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Francisco Rossetti A, Obelleiro Nadal S, Gutierrez de Quijano Miceli F, Garcia-Gozalbes J, Jiménez Lozano AI, Serre-Delcor N. [Syndromic approach in migrant patients: Fever, diarrhea, anemia, eosinophilia and chronic cough]. Aten Primaria 2024; 56:102924. [PMID: 38599015 PMCID: PMC11010778 DOI: 10.1016/j.aprim.2024.102924] [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: 02/15/2024] [Accepted: 02/16/2024] [Indexed: 04/12/2024] Open
Abstract
Migrant patients share the same diseases as natives, but biological or environmental differences may lead to distinct prevalence and manifestations of certain syndromes. Some common conditions in Primary Care stand out, such as fever, diarrhea, anemia, eosinophilia, and chronic cough, where it is important to have a special consideration. Fever may indicate a serious imported illness, and malaria should always be ruled out. Diarrhea is generally of infectious origin, and in most cases, management is outpatient. Anemia may indicate malnutrition or malabsorption, while eosinophilia may indicate a parasitic infection. Lastly, chronic cough may be a sign of tuberculosis, especially in immigrants from endemic areas. Family medicine holds a privileged position for the comprehensive, culturally sensitive, and person-centered approach to these conditions.
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Affiliation(s)
- Agustín Francisco Rossetti
- Equipo de Atención Primaria Centre, Institut Català de Salut, Hospitalet de Llobregat, Barcelona, Grupo de Trabajo Cooperación y Salud Internacional (COCOOPSI), Sociedad Catalana de Medicina Familiar y Comunitaria, Hospitalet de Llobregat, Barcelona, España.
| | - Sara Obelleiro Nadal
- Equipo de Atención Primaria Banyoles, Institut Català de la Salut, Banyoles, Girona, Grupo de Trabajo Cooperación y Salud Internacional (COCOOPSI), Sociedad Catalana de Medicina Familiar y Comunitaria, Banyoles, Girona, España
| | - Federica Gutierrez de Quijano Miceli
- Equipo de Atención Primaria Centre, Institut Català de Salut, Hospitalet de Llobregat, Barcelona, Grupo de Trabajo Cooperación y Salud Internacional (COCOOPSI), Sociedad Catalana de Medicina Familiar y Comunitaria, Hospitalet de Llobregat, Barcelona, España
| | - Julia Garcia-Gozalbes
- Urgencias Hospital Clinic, Barcelona, Grupo de Trabajo Cooperación y Salud Internacional (COCOOPSI), Sociedad Catalana de Medicina Familiar y Comunitaria, Barcelona, España
| | - Ana I Jiménez Lozano
- Equipo de Atención Primaria Roger-Badal 3I, Institut Català de la Salut, Barcelona, Grupo de Trabajo Cooperación y Salud Internacional (COCOOPSI), Sociedad Catalana de Medicina Familiar y Comunitaria, Barcelona, España
| | - Núria Serre-Delcor
- Centro de Salud Internacional y Enfermedades Transmisibles Drassanes Vall d'Hebron, Hospital Vall d'Hebron, PROSICS, Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, España
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Saseetharran A, Hiebert L, Gupta N, Nyirahabihirwe F, Kamali I, Ward JW. Prevention, testing, and treatment interventions for hepatitis B and C in refugee populations: results of a scoping review. BMC Infect Dis 2023; 23:866. [PMID: 38071291 PMCID: PMC10709891 DOI: 10.1186/s12879-023-08861-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND AND AIMS Refugees are at higher risk for hepatitis B (HBV) and hepatitis C (HCV), but often face unique healthcare barriers to vaccination, testing, and treatment. This scoping review aimed to identify and characterize HBV and HCV prevention and care services serving refugee populations globally. METHODS A literature search was conducted on Embase, Cochrane, and PubMed databases. Research studies published in English between January 2010 to July 2022 describing an HBV or HCV prevention, testing, or treatment intervention for refugees were included. RESULTS There were a total of 69 articles reporting viral hepatitis prevalence, implementation of services, or economic modelling. Of the 38 implementation studies, 14 were stand-alone HBV and/or HCV interventions, while 24 studies included HBV and/or HCV in an intervention targeting multiple infectious diseases and/or parasitic infections. Interventions commonly included a testing (n = 30) or referral (n = 24) component. Frequently reported features to promote program accessibility included bilingual services (n = 25), community partnerships (n = 21), and multidisciplinary staff members (n = 18), such as cultural and/or linguistic mediators, community health workers, community health leaders, lay health workers, local health staff, members of the refugee community, and social workers. The most commonly reported challenge was the transience of refugees (n = 5). Twenty studies noted funding sources, of which twelve reported governmental funding (not including national health insurance) and eight reported that refugees received national health insurance. CONCLUSIONS This is the first scoping review to characterize the types of hepatitis prevention, screening, and treatment interventions serving refugee populations globally. Published experiences of HBV and HCV services for refugee populations remain limited. Additional efforts are needed to disseminate models of hepatitis interventions for refugees to ensure access to care for this key population. To achieve hepatitis elimination globally, best practices must be identified and shared to expand access to hepatitis services for refugee populations.
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Affiliation(s)
- Ankeeta Saseetharran
- Coalition for Global Hepatitis Elimination, 330 W Ponce de Leon Ave, Decatur, GA 30030, USA.
| | - Lindsey Hiebert
- Coalition for Global Hepatitis Elimination, 330 W Ponce de Leon Ave, Decatur, GA 30030, USA
| | - Neil Gupta
- Coalition for Global Hepatitis Elimination, 330 W Ponce de Leon Ave, Decatur, GA 30030, USA
| | | | | | - John W Ward
- Coalition for Global Hepatitis Elimination, 330 W Ponce de Leon Ave, Decatur, GA 30030, USA
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Kim EE, Alemi Q, Stempel C, Siddiq H. Health disparities among Burmese diaspora: an integrative review. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 8:100083. [PMID: 37384141 PMCID: PMC10306005 DOI: 10.1016/j.lansea.2022.100083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
Tens of thousands of displaced Burmese ethnic minorities have endured various adversities for over six decades but are largely underserved. This study aimed to illuminate the health impacts of their misfortunes and unmet areas of concern. Using a holistic lens, we conducted an integrative review of 47 papers spanning the years 2004 to 2022 from diverse data sources. The results revealed widespread multimorbidity, triggered mainly by displacement. The diaspora's problematic health conditions were worse than their host country's general population. There was a strong indication that the diaspora's unfortunate health trajectory is determined early in life. Ongoing human rights violations and grossly inadequate health care interventions deepened pre-existing health conditions. Noteworthy emerging treatment initiatives, including integrative health care, were underutilized. The persisting health and intervention needs among the diaspora warrant advanced studies to facilitate much-needed resource mobilization and collaboration among stakeholders to promote health equity. Funding There was no financial support for this manuscript.
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Affiliation(s)
- Eunice E. Kim
- Department of Social Work and Social Ecology, Loma Linda University, Loma Linda, USA
| | - Qais Alemi
- Department of Social Work and Social Ecology, Loma Linda University, Loma Linda, USA
| | - Carl Stempel
- Department of Sociology and Social Services, California State University, East Bay, Hayward, USA
| | - Hafifa Siddiq
- Charles R. Drew University of Medicine and Science, Los Angeles, USA
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Duffey MM, Patel T, Koukaz Y, Sepulveda T, Barbour K, Fredricks K, Weatherhead JE. The impact of neglected tropical diseases on women and girl refugees: A call for increased awareness and strategic intervention. FRONTIERS IN TROPICAL DISEASES 2022. [DOI: 10.3389/fitd.2022.1095174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
As the number of forcibly displaced women and girls increases, it becomes ever important to recognize the negative health impacts of being displaced. Women and girl refugees are disproportionately affected by sexual and gender-based violence and mental health concerns. In addition to these health concerns in women, crowding and lack of clean water in refugee camps leads to the spread of infectious diseases in general. Neglected tropical diseases (NTDs) are infectious diseases of poverty found in tropical areas, and longstanding infections lead to significant morbidity. Particularly for women, these diseases can impact fertility, chronic disease in pregnancy, and social stigma. Despite being a high-risk group, there are minimal data on the impact of NTDs on the health of Women and girl refugees. Diseases such as schistosomiasis, soil-transmitted helminth infections, strongyloidiasis, and leishmaniasis have all been shown to affect Women and girl refugees, but the majority of these data describe NTDs in this population only after resettlement. Access to medical care with providers that are knowledgeable about NTDs while in situations of displacement as well as after third-country resettlement is crucial to their timely diagnosis and treatment to prevent longstanding sequalae. More studies in this at-risk population are needed to understand the extent of this issue and begin to work towards lasting, equitable healthcare.
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Iron deficiency, anemia and association with refugee camp exposure among recently resettled refugees: A Canadian retrospective cohort study. PLoS One 2022; 17:e0278838. [PMID: 36520858 PMCID: PMC9754286 DOI: 10.1371/journal.pone.0278838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 11/26/2022] [Indexed: 12/23/2022] Open
Abstract
Malnutrition and poor health are common among recently resettled refugees and may be differentially associated with pre-migration exposure to refugee camp versus non-camp dwelling. We aimed to investigate the associations of iron deficiency (ID), anemia, and ID anemia (IDA) with pre-migration refugee camp exposure among recently arrived refugees to Canada. To this end, we conducted a retrospective cohort study of 1032 adult refugees who received care between January 1, 2011, and December 31, 2015, within a specialized refugee health clinic in Calgary, Canada. We evaluated the prevalence, severity, and predictors of ID, anemia, and IDA, stratified by sex. Using multivariable logistic regression, we estimated the association of refugee camp exposure with these outcomes, adjusting for age, months in Canada prior to investigations, global region of origin, and parity. Among female refugees, the prevalence of ID, anemia, and IDA was 25% (134/534), 21% (110/534), and 14% (76/534), respectively; among males, 0.8% (4/494), 1.8% (9/494), and 0% (0/494), respectively. Anemia was mild, moderate, and severe in 55% (60/110), 44% (48/110) and 1.8% (2/110) of anemic females. Refugee camp exposure was not associated with ID, anemia, or IDA while age by year (ID OR = 0.96, 95% CI 0.93-0.98; anemia OR = 0.98, 95% CI 0.96-1.00; IDA OR = 0.96, 95% CI 0.94-0.99) and months in Canada prior to investigations (ID OR = 0.85, 95% CI 0.72-1.01; anemia OR = 0.81, 95% CI 0.67-0.97; IDA OR = 0.80, 95% CI 0.64-1.00) were inversely correlated with these outcomes. ID, anemia, and IDA are common among recently arrived refugee women irrespective of refugee camp exposure. Our findings suggest these outcomes likely improve after resettlement; however, given proportionally few refugees are resettled globally, likely millions of refugee women and girls are affected.
