some of these, such as the nurse home visits indicator, are more sensitive to context than others. There is no evidence that the best results were achieved at the expense of worse healthcare being offered to vulnerable populations, and there was no association with a reduction in inequalities in healthcare. It would be valuable if the Portuguese Government could stimulate the increase in the number of working USFs, especially in low-density areas, considering that they can achieve better results with lower costs for medicines and diagnostic tests.
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Affiliation(s)
- António Pereira
- Family Health Unit, Unidade de Saúde Familiar Prelada, ACES Porto Ocidental, 4250-113 Porto, Portugal
- PHC—Commissioning Department, Northern Regional Administration of Health, 4000-447 Porto, Portugal
- CINTESIS—Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - André Biscaia
- CINTESIS—Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Family Health Unit, Unidade de Saúde Familiar Marginal, ACES Cascais, ARS Lisboa e Vale do Tejo, 2765-618 São João do Estoril, Portugal
| | - Isis Calado
- University College London Medical School, London WC1E 6DE, UK
| | - Alberto Freitas
- CINTESIS—Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Andreia Costa
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon (ESEL), 1600-096 Lisbon, Portugal
- Católica Research Centre for Psychological, Family and Social Wellbeing, Faculdade de Ciências Humanas, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, 1099-085 Lisbon, Portugal
| | - Anabela Coelho
- Comprehensive Health Research Centre (CHRC), Nursing Department, University of Évora, 7004-516 Evora, Portugal
- H&TRC—Health & Technology Research Center, ESTeSL—Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, 1990-096 Lisbon, Portugal
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa, 1349-008 Lisbon, Portugal
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13
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Santoso D, Asfia SK, Mello MB, Baggaley RC, Johnson CC, Chow EP, Fairley CK, Ong JJ. HIV prevalence ratio of international migrants compared to their native-born counterparts: A systematic review and meta-analysis. EClinicalMedicine 2022; 53:101661. [PMID: 36147629 PMCID: PMC9486043 DOI: 10.1016/j.eclinm.2022.101661] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/29/2022] [Accepted: 08/30/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND People on the move, including international migrants, may face health inequities that expose them to a higher risk for HIV than native-born populations. We conducted a systematic review to calculate the HIV prevalence ratio of international migrants compared with native-born populations. METHODS We searched five databases between January 2010 and March 2022. Using random-effects meta-analysis, we calculated the pooled HIV prevalence ratios (PR) by comparing the HIV prevalence of migrants with native-born populations. Our research protocol is registered in the International prospective register of systematic reviews (PROSPERO, CRD42021250867). FINDINGS In total, 5,121 studies were screened, and 38 were included in the final analysis: 7,121,699 migrants and more than 270 million natives were included in the analysis. The pooled PR for any foreign-born migrants was 1·70 (95% CI 1·11 - 2·61, I2 =99·67%, n = 33 studies), refugees was 2·37 (95% CI 0·33-16·99, I2 =99·5%, n = 5), undocumented people was 3·98 (95% CI 0·11-143·01, I2 =94·6%, n = 3), whilst asylum seekers was 54·79 (95% CI 17·23-174·23, I2 =90·2%, n = 2). Meta-regression revealed that population type (adjusted R-squared 11.5%), region of origin (11.3%) and migrant type (10.8%) accounted for heterogeneity more than country-income (2.4%) and study setting (2.3%). INTERPRETATION Although it was not possible to assess if HIV infection occurred in the country of origin or destination, the HIV prevalence ratio was higher among migrants than in native-born populations. Inclusive health policies and strategies for delivering HIV testing, prevention and treatment services for migrant populations tailored to their needs are urgently needed. FUNDING J.J.O. and E.P.F.C. are supported by the Australian National Health and Medical Research Council (NHMRC) Emerging Leader Fellowship (GNT1193955 and GNT1172873, respectively).
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Affiliation(s)
- Devy Santoso
- Central Clinical School, Monash University, Melbourne, Australia
| | | | - Maeve B. Mello
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Rachel C. Baggaley
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Cheryl C. Johnson
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Eric P.F. Chow
- Central Clinical School, Monash University, Melbourne, Australia
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher K. Fairley
- Central Clinical School, Monash University, Melbourne, Australia
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Australia
| | - Jason J. Ong
- Central Clinical School, Monash University, Melbourne, Australia
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Australia
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Corresponding author at: 580 Swanston Street, Carlton, Victoria 3053, Australia.