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Lindsay K, Hanes G, Mutch R, McKinnon E, Cherian S. Looking beyond: complex holistic care needs of Syrian and Iraqi refugee children and adolescents. Arch Dis Child 2022; 107:461-467. [PMID: 34702714 DOI: 10.1136/archdischild-2021-322718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 10/08/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Protracted international conflict has seen escalating numbers of displaced and resettled Syrian and Iraqi refugees, raising concerns for their health and well-being. This paper describes the demographic and clinical profiles of recently resettled Syrian and Iraqi refugee children and adolescents across physical, psychosocial, developmental and educational domains using standardised multidisciplinary assessments. DESIGN A cross-sectional observational study was undertaken of initial specialist paediatric multidisciplinary Refugee Health Service assessments completed at the tertiary paediatric hospital (Western Australia) between June 2015 and September 2019. RESULTS Three hundred and twenty-seven children and adolescents (264 Syrian, 63 Iraqi) were assessed following resettlement. Witnessed trauma (86%) and disclosed adversity (median Refugee Adverse Childhood Experiences score 3, range 1-14) were universally high. Almost all patients had health issues identified across physical (99%), psychosocial (76%) and developmental/educational (75%) domains. Interrupted education (65%) and death of a family member (16%) were significantly associated with psychological morbidities. Common comorbidities included dental caries (78%), non-infectious disease (76%), vitamin D deficiency (72%), malnutrition (46%; overweight/obesity 23%), and psychological (32%; post-traumatic stress disorder 4.3%) and developmental (9.5%) concerns. Emerging and alarming child protection concerns were prevalent (17%), with females demonstrating especially high risks. CONCLUSION This is the largest comprehensive study demonstrating the complex and cross-dimensional health needs and specific vulnerabilities of resettled Syrian and Iraqi refugee children and adolescents. Early comprehensive standardised multidisciplinary paediatric assessments, and culturally safe, trauma-informed interventions and follow-up are required to optimise resettlement outcomes and promote well-being.
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Affiliation(s)
- Kristen Lindsay
- Refugee Health Service, Department of General Paediatrics, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Discipline of Paediatrics, Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Gemma Hanes
- Refugee Health Service, Department of General Paediatrics, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Raewyn Mutch
- Refugee Health Service, Department of General Paediatrics, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Discipline of Paediatrics, Medical School, The University of Western Australia, Perth, Western Australia, Australia.,Telethon Kids Institute, Nedlands, Western Australia, Australia
| | | | - Sarah Cherian
- Refugee Health Service, Department of General Paediatrics, Perth Children's Hospital, Nedlands, Western Australia, Australia .,Discipline of Paediatrics, Medical School, The University of Western Australia, Perth, Western Australia, Australia.,Telethon Kids Institute, Nedlands, Western Australia, Australia
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Müller F, Chandra S, Bogoch II, Rashid M, Redditt V. Intestinal parasites in stool testing among refugees at a primary care clinic in Toronto, Canada. BMC Infect Dis 2022; 22:249. [PMID: 35282824 PMCID: PMC8918311 DOI: 10.1186/s12879-022-07226-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/28/2022] [Indexed: 12/03/2022] Open
Abstract
Background Enteric parasites are endemic in many of the countries from which refugees originate. Clinical guidelines vary in approaches to screening for and treating intestinal parasites in refugee receiving countries. This study aims to investigate the prevalence and species of intestinal parasites identified in stool ova and parasite (O&P) specimens in a sample of newly arrived refugees in Toronto, Canada. Methods We conducted a retrospective chart review of 1042 refugee patients rostered at a specialized primary care clinic in Toronto from December 2011 to September 2016. Patients who completed recommended stool O&P analyses were included. Basic sociodemographic and clinical variables and results of stool O&P were examined. Results 419 patients (40.2%) had a stool O&P positive for any protozoan or helminth species. Sixty-nine patients (6.6%) had clinically significant parasite species (excluding B hominis, D fragilis, and E dispar, given their lower risk for causing symptoms/complications): 2.3% had clinically significant protozoans and 4.2% had helminths on stool analysis. Conclusion Given the relatively low prevalence of clinically significant parasites identified, our findings do not support universal screening for enteric parasites with stool O&P among refugee claimants/asylum seekers. However, stool analysis should be considered in certain clinical situations, as part of a more tailored approach.
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Hvass AMF, Norredam M, Sodemann M, Wejse C. Is there a need of health assessments for resettling refugees? A cross-sectional study of 1431 refugees who arrived in Denmark between 2014 and 2018. J Migr Health 2021; 3:100044. [PMID: 34405189 PMCID: PMC8352093 DOI: 10.1016/j.jmh.2021.100044] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 12/03/2020] [Accepted: 04/10/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Refugees have increased health risks due to factors related to their country of origin, the migration itself and the receiving country. Based on systematic general health assessments of newly arrived refugees, we aimed to study the characteristics with regard to background, migration and health needs. METHODS All refugees (children/adolescents and adults) arriving in Aarhus, Denmark from 1 January 2014 to 1 November 2018 were offered a general health assessment by a doctor including: medical history, a physical examination and blood samples. RESULTS A cohort of 1431 (of 1618 invited, (88.4%) participants accepted the health assessment. The most commonly found health conditions in children were vitamin D deficiency (28.3%), elevated serum-IgE (34%) and lack of immunity against vaccine-preventable diseases (measles 20.1%, polio 3.9%). In adults, vitamin D deficiency (34.6%), IgE elevation (30%), latent tuberculosis (20.3%) and symptoms of PTSD (15.9%) were most prevalent. We found participants from Southern Asia (Iran, Afghanistan and Pakistan) to be overrepresented with regard to vitamin D deficiency, vitamin B12 deficiency and symptoms of PTSD. Furthermore, we found that origin in Africa was associated with latent tuberculosis. In total, 63.8% of examined refugees had one or more health problems requiring further testing, treatment or follow-up. CONCLUSIONS A comprehensive health assessment among recently arrived refugees showed multiple health issues to address, and demonstrates the need of systematic health assessments for resettling refugees.
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Affiliation(s)
- Anne Mette F. Hvass
- Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Aarhus, Denmark
- Department of Social Medicine, Aarhus Municipality, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Denmark
| | - Marie Norredam
- Danish Research Centre for Migration, Ethnicity and Health, Institute of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1353, Copenhagen K, Denmark
- Section for Immigrant Medicine, Department of Infectious Diseases, Hvidovre University Hospital, Denmark
| | - Morten Sodemann
- Migrant Health Clinic, Department of Infectious Diseases, Odense University Hospital
| | - Christian Wejse
- Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Denmark
- Department of Public Health, Center for Global Health, Aarhus University, Bartolins Alle 4, 8000 Aarhus C, Denmark
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Gordon CA, Shield JM, Bradbury RS, Muhi S, Page W, Judd JA, Lee R, Biggs BA, Ross K, Kurscheid J, Gray DJ, McManus DP. HTLV-I and Strongyloides in Australia: The worm lurking beneath. ADVANCES IN PARASITOLOGY 2021; 111:119-201. [PMID: 33482974 DOI: 10.1016/bs.apar.2020.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Strongyloidiasis and HTLV-I (human T-lymphotropic virus-1) are important infections that are endemic in many countries around the world with an estimated 370 million infected with Strongyloides stercoralis alone, and 5-10 million with HTVL-I. Co-infections with these pathogens are associated with significant morbidity and can be fatal. HTLV-I infects T-cells thus causing dysregulation of the immune system which has been linked to dissemination and hyperinfection of S. stercoralis leading to bacterial sepsis which can result in death. Both of these pathogens are endemic in Australia primarily in remote communities in Queensland, the Northern Territory, and Western Australia. Other cases in Australia have occurred in immigrants and refugees, returned travellers, and Australian Defence Force personnel. HTLV-I infection is lifelong with no known cure. Strongyloidiasis is a long-term chronic disease that can remain latent for decades, as shown by infections diagnosed in prisoners of war from World War II and the Vietnam War testing positive decades after they returned from these conflicts. This review aims to shed light on concomitant infections of HTLV-I with S. stercoralis primarily in Australia but in the global context as well.
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Affiliation(s)
- Catherine A Gordon
- Infectious Diseases Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.
| | - Jennifer M Shield
- Department of Pharmacy and Biomedical Sciences, La Trobe University, Bendigo, VIC, Australia; Department of Medicine, The Peter Doherty Institute for Infection and Immunity, University of Melbourne and the Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Richard S Bradbury
- School of Health and Life Sciences, Federation University, Berwick, VIC, Australia
| | - Stephen Muhi
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Wendy Page
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
| | - Jenni A Judd
- School of Health Medical and Applied Sciences, Central Queensland University, Bundaberg, QLD, Australia; Centre for Indigenous Health Equity Research, Central Queensland University, Bundaberg, QLD, Australia
| | - Rogan Lee
- Westmead Clinical School, The University of Sydney, Westmead, NSW, Australia
| | - Beverley-Ann Biggs
- Department of Medicine, The Peter Doherty Institute for Infection and Immunity, University of Melbourne and the Royal Melbourne Hospital, Melbourne, VIC, Australia; Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Kirstin Ross
- College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
| | - Johanna Kurscheid
- Department of Global Health, Research School of Population Health, Australian National University, Acton, ACT, Australia
| | - Darren J Gray
- Department of Global Health, Research School of Population Health, Australian National University, Acton, ACT, Australia
| | - Donald P McManus
- Infectious Diseases Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
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Volkman T, Clifford V, Paxton GA. Schistosoma serology after praziquantel treatment of Schistosoma infection in refugee children resettled in Australia: A retrospective analysis. Travel Med Infect Dis 2020; 37:101680. [DOI: 10.1016/j.tmaid.2020.101680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 04/12/2020] [Accepted: 04/15/2020] [Indexed: 11/30/2022]
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Proença R, Mattos Souza F, Lisboa Bastos M, Caetano R, Braga JU, Faerstein E, Trajman A. Active and latent tuberculosis in refugees and asylum seekers: a systematic review and meta-analysis. BMC Public Health 2020; 20:838. [PMID: 32493327 PMCID: PMC7268459 DOI: 10.1186/s12889-020-08907-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 05/12/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In 2018, there were 70.8 million refugees, asylum seekers and persons displaced by wars and conflicts worldwide. Many of these individuals face a high risk for tuberculosis in their country of origin, which may be accentuated by adverse conditions endured during their journey. We summarised the prevalence of active and latent tuberculosis infection in refugees and asylum seekers through a systematic literature review and meta-analyses by country of origin and host continent. METHODS Articles published in Medline, EMBASE, Web of Science and LILACS from January 2000 to August 2017 were searched for, without language restriction. Two independent authors performed the study selection, data extraction and quality assessment. Random effect models were used to estimate average measures of active and latent tuberculosis prevalence. Sub-group meta-analyses were performed according to country of origin and host continent. RESULTS Sixty-seven out of 767 identified articles were included, of which 16 entered the meta-analyses. Average prevalence of active and latent tuberculosis was 1331 per 100 thousand inhabitants [95% confidence interval (CI) = 542-2384] and 37% (95% CI = 23-52%), respectively, both with high level of heterogeneity (variation in estimative attributable to heterogeneity [I2] = 98.2 and 99.8%). Prevalence varied more according to countries of origin than host continent. Ninety-one per cent of studies reported routine screening of recently arrived immigrants in the host country; two-thirds confirmed tuberculosis bacteriologically. Many studies failed to provide relevant information. CONCLUSION Tuberculosis is a major health problem among refugees and asylum seekers and should be given special attention in any host continent. To protect this vulnerable population, ensuring access to healthcare for early detection for prevention and treatment of the disease is essential.
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Affiliation(s)
- Raquel Proença
- State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | | | | | - José Ueleres Braga
- State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | | | - Anete Trajman
- State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
- McGill University, Montreal, QC, Canada.
- Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
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Page WA, Judd JA, MacLaren DJ, Buettner P. Integrating testing for chronic strongyloidiasis within the Indigenous adult preventive health assessment system in endemic communities in the Northern Territory, Australia: An intervention study. PLoS Negl Trop Dis 2020; 14:e0008232. [PMID: 32401755 PMCID: PMC7219702 DOI: 10.1371/journal.pntd.0008232] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 03/18/2020] [Indexed: 01/29/2023] Open
Abstract
Background The life-threatening clinical manifestations of strongyloidiasis are preventable with early detection and effective treatment. The aim of this study was to assess if there was an increase to the number and proportion of persons tested for chronic strongyloidiasis, as a result of integrating Strongyloides stercoralis serology into the existing preventive health assessment system in four Aboriginal health services in endemic communities. Methodology A prospective, longitudinal, before-and-after intervention study was conducted in four Aboriginal health services in remote endemically infected communities in the Northern Territory, Australia, from July 2012 to December 2016. The electronic patient information and recall systems enabled the integration of Strongyloides stercoralis serology into the adult preventive health assessment. Strongyloides reports for each health service were extracted half-yearly to examine the number and proportion of persons tested for chronic strongyloidiasis during the study and to measure the effect of the intervention. Principal findings The number and proportion of persons tested increased significantly during the study. From a total resident population of 3650 Indigenous adults over 15 years of age, 1686 persons (47.4%) were tested. The percentage of adults who had at least one serology test increased in all four health services to between 41% (446/1086) and 81.9% (172/210). Of the 1686 persons tested, 680 positive cases of chronic strongyloidiasis (40.3%) were identified. Conclusions/Significance This population health systems intervention increased the number and proportion of persons tested for chronic strongyloidiasis in four health services in endemically infected communities. This intervention is relevant to other health services with high-risk populations. Strongyloidiasis is a neglected tropical disease that is endemic in some Aboriginal communities in the Northern Territory. This study asks if the number and proportion of persons tested for chronic strongyloidiasis can be increased by incorporating a Strongyloides serology test into the existing routine Indigenous adult preventive health assessment system in remote endemic communities. This study demonstrated that integrating Strongyloides serology test within the Indigenous adult preventive health assessment system does increase the number and proportion of people tested in endemic communities. This intervention means that life-threatening clinical complications of strongyloidiasis can be prevented by early detection and treatment. Primary health care services have an important role in increased testing in this high-risk population. Primary health care clinicians incorporated chronic strongyloidiasis with other preventable chronic and infectious diseases. The sustainable population health systems-based approach successfully increased coverage by integrating testing for chronic strongyloidiasis into the adult preventive health assessment in health services in remote Indigenous Australian endemic communities, utilising the electronic health record system. The Strongyloides report developed to measure the change in clinical practice would be replicable in other health services with high risk populations.
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Affiliation(s)
- Wendy A. Page
- Miwatj Health Aboriginal Corporation, Nhulunbuy, Northern Territory, Australia
- College of Medicine and Dentistry, Division of Tropical Health and Medicine, James Cook University, Cairns, Queensland, Australia
- * E-mail:
| | - Jenni A. Judd
- School of Health, Medical and Applied Sciences, Division of Higher Education, Central Queensland University, Bundaberg, Queensland, Australia
- Centre for Indigenous Health Equity Research, Central Queensland University, Bundaberg, Queensland, Australia
- Centre for Health Systems Strengthening, James Cook University, Townsville, Queensland, Australia
| | - David J. MacLaren
- College of Medicine and Dentistry, Division of Tropical Health and Medicine, James Cook University, Cairns, Queensland, Australia
| | - Petra Buettner
- Centre for Chronic Disease Prevention, James Cook University, Cairns, Queensland, Australia
- Tropical Health Solutions, Queensland, Australia
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13
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Wickramasinghe Y, Eagar S, Smith M. Quality audit of an early childhood nurse program for resettled refugees. Collegian 2020. [DOI: 10.1016/j.colegn.2019.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Kavian F, Mehta K, Willis E, Mwanri L, Ward P, Booth S. Migration, Stress and the Challenges of Accessing Food: An Exploratory Study of the Experience of Recent Afghan Women Refugees in Adelaide, Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1379. [PMID: 32098027 PMCID: PMC7068606 DOI: 10.3390/ijerph17041379] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 02/17/2020] [Accepted: 02/18/2020] [Indexed: 11/16/2022]
Abstract
This study explored the migration and food experiences of Afghani women refugees residing in Adelaide, South Australia for 2 years or less. In-depth semi-structured qualitative interviews were conducted with 10 women between May and September 2017. The data were thematically analysed, and the Social Determinants of Health Framework was used to discuss the findings. Five key themes emerged from the data. In the transition country (Iran/Pakistan), respondents experienced (i) trauma, discrimination and exclusion and (ii) familiar food culture, but food stress. In the destination country (Adelaide, Australia) respondents experienced (iii) a sense of precariousness, (iv) unfamiliar food culture and (v) challenges in accessing halal food. Afghani refugees experienced considerable stressors both in the transition and the final destination country but for different reasons. In the transition country, stresses related to the lack of social services and support, discrimination, racism and poverty seemed to have affected their ability to afford food. In Australia stressors pertaining to socioeconomic, housing and employment precariousness, as well as difficulties in accessing halal foods were identified as challenges. Furthermore, food stress in Australia was associated with the cultural appropriateness of food, the complexity of the food system, and the women's lack of skills and experiences in navigating the food system. With increasing refugee and immigration flows globally, it is necessary to acknowledge how food and social determinants intersect for refugee immigrants to ensure positive health outcomes.
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Affiliation(s)
- Foorough Kavian
- College of Nursing and Health Sciences, Flinders University, GPO Box, Adelaide 2100, Australia; (F.K.); (K.M.); (E.W.)
| | - Kaye Mehta
- College of Nursing and Health Sciences, Flinders University, GPO Box, Adelaide 2100, Australia; (F.K.); (K.M.); (E.W.)
| | - Eileen Willis
- College of Nursing and Health Sciences, Flinders University, GPO Box, Adelaide 2100, Australia; (F.K.); (K.M.); (E.W.)
| | - Lillian Mwanri
- College of Medicine & Public Health, Flinders University, GPO Box, Adelaide 2100, Australia; (L.M.); (P.W.)
| | - Paul Ward
- College of Medicine & Public Health, Flinders University, GPO Box, Adelaide 2100, Australia; (L.M.); (P.W.)
| | - Sue Booth
- College of Medicine & Public Health, Flinders University, GPO Box, Adelaide 2100, Australia; (L.M.); (P.W.)
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15
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Paxton GA, Spink PCG, Danchin MH, Tyrrell L, Taylor CL, Casey S, Graham HR. Catching up with catch-up: a policy analysis of immunisation for refugees and asylum seekers in Victoria. Aust J Prim Health 2019; 24:480-490. [PMID: 30278862 DOI: 10.1071/py17049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 05/23/2018] [Indexed: 11/23/2022]
Abstract
This study examines catch-up immunisation for people of refugee-like background in Victoria, exploring effective models of service delivery to complete catch-up vaccinations. The analysis is based on: (i) review of the medical literature, Commonwealth and Victorian government immunisation policy and immunisation patient information; (ii) review of vaccination coverage and service delivery data; and (iii) stakeholder interviews completed in 2014 with 45 people from 34 agencies, including 9 local government areas in Victoria. Although refugees and asylum seekers all need catch-up vaccinations on arrival, they face significant barriers to completing immunisation in Australia. Analysis suggests missed opportunities by service providers and perceptions that catch-up vaccination is time-consuming, difficult and resource-intensive. Service delivery is fragmented across primary care and local government, and pathways depend on age, location and healthcare access. There are strengths, but also limitations in all current service delivery models. Gaps in vaccine funding for refugee-like populations have now been addressed through Commonwealth initiatives, however migration is still not well considered in immunisation policy, and existing systems for notification payments do not capture catch-up vaccination for these groups. Providers identify areas for improvement in professional development and support, patient information, patient-held records and immunisation surveillance data.
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Affiliation(s)
- Georgia A Paxton
- The Royal Children's Hospital, General Medicine, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Vic. 3052, Australia
| | - Pete C G Spink
- Victorian Refugee Health Network, 4 Gardiner Street, Brunswick, Vic. 3056, Australia
| | - Margaret H Danchin
- The Royal Children's Hospital, General Medicine, Murdoch Children's Research Institute, Department of Paediatrics, University of Melbourne, 50 Flemington Road, Parkville, Vic. 3052, Australia
| | - Lauren Tyrrell
- Victorian Refugee Health Network, 4 Gardiner Street, Brunswick, Vic. 3056, Australia
| | - Chelsea L Taylor
- Victorian Department of Health and Human Services, 50 Lonsdale Street, Melbourne, Vic. 3000, Australia
| | - Susan Casey
- Victorian Refugee Health Network, 4 Gardiner Street, Brunswick, Vic. 3056, Australia
| | - Hamish R Graham
- The Royal Children's Hospital, General Medicine, Murdoch Children's Research Institute, Department of Paediatrics, University of Melbourne, 50 Flemington Road, Parkville, Vic. 3052, Australia
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16
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Baauw A, Kist-van Holthe J, Slattery B, Heymans M, Chinapaw M, van Goudoever H. Health needs of refugee children identified on arrival in reception countries: a systematic review and meta-analysis. BMJ Paediatr Open 2019; 3:e000516. [PMID: 31646192 PMCID: PMC6782036 DOI: 10.1136/bmjpo-2019-000516] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 08/14/2019] [Accepted: 08/24/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The worldwide number of refugees has considerably increased due to ongoing wars, national instability, political persecution and food insecurity. In Europe, about one-third of all refugees are children, an increasing number of which are travelling alone. There are often no systematic medical health assessments for these refugee children on entry in reception countries despite the fact that they are recognised as an at-risk population due to increased burden of physical and mental health conditions. We aimed to perform a systematic review of the literature to describe the health status of refugee children on entering reception countries. METHODS A systematic search of published literature was conducted using the terms refugee, immigrant or migrant, medical or health, and screening. RESULTS Of the 3487 potentially relevant papers, 53 population-based studies were included in this review. This systematic review showed that refugee children exhibit high estimated prevalence rates for anaemia (14%), haemoglobinopathies (4%), chronic hepatitis B (3%), latent tuberculosis infection (11%) and vitamin D deficiency (45%) on entry in reception countries. Approximately one-third of refugee children had intestinal infection. Nutritional problems ranged from wasting and stunting to obesity. CONCLUSIONS Refugee children entering reception countries should receive comprehensive health assessments based on the outcomes of this systematic review, national budgets, cost-effectiveness and personal factors of the refugees. The health assessment should be tailored to individual child health needs depending on preflight, flight and postarrival conditions.A paradigm shift that places focus on child health and development will help this vulnerable group of children integrate into their new environments. PROSPERO REGISTRATION NUMBER 122561.