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14
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Eick F, Vallersnes OM, Fjeld HE, Sørbye IK, Storkås G, Ekrem M, Børmer M, Løberg SA, Ebbing C, Voldner N, Dahl C. Use of non-governmental maternity services and pregnancy outcomes among undocumented women: a cohort study from Norway. BMC Pregnancy Childbirth 2022; 22:789. [PMID: 36280826 PMCID: PMC9589618 DOI: 10.1186/s12884-022-05112-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 10/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2011 Norway granted undocumented women the right to antenatal care and to give birth at a hospital but did not include them in the general practitioner and reimbursement schemes. As a response to limited access to health care, Non-Governmental Organizations (NGO) have been running health clinics for undocumented migrants in Norway's two largest cities. To further facilitate universal health coverage, there is a need to investigate how pregnant undocumented women use NGO clinics and how this affects their maternal health. We therefore investigated the care received, occurrence of pregnancy-related complications and pregnancy outcomes in women receiving antenatal care at these clinics. METHODS In this historic cohort study we included pregnant women aged 18-49 attending urban NGO clinics from 2009 to 2020 and retrieved their medical records from referral hospitals. We compared women based on region of origin using log-binominal regression to estimate relative risk of adverse pregnancy outcomes. RESULTS We identified 582 pregnancies in 500 women during the study period. About half (46.5%) the women sought antenatal care after gestational week 12, and 25.7% after week 22. The women had median 1 (IQR 1-3) antenatal visit at the NGO clinics, which referred 77.7% of the women to public health care. A total of 28.4% of women were referred for induced abortion. In 205 retrieved deliveries in medical records, there was a 45.9% risk for any adverse pregnancy outcome. The risk of stillbirth was 1.0%, preterm birth 10.3%, and emergency caesarean section 19.3%. CONCLUSION Pregnant undocumented women who use NGO clinics receive substandard antenatal care and have a high risk of adverse pregnancy outcomes despite low occurrence of comorbidities. To achieve universal health coverage, increased attention should be given to the structural vulnerabilities of undocumented women and to ensure that adequate antenatal care is accessible for them.
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Affiliation(s)
- Frode Eick
- grid.5510.10000 0004 1936 8921Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Postboks 1130 Blindern, 0318 Oslo, Norway
| | - Odd Martin Vallersnes
- grid.5510.10000 0004 1936 8921Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Heidi E. Fjeld
- grid.5510.10000 0004 1936 8921Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Postboks 1130 Blindern, 0318 Oslo, Norway
| | - Ingvil Krarup Sørbye
- grid.55325.340000 0004 0389 8485Department of Obstetrics, Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - Guro Storkås
- grid.5510.10000 0004 1936 8921Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Marthe Ekrem
- grid.5510.10000 0004 1936 8921Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Marie Børmer
- grid.7914.b0000 0004 1936 7443Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Sara Andrea Løberg
- grid.411279.80000 0000 9637 455XDivision of Gynaecology and Obstetrics, Akershus University Hospital, Oslo, Norway
| | - Cathrine Ebbing
- grid.7914.b0000 0004 1936 7443Department of Obstetrics and Gynaecology, Haukeland University Hospital, and Department of clinical medicine, University of Bergen, Bergen, Norway
| | - Nanna Voldner
- grid.463529.f0000 0004 0610 6148Faculty of Health Studies, VID specialized university, Oslo, Norway
| | - Cecilie Dahl
- grid.5510.10000 0004 1936 8921Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Postboks 1130 Blindern, 0318 Oslo, Norway
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15
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Tankink JB, Verschuuren AEH, Postma IR, van der Lans PJA, de Graaf JP, Stekelenburg J, Mesman AW. Childbirths and the Prevalence of Potential Risk Factors for Adverse Perinatal Outcomes among Asylum Seekers in The Netherlands: A Five-Year Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182412933. [PMID: 34948540 PMCID: PMC8700803 DOI: 10.3390/ijerph182412933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/26/2021] [Accepted: 12/06/2021] [Indexed: 11/16/2022]
Abstract
This five-year cross-sectional study mapped the prevalence of several known risk factors for adverse perinatal outcomes in asylum-seeking women in The Netherlands. Characteristics of 2831 registered childbirths among residents of asylum seekers centers (ASCs) in The Netherlands from 2016 to 2020 were included. Results showed a high general and teenage birthrate (2.15 and 6.77 times higher compared to the Dutch, respectively). Most mothers were pregnant upon arrival, and the number of births was highest in the second month of stay in ASCs. Another peak in births between 9 and 12 months after arrival suggested that many women became pregnant shortly after arrival in The Netherlands. Furthermore, 69.5 percent of all asylum-seeking women were relocated between ASCs at least once during pregnancy, which compromises continuity of care. The high prevalence of these risk factors in our study population might explain the increased rate of adverse pregnancy outcomes in asylum seekers compared to native women found in earlier studies. Incorporating migration-related indicators in perinatal health registration is key to support future interventions, policies, and research. Ultimately, our findings call for tailored and timely reproductive and perinatal healthcare for refugee women who simultaneously face the challenges of resettlement and pregnancy.