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Affiliation(s)
- Albertine Baauw
- Emma Children's Hospital, University of Amsterdam, Amsterdam, The Netherlands
- Pediatrics, Wilhelmina Children's Hospital University Medical Centre, Utrecht, The Netherlands
- Public and Occupational Health, Amsterdam Public Health Research Institute, VU Medical Center, Amsterdam, The Netherlands
| | - Joana Kist-van Holthe
- Public and Occupational Health, Amsterdam Public Health Research Institute, VU Medical Center, Amsterdam, The Netherlands
| | - Bridget Slattery
- Emma Children's Hospital, University of Amsterdam, Amsterdam, The Netherlands
| | - Martijn Heymans
- Department of Epidemiology and Biostatistics, University of Amsterdam, Amsterdam, The Netherlands
| | - Mai Chinapaw
- Public and Occupational Health, Amsterdam Public Health Research Institute, VU Medical Center, Amsterdam, The Netherlands
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Schrier L, Wyder C, Del Torso S, Stiris T, von Both U, Brandenberger J, Ritz N. Medical care for migrant children in Europe: a practical recommendation for first and follow-up appointments. Eur J Pediatr 2019; 178:1449-1467. [PMID: 31240389 DOI: 10.1007/s00431-019-03405-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 05/31/2019] [Accepted: 06/04/2019] [Indexed: 12/21/2022]
Abstract
Between 2015 and 2017, an estimated 200,000 to 400,000 children were seeking asylum each year in EU/EEA countries. As access to high-quality health care is important, we collected and compared current recommendations across Europe for a consensus recommendation on medical care for migrant (asylum-seeking and refugee) children. Existing recommendations were collected from published literature and identified through national representatives from paediatric societies of 31 EU/EEA countries through the European Academy of Paediatrics (EAP). Recommendations were systematically extracted and collected in a database. Those mentioned in at least one recommendation were evaluated for inclusion, and evidence on recommendations was specifically identified in literature searches focused on recent evidence from Europe. For eight EU/EEA countries, a national recommendation was identified. Growth and development, vision and hearing impairment, skin and dental problems, immunisations, anaemia, micronutrient deficiency, helminths, hepatitis B and C, human immunodeficiency virus, malaria, schistosomiasis, syphilis, tuberculosis, mental health disorder and sexual health were most frequently mentioned and therefore selected for inclusion in the recommendation.Conclusion: The current document includes general recommendations on ethical standards, use of interpreters and specific recommendations for prevention or early detection of communicable and non-communicable diseases. It may serve as a tool to ensure the fundamental right that migrant children in Europe receive a comprehensive, patient-centred health care.
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Affiliation(s)
- Lenneke Schrier
- Willem Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - Corinne Wyder
- Kinderaerzte KurWerk, Poststrasse 9, 3400, Burgdorf, Switzerland
- Department of Paediatrics, University of Bern, Bern, Switzerland
| | | | - Tom Stiris
- Department of Neonatology, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ulrich von Both
- Division of Paediatric Infectious Diseases, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
- German Centre for Infection Research (DZIF), partner site, Munich, Germany
- Paediatric Infection and Immunity, Section of Paediatric, Department of Medicine, Imperial College London, London, UK
| | - Julia Brandenberger
- Migrant Health Service, University Children's Hospital Basel, University of Basel, Spitalstrasse 33, 4056, Basel, Switzerland
| | - Nicole Ritz
- Migrant Health Service, University Children's Hospital Basel, University of Basel, Spitalstrasse 33, 4056, Basel, Switzerland.
- Infectious Diseases and Vaccinology Unit, University Children's Hospital Basel, University of Basel, Basel, Switzerland.
- Department of Paediatrics, The University of Melbourne, Parkville, Australia.
- Infectious Diseases Unit, Royal Children's Hospital Melbourne, Parkville, Australia.
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Newman K, O'Donovan K, Bear N, Robertson A, Mutch R, Cherian S. Nutritional assessment of resettled paediatric refugees in Western Australia. J Paediatr Child Health 2019; 55:574-581. [PMID: 30288837 DOI: 10.1111/jpc.14250] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 08/19/2018] [Accepted: 09/07/2018] [Indexed: 11/26/2022]
Abstract
AIM Nutritional deprivation, inadequate diet and food insecurity are common refugee experiences. The growth and nutritional status of paediatric refugees following resettlement in developed countries and the related interplay with socio-economic factors remain less defined; this study aims to describe these features. METHODS Standardised dietary, medical and socio-demographic health assessments of new refugee patients attending a multidisciplinary paediatric Refugee Health Service (RHS) in Western Australia between 2010 and 2015 were analysed. RESULTS Demographic data from 1131 paediatric refugees are described (age 2 months to 17.8 years). The majority experienced socio-economic disadvantage, had limited parental education and required interpreters. Nutritional deficiencies were common but varied across ethnicities: iron deficiency (ID) (12.3%), anaemia (7.3%) and inadequate dairy intake (41.0%). A third of children (32.6%) did not consume meat. Infant breastfeeding was sustained (77.8%) in infants <12 months. Prolonged breastfeeding (44.9% aged 12-24 months) was associated with an increased risk of ID (odds ratio 4.0, 95% confidence interval 1.4-11.6). Median body mass index increased significantly for those >24 months between referral and RHS assessment (median period 1.8 months). Overall, 27.1% required additional formal dietetic follow-up, with higher nutritional concerns in refugee children <24 months compared to older patients. CONCLUSIONS Identification of frequent post-settlement nutritional concerns has been captured through structured multidisciplinary paediatric health screening. Specific screening for socio-economic influencing factors, including education, poverty and food insecurity, during refugee clinical assessments is recommended. Development of targeted, culturally appropriate parental education resources and interventions may improve management following resettlement. Longitudinal research assessing resettlement growth trajectories is required.
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Affiliation(s)
- Katie Newman
- Refugee Health Service, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Kelly O'Donovan
- Women and Newborn Health Service, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Natasha Bear
- Department of Clinical Research and Education, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Annie Robertson
- Refugee Health Service, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Raewyn Mutch
- Refugee Health Service, Perth Children's Hospital, Perth, Western Australia, Australia.,Division of Paediatrics, Faculty of Health and Medical Sciences, Perth, Western Australia, Australia
| | - Sarah Cherian
- Refugee Health Service, Perth Children's Hospital, Perth, Western Australia, Australia.,Division of Paediatrics, University of Western Australia, Perth, Western Australia, Australia
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Beukeboom C, Arya N. Prevalence of Nutritional Deficiencies Among Populations of Newly Arriving Government Assisted Refugee Children to Kitchener/Waterloo, Ontario, Canada. J Immigr Minor Health 2019; 20:1317-1323. [PMID: 29611017 DOI: 10.1007/s10903-018-0730-9] [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: 10/17/2022]
Abstract
This study examined the variation among ethnic populations in prevalence of anemia, vitamin D and B12 deficiencies among refugee children. A retrospective chart review of 388 government assisted refugee children ≤ 16 years of age, seen at the Refugee Health Clinic in Kitchener, Canada from January 2009 to December 2014 was conducted. Vitamin D levels were only collected until December 1st 2010 (116 children). 15.7% were anemic (25% < 5 years, 8.7% 5-11 years, and 18.3% 12-16 years old) with Somali children having the lowest hemoglobin levels compared to those from Iraq, Afghanistan and Myanmar. 53.5% were vitamin D deficient (25(OH)D < 50 nmol/L), seen most commonly in Iraqis and Afghans. 11.2% had vitamin B12 levels < 150 pmol/L. Providers' knowledge of prevalence of nutritional deficiencies related to region of origin, can guide appropriate screening and treatment options to promote longer term cognitive, physical and developmental health.
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Affiliation(s)
- Carolyn Beukeboom
- School of Nursing, Western University, London, ON, Canada. .,School of Nursing, McMaster University, Hamilton, ON, Canada. .,, London, ON, Canada.
| | - Neil Arya
- Centre for Family Medicine Refugee Health Clinic, Waterloo, ON, Canada.,Family Medicine McMaster University, Hamilton, ON, Canada.,Family Medicine Western University, London, ON, Canada
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20
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Heywood AE, López-Vélez R. Reducing infectious disease inequities among migrants. J Travel Med 2019; 26:5198602. [PMID: 30476162 DOI: 10.1093/jtm/tay131] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 11/13/2018] [Accepted: 11/20/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND migration has reached unprecedented levels, with 3.6% of the world's population living outside their country of birth. Migrants comprise a substantial proportion of high-income country populations, are at increased risk of a range of infectious diseases, compared to native-born populations and may experience worse health outcomes due to barriers accessing timely diagnoses and treatment. Poor access to essential healthcare services can be attributed to several factors, including language and cultural barriers and lack of specific inclusive health policies. METHODS This review draws on evidence from the immigrant health and travel medicine literature, with a focus on infectious disease risks. It presents strategies to reduce barriers to healthcare access through health promotion and screening programs both at the community and clinic level and the delivery of linguistically and culturally competent care. The Methods: Salud Entre Culturas (SEC) 'Health Between Cultures' project from the Tropical Medicine Unit at the Hospital Ramon y Cajal in Madrid is described as an effective model of care. RESULTS For those providing healthcare to migrant populations, the use of community-consulted approaches are considered best practice in the development of health education, health promotion and the delivery of targeted health services. At the clinic-level, strategies optimizing care for migrants include the use of bilingual healthcare professionals or community-based healthcare workers, cultural competence training of all clinic staff, the appropriate use of trained interpreters and the use of culturally appropriate health promotion materials. CONCLUSIONS Multifaceted strategies are needed to improve access, community knowledge, community engagement and healthcare provider training to provide appropriate care to migrant populations to reduce infectious disease disparities.
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Affiliation(s)
- Anita E Heywood
- Level 3, Samuels Building, School of Public Health and Community Medicine, UNSW Sydney, NSW, Australia
| | - Rogelio López-Vélez
- National Referral Unit for Tropical Diseases, Department of Infectious Diseases, Ramón y Cajal University Hospital, Madrid, Spain
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21
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Heenan RC, Volkman T, Stokes S, Tosif S, Graham H, Smith A, Tran D, Paxton G. 'I think we've had a health screen': New offshore screening, new refugee health guidelines, new Syrian and Iraqi cohorts: Recommendations, reality, results and review. J Paediatr Child Health 2019; 55:95-103. [PMID: 30094942 DOI: 10.1111/jpc.14142] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 06/24/2018] [Accepted: 06/28/2018] [Indexed: 11/30/2022]
Abstract
AIM To examine refugee health assessments in Syrian and Iraqi children in the context of changes to offshore immigration screening, updated Australian refugee health guidelines and the primary care refugee health model in Victoria. METHODS This is a retrospective audit of Syrian and Iraqi children aged 0-17 years attending a specialist immigrant health service from January 2015 to September 2017. RESULTS We saw 128 children (7 months-16 years, 64.8% male). Prior to arrival, 58.9% of children had experienced trauma, and 67.9% had missed at least 1 year of school. Almost all children (93.3%) were linked with a regular general practitioner in Australia, and 23.6% children were linked with a refugee health nurse; offshore health records were infrequently available. Of school-aged children, 25% were not enrolled in school 3 months after arrival. Only 2 of 113 (1.8%) children had completed a recommended refugee health assessment, and 55.1% had commenced appropriate catch-up vaccination in primary care. After screening completion, the most prevalent conditions were low vitamin D (63.6%); growth/nutrition (24.2%), neurological/metabolic (16.4%), learning/behaviour (15.6%) and mental health (12.5%) concerns; latent tuberculosis infection (11.8%); and developmental delay (10.2%). Sixteen children required surgery after arrival, and six children had life-threatening medical conditions on arrival - only one had an offshore critical alert; care for the other five children resulted in 133 unanticipated hospital admission days. CONCLUSIONS There are substantial challenges with the current primary care screening model in Victoria. Disability, developmental and mental health concerns were prominent in this cohort, and many children had delays in education access, compounding prior disadvantage.
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Affiliation(s)
- Rachel C Heenan
- Immigrant Health Service, Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Thomas Volkman
- Immigrant Health Service, Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Infection and Immunity, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Simon Stokes
- Immigrant Health Service, Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Shidan Tosif
- Immigrant Health Service, Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Infection and Immunity, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Hamish Graham
- Immigrant Health Service, Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Infection and Immunity, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Andrea Smith
- Immigrant Health Service, Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - David Tran
- Immigrant Health Service, Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, Northern Hospital, Melbourne, Victoria, Australia
| | - Georgia Paxton
- Immigrant Health Service, Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.,Infection and Immunity, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
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22
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Engidaw MT, Wassie MM, Teferra AS. Anemia and associated factors among adolescent girls living in Aw-Barre refugee camp, Somali regional state, Southeast Ethiopia. PLoS One 2018; 13:e0205381. [PMID: 30308060 PMCID: PMC6181359 DOI: 10.1371/journal.pone.0205381] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 09/25/2018] [Indexed: 11/18/2022] Open
Abstract
Background Adolescent girls have a higher risk of anemia due to an increased requirement, low intake of hematopoietic nutrients and low intake of a nutrient that enhance absorption of these hematopoietic nutrients. Adolescent girls living in refugee camps are more vulnerable to anemia. The study aimed to determine the prevalence of anemia and associated factors among adolescent girls aged 10–19 years in Aw-Barre refugee camp, Somalia regional state, Southeast Ethiopia. Methods A cross-sectional study design was employed. Study participants were recruited using a simple random sampling technique. A structured questionnaire was used to collect the data. Hemoglobin level was tested using HemoCueHb 301 from 10μl finger prick blood samples. Adolescents with a hemoglobin level of <12.5gm/dl after altitude adjustment were classified as anemic. Data were entered using Epi Info version 7.0 and analyzed using SPSS version 20.0. Binary logistic regression was used to explore the association of independent variables with anemia. Variables having P—value ≤ 0.05 was considered to be statistically significant. Results Four hundred thirty-seven adolescent girls participated in the study with a response rate of 95.83%. The prevalence of anemia was 22% (95% CI (17.6, 26.1)). Late adolescents were 2 times more likely to have anemia as compared to early adolescents (AOR: 1.95, 95% CI (1.09, 3.47). Those who stayed ≥8 years in the camp were 3 times more likely to develop anemia (AOR: 2.92, 95% CI (1.14, 7.50)). Those who ate heme iron food sources less than one time per month were 11 times more likely to develop anemia compared to those who ate more than twice within a week (AOR: 11.42, 95% CI (3.42, 38.18)). Conclusions The prevalence of anemia among adolescent girls was a moderate public health problem. Education and awareness on adolescent nutrition with special attention of late adolescents and duration in the refugee camps is warranted. Moreover, promoting the intake of foods rich in heme iron is suggested.
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Affiliation(s)
- Melaku Tadege Engidaw
- Social and Population Health Unit, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
- * E-mail:
| | - Molla Mesele Wassie
- Department of Human Nutrition, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Alemayehu Shimeka Teferra
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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23
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DeVetten G, Dirksen M, Weaver R, Chowdhury TT, Aucoin MW. Parasitic stool testing in newly arrived refugees in Calgary, Alta. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2017; 63:e518-e525. [PMID: 29237648 PMCID: PMC5729156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To determine the prevalence of intestinal parasites and rates of stool testing compliance, as well as associated patient characteristics, among newly arrived refugees at the Mosaic Refugee Health Clinic in Calgary, Alta. DESIGN Retrospective chart review. SETTING Primary care clinic for refugee patients. PARTICIPANTS A total of 1390 new refugee patients at the clinic from May 1, 2011, to June 30, 2013. MAIN OUTCOME MEASURES Stool ova and parasite test completion and proportion of positive test results. RESULTS Of 1390 patients, 74.1% (95% CI 71.7% to 76.4%) completed at least 1 stool ova and parasite test. Among those completing tests, 29.7% (95% CI 26.9% to 32.6%) had at least 1 positive result. Patients aged 6 to 18 years were more likely to have positive test results (38.5%, 95% CI 32.2% to 45.0%) than patients aged 19 to 39 were, as were those last residing in Asia (36.4%, 95% CI 30.4% to 42.8%) or sub-Saharan Africa (30.9%, 95% CI 26.8% to 35.1%), compared with those arriving from the Middle East. Giardia lamblia, Blastocystis hominis, Dientamoeba fragilis, and Entamoeba histolytica or Entamoeba dispar were the most prevalent parasites. If B hominis and D fragilis are excluded because of their lower potential to cause harm, the overall prevalence was 16.3%. CONCLUSION Given the high compliance of patients submitting stool ova and parasite tests and a high prevalence of positive test results in some refugee groups, targeted screening should be considered in newly arrived refugees at greater risk of intestinal parasites.
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Affiliation(s)
- Giselle DeVetten
- Physician with the Mosaic Refugee Health Program and Clinical Lecturer in the Department of Family Medicine at the University of Calgary in Alberta, and was a family medicine resident at the University of Calgary at the time of the study
| | - Meghan Dirksen
- Family physician working in hospital and community medicine in Calgary and was a family medicine resident at the University of Calgary at the time of the study
| | - Robert Weaver
- Statistical Associate in the Department of Medicine at the University of Calgary
| | - Tanvir Turin Chowdhury
- Research Director and Assistant Professor in the Department of Family Medicine at the University of Calgary
| | - Michael William Aucoin
- Physician with the Mosaic Refugee Health Program and Clinical Lecturer in the Department of Family Medicine at the University of Calgary.
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24
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Adeel AA. Schistosomiasis in International Refugees and Migrant Populations. CURRENT TROPICAL MEDICINE REPORTS 2017. [DOI: 10.1007/s40475-017-0128-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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25
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Schulz TR, Edwards R, Thurnheer MC, Yuen L, Littlejohn M, Revill P, Chu M, Tanyeri F, Wade A, Biggs BA, Sasadeusz J. Hepatitis B among immigrants from Myanmar: Genotypes and their clinical relevance. J Med Virol 2017; 90:271-276. [PMID: 28885711 DOI: 10.1002/jmv.24939] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 08/24/2017] [Indexed: 12/20/2022]
Abstract
Hepatitis B virus (HBV) from 76 adult immigrants in Australia from Myanmar was characterized to determine the prevalence of different HBV genotypes and subgenotypes. A mutational analysis was then performed to determine the presence of clinically significant mutations and correlate them to clinical outcomes. Initial genotyping revealed 68 patients with genotype C (89.5%) and eight patients with genotype B (10.5%). Phylogenetic analysis revealed the large majority of the genotype C infections were of subgenotype C1 (67/68). Sequencing of the HBV polymerase gene (and overlapping surface gene) revealed no mutations associated with antiviral resistance. HBV surface gene mutations were detected in 10 patients with subgenotype C1. HBV BCP/PC sequencing was obtained for 71/76 (93%) patients. BCP and/or PC mutations were identified in 57/71 (80%) of PCR positive patients. Treatment had been commenced for 15/76 (18%) patients, a further 26 untreated patients were in a stage of disease where HBV treatment would be considered standard of care. It was identified that genotype C1 is the predominant sub-genotype in this population. Genotype C is known to be associated with increased risk of development of HCC. This highlights the need for screening for HCC given the potential for the development of liver cancer. It was also identified that people with HBV were potentially not receiving optimal therapy in a timely fashion.
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Affiliation(s)
- Thomas R Schulz
- Victorian Infectious Diseases Service, at the Doherty Institute, The Royal Melbourne Hospital, Melbourne, Victoria.,Department of Medicine/ RMH, at the Doherty Institute, University of Melbourne, Melbourne, Victoria
| | - Rosalind Edwards
- Victorian Infectious Diseases Reference Laboratory, at the Doherty Institute, Melbourne, Victoria
| | - M Christine Thurnheer
- Victorian Infectious Diseases Service, at the Doherty Institute, The Royal Melbourne Hospital, Melbourne, Victoria
| | - Lilly Yuen
- Victorian Infectious Diseases Reference Laboratory, at the Doherty Institute, Melbourne, Victoria
| | - Margaret Littlejohn
- Victorian Infectious Diseases Reference Laboratory, at the Doherty Institute, Melbourne, Victoria
| | - Peter Revill
- Victorian Infectious Diseases Reference Laboratory, at the Doherty Institute, Melbourne, Victoria
| | - Melissa Chu
- Department of Medicine, University of Melbourne, Parkville, Victoria
| | - Firuz Tanyeri
- Department of Medicine, University of Melbourne, Parkville, Victoria
| | - Amanda Wade
- Department of Infectious Diseases, University Hospital, Geelong, Victoria
| | - Beverley-Ann Biggs
- Victorian Infectious Diseases Service, at the Doherty Institute, The Royal Melbourne Hospital, Melbourne, Victoria.,Department of Medicine/ RMH, at the Doherty Institute, University of Melbourne, Melbourne, Victoria
| | - Joseph Sasadeusz
- Victorian Infectious Diseases Service, at the Doherty Institute, The Royal Melbourne Hospital, Melbourne, Victoria
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Mahimbo A, Seale H, Heywood AE. Immunisation for refugees in Australia: a policy review and analysis across all States and Territories. Aust N Z J Public Health 2017; 41:635-640. [PMID: 28898492 DOI: 10.1111/1753-6405.12710] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 05/01/2017] [Accepted: 06/01/2017] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Although people of refugee background are likely to be under-immunised before and after resettlement, no study to date has evaluated refugee specific immunisation policies in Australia. We developed a framework to analyse immunisation policies across Australia to highlight the strengths and gaps so as to inform development of more effective refugee specific immunisation policies. METHODS We sourced publicly available immunisation policy documents from state and territory government websites. Content analysis of seven policy documents was undertaken using a developed framework comprising crucial policy determinants. RESULTS Immunisation policy differed substantially across the jurisdictions. While most policies did not highlight the importance of data collection on immunisation for refugees and the public funding of vaccines for refugees, policy determinants such as accessibility and obligations were fulfilled by most jurisdictions. CONCLUSION Our findings indicate stark differences in immunisation policy for people of refugee background across Australia. Highlighted gaps demonstrate the need to revise current policies so that they are aligned with their intended outcome of enhancing uptake of vaccines and improving immunisation coverage among resettled refugees in Australia. Implications for public health: Immunisation policy development for refugees needs to be robust enough to ensure equitable health services to this group.
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Affiliation(s)
- Abela Mahimbo
- School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, New South Wales
| | - Holly Seale
- School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, New South Wales
| | - Anita E Heywood
- School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, New South Wales
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Salzer HJF, Rolling T, Vinnemeier CD, Tannich E, Schmiedel S, Addo MM, Cramer JP. Helminthic infections in returning travelers and migrants with eosinophilia: Diagnostic value of medical history, eosinophil count and IgE. Travel Med Infect Dis 2017; 20:49-55. [PMID: 28882532 DOI: 10.1016/j.tmaid.2017.09.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Revised: 07/26/2017] [Accepted: 09/01/2017] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Eosinophilia in travelers and migrants returning from the tropics is often associated with invasive helminthic infections. Total IgE is considered a useful additional diagnostic parameter; however, both parameters are also increased in various other non-helminthic diseases. METHODS We retrospectively evaluated travelers and migrants seen at our department between September 2007 and May 2014. Patients with an absolute eosinophil count ≥500 cells/μl were considered for further analyses. RESULTS Among 6618 returned travelers and migrants, 154 (2.3%) had a total eosinophil count ≥500 cells/μL. Of these, 71 patients (46%) were diagnosed with helminthic infection. In an additional 62 patients (40%) with eosinophilia a final diagnosis was found, including non-helminthic infections in 34 patients and non-infectious causes in 28 patients, while in 21 patients (14%) no diagnosis was made. Patients with helminthic infections had higher eosinophil counts than travelers and migrants with other diagnoses (median 981 vs. 710 cells/μl; p = 0.001), while total IgE levels (n = 70; 172 vs. 152 kU/l; p = 0.731) were similar in both groups. CONCLUSION Eosinophil count but not total IgE levels are associated with helminthic infections in returning travelers and migrants with eosinophilia. Our results do not support the use of total IgE to differentiate helminthic infections from other causes of eosinophilia in this population.