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Affiliation(s)
- Julia B. Tankink
- Department of Obstetrics and Gynecology, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands;
- Correspondence: (J.B.T.); (A.E.H.V.)
| | - Anouk E. H. Verschuuren
- Global Health Unit, Department of Health Sciences, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
- Correspondence: (J.B.T.); (A.E.H.V.)
| | - Ineke R. Postma
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
| | - Peggy J. A. van der Lans
- Department of Obstetrics and Gynecology, Hospital Twente ZGT/MST, 7512 KZ Enschede, The Netherlands;
| | - Johanna P. de Graaf
- Department of Obstetrics and Gynecology, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands;
| | - Jelle Stekelenburg
- Global Health Unit, Department of Health Sciences, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
- Department of Obstetrics and Gynecology, Medical Center Leeuwarden, Henri Dunantweg 2, 8934 AD Leeuwarden, The Netherlands
| | - Annelies W. Mesman
- Netherlands Association for Community Health Services (GGD GHOR Nederland), Zwarte Woud 2, 3524 SJ Utrecht, The Netherlands;
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16
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Aro T, Kantele A. Hospital admissions of refugees, asylum seekers and undocumented migrants: Ten-year retrospective study. Travel Med Infect Dis 2021; 44:102186. [PMID: 34688889 DOI: 10.1016/j.tmaid.2021.102186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 08/05/2021] [Accepted: 10/18/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The worldwide population of forcibly displaced people has increased over the past decade, approaching 80 million and encompassing more than 30 million refugees and asylum seekers. Research into refugee and migrant health has remained scarce, however. METHODS To investigate the reasons for hospital admissions of refugees, asylum seekers and undocumented migrants, we collected medical data from Helsinki University Hospital (HUH) records 2010-20. RESULTS The study population consisted of 647 patients originally from 54 different countries, mainly Iraq, Syria, and Afghanistan. Among adults, 40.9% of the admissions were related to pregnancy. For minors, the group comprising congenital malformations, deformations, and chromosomal abnormalities accounted for most hospitalizations, followed by diseases of the digestive or nervous system. Every fifth patient (19.3%) was admitted because of an infection: adults mostly for urinary tract infection (16.3%), pneumonia (14.1%), and tuberculosis (9.8%), and minors for acute gastroenteritis (15.2%). Infectious reason was more frequent within two months after immigration than later. CONCLUSIONS Our data reveal a unique admission profile for forced migrants: in addition to infectious diseases, a particularly high rate of obstetric diagnoses was recorded, the two ranking as the most common reasons for hospitalization.
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Affiliation(s)
- Tuomas Aro
- Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Finland; Meilahti Infectious Diseases and Vaccine Research Center, MeiVac, Inflammation Center, University of Helsinki and Helsinki University Hospital, Finland
| | - Anu Kantele
- Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Finland; Meilahti Infectious Diseases and Vaccine Research Center, MeiVac, Inflammation Center, University of Helsinki and Helsinki University Hospital, Finland.
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