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Affiliation(s)
- Helmut J F Salzer
- Sections of Infectious Diseases and Tropical Medicine, I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Division of Clinical Infectious Diseases and German Center for Infection Research Tuberculosis Unit, Research Center Borstel Borstel, Germany.
| | - Thierry Rolling
- Sections of Infectious Diseases and Tropical Medicine, I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Clinical Research, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany.
| | - Christof D Vinnemeier
- Sections of Infectious Diseases and Tropical Medicine, I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Clinical Research, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany.
| | - Egbert Tannich
- Department of Molecular Parasitology, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany; National Reference Centre for Tropical Infections, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany.
| | - Stefan Schmiedel
- Sections of Infectious Diseases and Tropical Medicine, I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Marylyn M Addo
- Sections of Infectious Diseases and Tropical Medicine, I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Jakob P Cramer
- Department of Clinical Research, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany.
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Mahimbo A, Seale H, Smith M, Heywood A. Challenges in immunisation service delivery for refugees in Australia: A health system perspective. Vaccine 2017; 35:5148-5155. [PMID: 28802753 DOI: 10.1016/j.vaccine.2017.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 07/21/2017] [Accepted: 08/01/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Refugees are at risk of being under-immunised in their countries of origin, in transit and post-resettlement in Australia. Whilst studies have focused on identifying barriers to accessibility of health services among refugees, few focus on providers' perspectives on immunisation service delivery to this group. Health service providers are well placed to provide insights into the pragmatic challenges associated with refugee health service delivery, which can be useful in identifying strategies aimed at improving immunisation coverage among this group. METHODS A qualitative study involving 30 semi-structured interviews was undertaken with key stakeholders in immunisation service delivery across all States and Territories in Australia between December 2014 and December 2015. Thematic analysis was undertaken. RESULTS Variability in accessing program funding and vaccines, lack of a national policy for catch-up vaccination, unclear roles and responsibilities for catch-up, a lack of a central immunisation register and insufficient training among general practitioners were seen as the main challenges impacting on immunisation service delivery for refugees. CONCLUSIONS This study provides insight into the challenges that impact on effective immunisation service delivery for refugees. Deliberate strategies such as national funding for relevant vaccines, improved data collection nationally and increased guidance for general practitioners on catch-up immunisation for refugees would help to ensure equitable access across all age groups.
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Affiliation(s)
- A Mahimbo
- School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, New South Wales, Australia.
| | - H Seale
- School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, New South Wales, Australia
| | - M Smith
- NSW Refugee Health Service, Liverpool, NSW 2170, Australia
| | - A Heywood
- School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, New South Wales, Australia
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29
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Hvass AMF, Wejse C. Systematic health screening of refugees after resettlement in recipient countries: a scoping review. Ann Hum Biol 2017; 44:475-483. [PMID: 28562071 DOI: 10.1080/03014460.2017.1330897] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
CONTEXT Health screening of refugees after settlement in a recipient country is an important tool to find and treat diseases. Currently, there are no available reviews on refugee health screening after resettlement. METHODS A systematic literature search was conducted using the online Medical Literature Analysis and Retrieval System ('MEDLINE') database. Data extraction and synthesis were performed according to the PRISMA statement. RESULTS The search retrieved 342 articles. Relevance screening was conducted on all abstracts/titles. The final 53 studies included only original scientific articles on health screening of refugees conducted after settlement in another country. The 53 studies were all from North America, Australia/New Zealand and Europe. Because of differences in country policies, the screenings were conducted differently in the various locations. The studies demonstrated great variation in who was targeted for screening and how screening was conducted. The disease most frequently screened for was tuberculosis; this was done in approximately half of the studies. Few studies included screening for mental health and non-infectious diseases like diabetes and hypertension. CONCLUSION Health screening of refugees after resettlement is conducted according to varying local policies and there are vast differences in which health conditions are covered in the screening and whom the screening is available to.
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Affiliation(s)
| | - Christian Wejse
- a Department of Infectious Diseases , Aarhus University Hospital , Aarhus , Denmark.,b Department of Public Health, Center for Global Health , Aarhus University , Aarhus , Denmark
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30
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Chaves NJ, Paxton GA, Biggs BA, Thambiran A, Gardiner J, Williams J, Smith MM, Davis JS. The Australasian Society for Infectious Diseases and Refugee Health Network of Australia recommendations for health assessment for people from refugee-like backgrounds: an abridged outline. Med J Aust 2017; 206:310-315. [PMID: 28403765 DOI: 10.5694/mja16.00826] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 11/15/2016] [Indexed: 11/17/2022]
Abstract
INTRODUCTION In 2009, the Australasian Society of Infectious Diseases published guidelines on the post-arrival health assessment of recently arrived refugees. Since then, the number of refugees and asylum seekers reaching Australia has increased substantially (17 555 refugees in 2015-16) and the countries of origin have changed. These groups are likely to have had poor access to health care pre-arrival and, consequently, are at risk of a range of chronic and infectious diseases. We established an advisory group that included infectious diseases physicians, general practitioners, public health specialists, paediatricians and refugee health nurses to update the 2009 guidelines.Main recommendations: All people from refugee-like backgrounds, including children, should be offered a tailored comprehensive health assessment and management plan, ideally within 1 month of arrival in Australia. This can be offered at any time if initial contact with a GP or clinic is delayed. Recommended screening depends on history, examination and previous investigations, and is tailored based on age, gender, countries of origin and transit and risk profile. The full version of the guidelines is available at http://www.asid.net.au/documents/item/1225.Changes in management as a result of this guideline: These guidelines apply to all people from refugee-like backgrounds, including asylum seekers. They provide more information about non-communicable diseases and consider Asia and the Middle East as regions of origin as well as Africa. Key changes include an emphasis on person-centred care; risk-based rather than universal screening for hepatitis C virus, malaria, schistosomiasis and sexually transmissible infections; updated immunisation guidelines; and new recommendations for other problems, such as nutritional deficiencies, women's health and mental health.
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Affiliation(s)
| | | | | | - Aesen Thambiran
- Humanitarian Entrant Health Service, Department of Health Western Australia, Perth, WA
| | - Joanne Gardiner
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, VIC
| | - Jan Williams
- Migrant Health Service, Central Adelaide Local Health Network, Adelaide, SA
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Paxton GA, Tyrrell L, Oldfield SB, Kiang K, Danchin MH. No Jab, No Pay — no planning for migrant children. Med J Aust 2016; 205:296-8. [DOI: 10.5694/mja16.00351] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 07/07/2016] [Indexed: 11/17/2022]
Affiliation(s)
| | | | | | | | - Margie H Danchin
- Royal Children's Hospital, Melbourne, VIC
- Murdoch Childrens Research Institute, Melbourne, VIC
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32
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Maskery B, Coleman MS, Weinberg M, Zhou W, Rotz L, Klosovsky A, Cantey PT, Fox LM, Cetron MS, Stauffer WM. Economic Analysis of the Impact of Overseas and Domestic Treatment and Screening Options for Intestinal Helminth Infection among US-Bound Refugees from Asia. PLoS Negl Trop Dis 2016; 10:e0004910. [PMID: 27509077 PMCID: PMC4980012 DOI: 10.1371/journal.pntd.0004910] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 07/18/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Many U.S.-bound refugees travel from countries where intestinal parasites (hookworm, Trichuris trichuria, Ascaris lumbricoides, and Strongyloides stercoralis) are endemic. These infections are rare in the United States and may be underdiagnosed or misdiagnosed, leading to potentially serious consequences. This evaluation examined the costs and benefits of combinations of overseas presumptive treatment of parasitic diseases vs. domestic screening/treating vs. no program. METHODS An economic decision tree model terminating in Markov processes was developed to estimate the cost and health impacts of four interventions on an annual cohort of 27,700 U.S.-bound Asian refugees: 1) "No Program," 2) U.S. "Domestic Screening and Treatment," 3) "Overseas Albendazole and Ivermectin" presumptive treatment, and 4) "Overseas Albendazole and Domestic Screening for Strongyloides". Markov transition state models were used to estimate long-term effects of parasitic infections. Health outcome measures (four parasites) included outpatient cases, hospitalizations, deaths, life years, and quality-adjusted life years (QALYs). RESULTS The "No Program" option is the least expensive ($165,923 per cohort) and least effective option (145 outpatient cases, 4.0 hospitalizations, and 0.67 deaths discounted over a 60-year period for a one-year cohort). The "Overseas Albendazole and Ivermectin" option ($418,824) is less expensive than "Domestic Screening and Treatment" ($3,832,572) or "Overseas Albendazole and Domestic Screening for Strongyloides" ($2,182,483). According to the model outcomes, the most effective treatment option is "Overseas Albendazole and Ivermectin," which reduces outpatient cases, deaths and hospitalization by around 80% at an estimated net cost of $458,718 per death averted, or $2,219/$24,036 per QALY/life year gained relative to "No Program". DISCUSSION Overseas presumptive treatment for U.S.-bound refugees is a cost-effective intervention that is less expensive and at least as effective as domestic screening and treatment programs. The addition of ivermectin to albendazole reduces the prevalence of chronic strongyloidiasis and the probability of rare, but potentially fatal, disseminated strongyloidiasis.
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Affiliation(s)
- Brian Maskery
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Margaret S. Coleman
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Michelle Weinberg
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Weigong Zhou
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Lisa Rotz
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Alexander Klosovsky
- International Organization for Migration, Washington, D.C., United States of America
| | - Paul T. Cantey
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - LeAnne M. Fox
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Martin S. Cetron
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - William M. Stauffer
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
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33
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Kaplan I, Stolk Y, Valibhoy M, Tucker A, Baker J. Cognitive assessment of refugee children: Effects of trauma and new language acquisition. Transcult Psychiatry 2016; 53:81-109. [PMID: 26563891 DOI: 10.1177/1363461515612933] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Each year, approximately 60,000 children of refugee background are resettled in Western countries. This paper reviews the effects of the refugee experience on cognitive functioning. The distinctive influences for these children include exposure to traumatic events and the need to acquire a new language, factors that need to be considered to avoid overdiagnosis of learning disorders and inappropriate educational placements. Prearrival trauma, psychological sequelae of traumatic events, developmental impact of trauma, and the quality of family functioning have been found to influence cognitive functioning, learning, and academic performance. In addition, the refugee child may be semiproficient in several languages, but proficient in none, whilst also trying to learn a new language. The influence that the child's limited English proficiency, literacy, and school experience may have on academic and test performance is demonstrated by drawing on the research on refugees' English language acquisition, as well as the more extensive literature on bilingual English language learners. Implications for interventions are drawn at the level of government policy, schools, and the individual. The paper concludes with the observation that there is a major need for longitudinal research on refugee children's learning and academic performance and on interventions that will close the academic gap, thereby enabling refugee children to reach their educational potential.
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Affiliation(s)
- Ida Kaplan
- Victorian Foundation for Survivors of Torture, Australia
| | | | | | - Alan Tucker
- La Trobe University, AustraliaVictoria University, Australia
| | - Judy Baker
- Victoria State Government Department of Education and Training, Australia
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Martin CA, Gowda U, Renzaho AM. The prevalence of vitamin D deficiency among dark-skinned populations according to their stage of migration and region of birth: A meta-analysis. Nutrition 2016; 32:21-32. [DOI: 10.1016/j.nut.2015.07.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 07/14/2015] [Accepted: 07/14/2015] [Indexed: 12/17/2022]
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Yun K, Matheson J, Payton C, Scott KC, Stone BL, Song L, Stauffer WM, Urban K, Young J, Mamo B. Health Profiles of Newly Arrived Refugee Children in the United States, 2006-2012. Am J Public Health 2015; 106:128-35. [PMID: 26562126 DOI: 10.2105/ajph.2015.302873] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES We conducted a large-scale study of newly arrived refugee children in the United States with data from 2006 to 2012 domestic medical examinations in 4 sites: Colorado; Minnesota; Philadelphia, Pennsylvania; and Washington State. METHODS Blood lead level, anemia, hepatitis B virus (HBV) infection, tuberculosis infection or disease, and Strongyloides seropositivity data were available for 8148 refugee children (aged < 19 years) from Bhutan, Burma, Democratic Republic of Congo, Ethiopia, Iraq, and Somalia. RESULTS We identified distinct health profiles for each country of origin, as well as for Burmese children who arrived in the United States from Thailand compared with Burmese children who arrived from Malaysia. Hepatitis B was more prevalent among male children than female children and among children aged 5 years and older. The odds of HBV, tuberculosis, and Strongyloides decreased over the study period. CONCLUSIONS Medical screening remains an important part of health care for newly arrived refugee children in the United States, and disease risk varies by population.
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Affiliation(s)
- Katherine Yun
- Katherine Yun is with PolicyLab, Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA. Jasmine Matheson is with Refugee Health Program, Washington State Department of Health, Shoreline. Colleen Payton and Kevin C. Scott are with Family and Community Medicine, Thomas Jefferson University, Philadelphia. Barbara L. Stone is with Refugee Health Program, Colorado Department of Public Health and Environment, Denver. Lihai Song is with Healthcare Analytics Unit, Center for Pediatric Clinical Effectiveness, and Policylab, The Children's Hospital of Philadelphia. Kailey Urban and Blain Mamo are with Refugee Health Program, Minnesota Department of Health, Saint Paul. Janine Young is with General Pediatrics, Denver Health and Hospitals, Denver, CO. William M. Stauffer is with Departments of Medicine and Pediatrics, University of Minnesota, Minneapolis
| | - Jasmine Matheson
- Katherine Yun is with PolicyLab, Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA. Jasmine Matheson is with Refugee Health Program, Washington State Department of Health, Shoreline. Colleen Payton and Kevin C. Scott are with Family and Community Medicine, Thomas Jefferson University, Philadelphia. Barbara L. Stone is with Refugee Health Program, Colorado Department of Public Health and Environment, Denver. Lihai Song is with Healthcare Analytics Unit, Center for Pediatric Clinical Effectiveness, and Policylab, The Children's Hospital of Philadelphia. Kailey Urban and Blain Mamo are with Refugee Health Program, Minnesota Department of Health, Saint Paul. Janine Young is with General Pediatrics, Denver Health and Hospitals, Denver, CO. William M. Stauffer is with Departments of Medicine and Pediatrics, University of Minnesota, Minneapolis
| | - Colleen Payton
- Katherine Yun is with PolicyLab, Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA. Jasmine Matheson is with Refugee Health Program, Washington State Department of Health, Shoreline. Colleen Payton and Kevin C. Scott are with Family and Community Medicine, Thomas Jefferson University, Philadelphia. Barbara L. Stone is with Refugee Health Program, Colorado Department of Public Health and Environment, Denver. Lihai Song is with Healthcare Analytics Unit, Center for Pediatric Clinical Effectiveness, and Policylab, The Children's Hospital of Philadelphia. Kailey Urban and Blain Mamo are with Refugee Health Program, Minnesota Department of Health, Saint Paul. Janine Young is with General Pediatrics, Denver Health and Hospitals, Denver, CO. William M. Stauffer is with Departments of Medicine and Pediatrics, University of Minnesota, Minneapolis
| | - Kevin C Scott
- Katherine Yun is with PolicyLab, Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA. Jasmine Matheson is with Refugee Health Program, Washington State Department of Health, Shoreline. Colleen Payton and Kevin C. Scott are with Family and Community Medicine, Thomas Jefferson University, Philadelphia. Barbara L. Stone is with Refugee Health Program, Colorado Department of Public Health and Environment, Denver. Lihai Song is with Healthcare Analytics Unit, Center for Pediatric Clinical Effectiveness, and Policylab, The Children's Hospital of Philadelphia. Kailey Urban and Blain Mamo are with Refugee Health Program, Minnesota Department of Health, Saint Paul. Janine Young is with General Pediatrics, Denver Health and Hospitals, Denver, CO. William M. Stauffer is with Departments of Medicine and Pediatrics, University of Minnesota, Minneapolis
| | - Barbara L Stone
- Katherine Yun is with PolicyLab, Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA. Jasmine Matheson is with Refugee Health Program, Washington State Department of Health, Shoreline. Colleen Payton and Kevin C. Scott are with Family and Community Medicine, Thomas Jefferson University, Philadelphia. Barbara L. Stone is with Refugee Health Program, Colorado Department of Public Health and Environment, Denver. Lihai Song is with Healthcare Analytics Unit, Center for Pediatric Clinical Effectiveness, and Policylab, The Children's Hospital of Philadelphia. Kailey Urban and Blain Mamo are with Refugee Health Program, Minnesota Department of Health, Saint Paul. Janine Young is with General Pediatrics, Denver Health and Hospitals, Denver, CO. William M. Stauffer is with Departments of Medicine and Pediatrics, University of Minnesota, Minneapolis
| | - Lihai Song
- Katherine Yun is with PolicyLab, Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA. Jasmine Matheson is with Refugee Health Program, Washington State Department of Health, Shoreline. Colleen Payton and Kevin C. Scott are with Family and Community Medicine, Thomas Jefferson University, Philadelphia. Barbara L. Stone is with Refugee Health Program, Colorado Department of Public Health and Environment, Denver. Lihai Song is with Healthcare Analytics Unit, Center for Pediatric Clinical Effectiveness, and Policylab, The Children's Hospital of Philadelphia. Kailey Urban and Blain Mamo are with Refugee Health Program, Minnesota Department of Health, Saint Paul. Janine Young is with General Pediatrics, Denver Health and Hospitals, Denver, CO. William M. Stauffer is with Departments of Medicine and Pediatrics, University of Minnesota, Minneapolis
| | - William M Stauffer
- Katherine Yun is with PolicyLab, Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA. Jasmine Matheson is with Refugee Health Program, Washington State Department of Health, Shoreline. Colleen Payton and Kevin C. Scott are with Family and Community Medicine, Thomas Jefferson University, Philadelphia. Barbara L. Stone is with Refugee Health Program, Colorado Department of Public Health and Environment, Denver. Lihai Song is with Healthcare Analytics Unit, Center for Pediatric Clinical Effectiveness, and Policylab, The Children's Hospital of Philadelphia. Kailey Urban and Blain Mamo are with Refugee Health Program, Minnesota Department of Health, Saint Paul. Janine Young is with General Pediatrics, Denver Health and Hospitals, Denver, CO. William M. Stauffer is with Departments of Medicine and Pediatrics, University of Minnesota, Minneapolis
| | - Kailey Urban
- Katherine Yun is with PolicyLab, Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA. Jasmine Matheson is with Refugee Health Program, Washington State Department of Health, Shoreline. Colleen Payton and Kevin C. Scott are with Family and Community Medicine, Thomas Jefferson University, Philadelphia. Barbara L. Stone is with Refugee Health Program, Colorado Department of Public Health and Environment, Denver. Lihai Song is with Healthcare Analytics Unit, Center for Pediatric Clinical Effectiveness, and Policylab, The Children's Hospital of Philadelphia. Kailey Urban and Blain Mamo are with Refugee Health Program, Minnesota Department of Health, Saint Paul. Janine Young is with General Pediatrics, Denver Health and Hospitals, Denver, CO. William M. Stauffer is with Departments of Medicine and Pediatrics, University of Minnesota, Minneapolis
| | - Janine Young
- Katherine Yun is with PolicyLab, Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA. Jasmine Matheson is with Refugee Health Program, Washington State Department of Health, Shoreline. Colleen Payton and Kevin C. Scott are with Family and Community Medicine, Thomas Jefferson University, Philadelphia. Barbara L. Stone is with Refugee Health Program, Colorado Department of Public Health and Environment, Denver. Lihai Song is with Healthcare Analytics Unit, Center for Pediatric Clinical Effectiveness, and Policylab, The Children's Hospital of Philadelphia. Kailey Urban and Blain Mamo are with Refugee Health Program, Minnesota Department of Health, Saint Paul. Janine Young is with General Pediatrics, Denver Health and Hospitals, Denver, CO. William M. Stauffer is with Departments of Medicine and Pediatrics, University of Minnesota, Minneapolis
| | - Blain Mamo
- Katherine Yun is with PolicyLab, Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA. Jasmine Matheson is with Refugee Health Program, Washington State Department of Health, Shoreline. Colleen Payton and Kevin C. Scott are with Family and Community Medicine, Thomas Jefferson University, Philadelphia. Barbara L. Stone is with Refugee Health Program, Colorado Department of Public Health and Environment, Denver. Lihai Song is with Healthcare Analytics Unit, Center for Pediatric Clinical Effectiveness, and Policylab, The Children's Hospital of Philadelphia. Kailey Urban and Blain Mamo are with Refugee Health Program, Minnesota Department of Health, Saint Paul. Janine Young is with General Pediatrics, Denver Health and Hospitals, Denver, CO. William M. Stauffer is with Departments of Medicine and Pediatrics, University of Minnesota, Minneapolis
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Greenaway C, Thu Ma A, Kloda LA, Klein M, Cnossen S, Schwarzer G, Shrier I. The Seroprevalence of Hepatitis C Antibodies in Immigrants and Refugees from Intermediate and High Endemic Countries: A Systematic Review and Meta-Analysis. PLoS One 2015; 10:e0141715. [PMID: 26558905 PMCID: PMC4641717 DOI: 10.1371/journal.pone.0141715] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 10/12/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND & AIMS Hepatitis C virus (HCV) infection is a significant global health issue that leads to 350,000 preventable deaths annually due to associated cirrhosis and hepatocellular carcinoma (HCC). Immigrants and refugees (migrants) originating from intermediate/high HCV endemic countries are likely at increased risk for HCV infection due to HCV exposure in their countries of origin. The aim of this study was to estimate the HCV seroprevalence of the migrant population living in low HCV prevalence countries. METHODS Four electronic databases were searched from database inception until June 17, 2014 for studies reporting the prevalence of HCV antibodies among migrants. Seroprevalence estimates were pooled with a random-effect model and were stratified by age group, region of origin and migration status and a meta-regression was modeled to explore heterogeneity. RESULTS Data from 50 studies representing 38,635 migrants from all world regions were included. The overall anti-HCV prevalence (representing previous and current infections) was 1.9% (95% CI, 1.4-2.7%, I2 96.1). Older age and region of origin, particularly Sub-Saharan Africa, Asia, and Eastern Europe were the strongest predictors of HCV seroprevalence. The estimated HCV seroprevalence of migrants from these regions was >2% and is higher than that reported for most host populations. CONCLUSION Adult migrants originating from Asia, Sub-Saharan Africa and Eastern Europe are at increased risk for HCV and may benefit from targeted HCV screening.
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Affiliation(s)
- Christina Greenaway
- Division of Infectious Diseases, Jewish General Hospital, McGill University, Montreal, Canada
- Centre for Clinical Epidemiology, Lady Davis Research Institute for Medical Research, Jewish General Hospital, Montreal, Canada
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada
| | - Ann Thu Ma
- Department of Internal Medicine, Centre Hospitalier de l’Université de Montréal, Montreal, Canada
| | | | - Marina Klein
- Division of Infectious Diseases, McGill University Health Center, McGill University, Montreal, Canada
| | - Sonya Cnossen
- Centre for Clinical Epidemiology, Lady Davis Research Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Guido Schwarzer
- Institute of Medical Biometry and Statistics, Medical Centre - University of Freiburg, Freiburg, Germany
| | - Ian Shrier
- Centre for Clinical Epidemiology, Lady Davis Research Institute for Medical Research, Jewish General Hospital, Montreal, Canada
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada
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Abstract
BACKGROUND High immigration rates from tuberculosis (TB) endemic countries to low-incidence countries have caused new TB guidelines in these countries to reconsider latent TB infection (LTBI) screening in these immigrants. OBJECTIVES We performed a systematic review with the primary outcome of evaluating the number of cases recommended LTBI treatment with the tuberculin skin test (TST) or interferon gamma release assay (IGRA). Secondary objectives were to examine prevalence of positive LTBI diagnostic tests stratified by age and incidence of TB in country of origin. METHODS We performed a systematic search of seven electronic databases for studies assessing TST and/or IGRA performance in immigrant populations to low incidence countries. Demographics, LTBI diagnosis, longitudinal TB development, and test result data were the primary data extracted from the studies. Prevalence of positive test data was stratified by age and country of origin. Studies were evaluated using a modified SIGN checklist for diagnostic studies. Data was compared using Fisher's exact test or χ (2) test, where appropriate. RESULTS Our literature search yielded 51 studies (n = 34 TST, n = 9 IGRA, n = 8 both). Recommendation of LTBI treatment was less common in those tested with an IGRA compared to TST (p < 0.0001), while long-term development of active TB appears higher in those with a positive IGRA. There was no difference in the sensitivity and specificity of the IGRA and TST for prevalent TB (p > 0.05). Prevalence of a positive test was significantly lower in those who were <18 years of age compared to those ≥18 years of age (p < 0.0001) and those from low TB incidence countries compared to high incidence countries (p < 0.0001) for both TST and IGRA. When comparing the two tests within the 2 subgroups: age and TB incidence in country of origin, the prevalence of positive results was significantly lower for the IGRA than the TST (p < 0.0001). LIMITATIONS The number of available studies evaluating the IGRA and longitudinal active TB development in those tested limits this study. CONCLUSION Prevalence of positive test results were significantly lower in immigrants who were tested with an IGRA, resulting in fewer immigrants being recommended for LTBI treatment compared to TST. Coupled with comparable performance for detecting prevalent TB cases, the IGRA appears to exhibit better specificity than the TST and may be preferred as the standard of care for detecting LTBI in immigrants moving to low TB incidence countries.
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Gibson-Helm ME, Teede HJ, Cheng IH, Block AA, Knight M, East CE, Wallace EM, Boyle JA. Maternal health and pregnancy outcomes comparing migrant women born in humanitarian and nonhumanitarian source countries: a retrospective, observational study. Birth 2015; 42:116-24. [PMID: 25864573 DOI: 10.1111/birt.12159] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/20/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND The relationship between migration and pregnancy outcomes is complex, with little insight into whether women of refugee background have greater risks of adverse pregnancy outcomes than other migrant women. This study aimed to describe maternal health, pregnancy care, and pregnancy outcomes among migrant women from humanitarian and nonhumanitarian source countries. METHODS Retrospective, observational study of singleton births, at a single maternity service in Australia 2002-2011, to migrant women born in humanitarian source countries (HSCs, n = 2,713) and non-HSCs (n = 10,606). Multivariable regression analysis assessed associations between maternal HSC-birth and pregnancy outcomes. RESULTS Compared with women from non-HSCs, the following were more common in women from HSCs: age < 20 years (0.6 vs 2.9% p < 0.001), multiparity (51 vs 76% p < 0.001), body mass index (BMI) ≥ 25 (38 vs 50% p < 0.001), anemia (3.2 vs 5.9% p < 0.001), tuberculosis (0.1 vs 0.4% p = 0.001), and syphilis (0.4 vs 2.5% p < 0.001). Maternal HSC-birth was independently associated with poor or no pregnancy care attendance (OR 2.5 [95% CI 1.8-3.6]), late first pregnancy care visit (OR 1.3 [95% CI 1.1-1.5]), and postterm birth (> 41 weeks gestation) (OR 2.5 [95% CI 1.9-3.4]). Stillbirth (0.8 vs 1.2% p = 0.04, OR 1.5 [95% CI 1.0-2.4]) and unplanned birth before arrival at the hospital (0.6 vs 1.2% p < 0.001, OR 1.3 [95% CI 0.8-2.1]) were more common in HSC-born women but not independently associated with maternal HSC-birth after adjusting for age, parity, BMI and relative socioeconomic disadvantage. CONCLUSIONS These findings suggest areas where women from HSCs may have additional needs in pregnancy compared with women from non-HSCs. Refugee-focused strategies to support engagement in pregnancy care and address maternal health needs would be expected to improve health outcomes in resettlement countries.
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Affiliation(s)
- Melanie E Gibson-Helm
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | | | - I-Hao Cheng
- Southern Academic Primary Care Research Unit, School of Primary Health Care, Monash University, Dandenong, Victoria, Australia.,South Eastern Melbourne Medicare Local, Dandenong, Victoria, Australia
| | - Andrew A Block
- Dandenong Hospital, Monash Health, Dandenong, Victoria, Australia
| | - Michelle Knight
- Monash Women's Maternity Services, Monash Health, Clayton, Victoria, Australia
| | - Christine E East
- School of Nursing and Midwifery, Monash University Clayton, Victoria, Australia
| | | | - Jacqueline A Boyle
- Monash Centre for Health Research and Implementation, Monash University Clayton, Victoria, Australia
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Gibson-Helm M, Boyle J, Cheng IH, East C, Knight M, Teede H. Maternal health and pregnancy outcomes among women of refugee background from Asian countries. Int J Gynaecol Obstet 2015; 129:146-51. [DOI: 10.1016/j.ijgo.2014.10.036] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 10/23/2014] [Accepted: 01/09/2015] [Indexed: 10/24/2022]
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40
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Furber S, Jackson J, Johnson K, Sukara R, Franco L. A qualitative study on tobacco smoking and betel quid use among Burmese refugees in Australia. J Immigr Minor Health 2014; 15:1133-6. [PMID: 23892575 DOI: 10.1007/s10903-013-9881-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Anecdotal evidence suggests that there are high rates of smoking among Burmese men in Wollongong, Australia. A qualitative study was undertaken to explore the beliefs and experiences of Burmese refugees in Wollongong on smoking to guide the development of smoking cessation interventions. Three focus groups were conducted with Burmese refugees. Ten semi-structured interviews were conducted with service providers involved with Burmese refugees. Qualitative content analysis was used to categorise responses to the questions. Participants were aware of the health effects of tobacco smoking but had little knowledge of support for quitting. Many participants chewed betel quid and were unaware of the health consequences. Service providers noted the lack of resources on smoking and betel quid use for Burmese people. Smoking cessation interventions for Burmese people should consider the co-related use of betel quid due to the possibility of inadvertently encouraging use of betel nut as an alternative to tobacco.
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Affiliation(s)
- Susan Furber
- Health Promotion Service, Illawarra Shoalhaven Local Health District, Locked Mail Bag 9, Wollongong, NSW, 2500, Australia,
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Gibson-Helm M, Boyle J, Block A, Teede H. Use of country of birth as an indicator of refugee background in health datasets. BMC Med Res Methodol 2014; 14:27. [PMID: 24552123 PMCID: PMC3932110 DOI: 10.1186/1471-2288-14-27] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Accepted: 02/13/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Routine public health databases contain a wealth of data useful for research among vulnerable or isolated groups, who may be under-represented in traditional medical research. Identifying specific vulnerable populations, such as resettled refugees, can be particularly challenging; often country of birth is the sole indicator of whether an individual has a refugee background. The objective of this article was to review strengths and weaknesses of different methodological approaches to identifying resettled refugees and comparison groups from routine health datasets and to propose the application of additional methodological rigour in future research. DISCUSSION Methodological approaches to selecting refugee and comparison groups from existing routine health datasets vary widely and are often explained in insufficient detail. Linked data systems or datasets from specialized refugee health services can accurately select resettled refugee and asylum seeker groups but have limited availability and can be selective. In contrast, country of birth is commonly collected in routine health datasets but a robust method for selecting humanitarian source countries based solely on this information is required. The authors recommend use of national immigration data to objectively identify countries of birth with high proportions of humanitarian entrants, matched by time period to the study dataset. When available, additional migration indicators may help to better understand migration as a health determinant. Methodologically, if multiple countries of birth are combined, the proportion of the sample represented by each country of birth should be included, with sub-analysis of individual countries of birth potentially providing further insights, if population size allows. United Nations-defined world regions provide an objective framework for combining countries of birth when necessary. A comparison group of economic migrants from the same world region may be appropriate if the resettlement country is particularly diverse ethnically or the refugee group differs in many ways to those born in the resettlement country. SUMMARY Routine health datasets are valuable resources for public health research; however rigorous methods for using country of birth to identify resettled refugees would optimize usefulness of these resources.
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Affiliation(s)
- Melanie Gibson-Helm
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Locked Bag 29, Clayton, VIC 3168, Australia
| | - Jacqueline Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Locked Bag 29, Clayton, VIC 3168, Australia
| | - Andrew Block
- Refugee Health Service, Monash Health, David Street, Dandenong, VIC 3175, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Locked Bag 29, Clayton, VIC 3168, Australia
- Diabetes and Vascular Medicine Unit, Monash Health, Locked Bag 29, Clayton, VIC 3168, Australia
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Paxton GA, Teale GR, Nowson CA, Mason RS, McGrath JJ, Thompson MJ, Siafarikas A, Rodda CP, Munns CF. Vitamin D and health in pregnancy, infants, children and adolescents in Australia and New Zealand: a position statement. Med J Aust 2013; 198:142-3. [PMID: 23418693 DOI: 10.5694/mja11.11592] [Citation(s) in RCA: 129] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Accepted: 12/16/2012] [Indexed: 12/20/2022]
Abstract
• The recommended level for serum 25-hydroxyvitamin D (25(OH)D) in infants, children, adolescents and during pregnancy and lactation is ≥ 50 nmol/L. This level may need to be 10-20 nmol/L higher at the end of summer to maintain levels ≥ 50 nmol/L over winter and spring. • Sunlight is the most important source of vitamin D. The US recommended dietary allowance for vitamin D is 600 IU daily in children aged over 12 months and during pregnancy and lactation, assuming minimal sun exposure. • Risk factors for low vitamin D are: lack of skin exposure to sunlight, dark skin, southerly latitude, conditions affecting vitamin D metabolism and storage (including obesity) and, for infants, being born to a mother with low vitamin D and exclusive breastfeeding combined with at least one other risk factor. • Targeted measurement of 25(OH)D levels is recommended for infants, children and adolescents with at least one risk factor for low vitamin D and for pregnant women with at least one risk factor for low vitamin D at the first antenatal visit. • Vitamin D deficiency can be treated with daily low-dose vitamin D supplements, although barriers to adherence have been identified. High-dose intermittent vitamin D can be used in children and adolescents. Treatment should be paired with health education and advice about sensible sun exposure. Infants at risk of low vitamin D should be supplemented with 400 IU vitamin D₃ daily for at least the first year of life. • There is increasing evidence of an association between low vitamin D and a range of non-bone health outcomes, however there is a lack of data from robust randomised controlled trials of vitamin D supplementation.
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Affiliation(s)
- Georgia A Paxton
- Department of General Medicine, Royal Children's Hospital, Melbourne, VIC, Australia.
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