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Değer VB, Çifçi S, Ertem M. The effect of socioeconomic factors on malnutrition in Syrian children aged 0-6 years living in Turkey: a cross-sectional study. BMC Public Health 2024; 24:2472. [PMID: 39261868 PMCID: PMC11389438 DOI: 10.1186/s12889-024-19791-1] [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: 03/10/2024] [Accepted: 08/13/2024] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND This study was conducted to examine the prevalence of malnutrition in Syrian immigrant children living in Turkey. METHODS The study was carried out in the city of Mardin, which is one of the cities with a high Syrian immigrant population in Turkey. Height, body weight and BMI values were recorded to determine the malnutrition status of the children. Z-scores of children were calculated using the malnutrition assessment WHOAntro program. RESULTS The data show that 30.5% of Syrian children between the ages of 0 and 6 months are male, making up 55.8% of the total, and that 55.3% do not follow a regular breakfast schedule. The percentages of body weight for height, height for age, and BMI for age of Syrian children with a score between - 2 and + 2 SD Number were (89.3%), (74.3%), and (79.3%), respectively. Girls are more likely than boys to experience stunting and low body weight in the context of Syrian children (Stunting OR: 0.855(0.761-1.403), Underweight OR: 0.705(0.609-1,208)). Additionally, there is a link between levels of stunting and underweight and elements like the mother's educational level and the family's income. Contrary to the situation of adequate nutrition, it was discovered that the likelihood of stunting and low body weight in children increased by 0.809 and 1.039 times, respectively, when access to an adequate food supply was not available within the family (p < 0.05). CONCLUSION s According to the results of the study, gender, family income, mother's education level and access to food affected the severity of malnutrition in children. Migration is an imporatnt factor affecting children's health. In this study malnutrition was found high im immigrant children. Programs should be developed to monitor the growth and development of disadvantaged children and to support their nutrition.
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Affiliation(s)
- Vasfiye Bayram Değer
- Mardin Artuklu University/faculty of health sciences/public health nursing, Mardin, Turkey.
| | - Sema Çifçi
- Mardin Artuklu University/faculty of health sciences/public health nursing, Mardin, Turkey
| | - Melikşah Ertem
- Melikşah Ertem (MD), Public of Health, Medicine Faculty, University Of Kyrenia, Kyrenia, Kıbrıs, Turkey
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Phung B. Caring for resettled refugee children in the United States: guidelines, challenges and public health perspectives. Front Public Health 2023; 11:1046319. [PMID: 37818302 PMCID: PMC10561301 DOI: 10.3389/fpubh.2023.1046319] [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: 09/16/2022] [Accepted: 09/07/2023] [Indexed: 10/12/2023] Open
Abstract
The global refugee crisis has become an urgent, pressing humanitarian issue, with an estimated 37 million children forcibly displaced from their homes due to conflict, persecution, violence and other human rights violations by mid-2022. Of these children, only a small percentage are eligible for resettlement in a new country. This narrative review examines the physical health needs of resettled refugee children (RRC) in the United States. By analyzing nutrition and growth, infectious diseases, and general health care/screening measures, a set of comprehensive, evidence-based guidelines and public health perspectives are formulated to facilitate ongoing discussion to ensure that RRC receive equitable health care access. An urgent call to action emphasizes cross-border collaboration between governments, public health experts, refugee populations, and disease preparedness authorities in order to prioritize the physical health of RRC. This review will provide primary care providers, public health professionals, social service workers, and community advocates with up-to-date recommendations to meet the health needs of RRC in the U.S.
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Affiliation(s)
- Binh Phung
- Department of Pediatrics, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
- Department of Epidemiology and Public Health, Yale University, New Haven, CT, United States
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Moura HSD, Berra TZ, Rosa RJ, Silva RVDS, Soares DDA, de Araújo JST, Costa FBP, de Souza RMP, do Nascimento MC, Teibo TKA, Serrano-Gallardo MDP, Arcêncio RA. Health condition, income loss, food insecurity and other social inequities among migrants and refugees during the COVID-19 pandemic in Brazil. BMC Public Health 2023; 23:1728. [PMID: 37670227 PMCID: PMC10481567 DOI: 10.1186/s12889-023-16620-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/25/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Brazil is the destination of many international migrants and refugees and, given the circumstances of their entry into the country, many face difficulties due to the absence of targeted policies. Thus, the objective of this study was to survey the social impact of COVID-19 on international migrants and refugees regarding income loss, food insecurity and other social inequities, and to identify explanatory factors on these aspects. METHODS This is a cross-sectional, analytical study. We used a validated instrument applied by trained interviewers. Descriptive analysis and binary logistic regression were performed to identify factors associated with income loss and food insecurity. RESULTS A total of 360 individuals from sub-Saharan African and South American countries participated in the study. Individuals who were white, black/brown, yellow, had an occupation/employment, and earned less than one minimum wage were more likely to lose income. Those who reported no income, received less than one minimum wage, and were diagnosed with COVID-19 were more likely to be food insecure. CONCLUSIONS The study advances knowledge by identifying factors associated with income loss, food insecurity, and individuals' difficulty in accessing health services and social support measures in Brazil.
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Affiliation(s)
- Heriederson Sávio Dias Moura
- Avenida dos Bandeirantes, University of São Paulo at Ribeirão Preto School of Nursing, São Paulo, Brazil, 3900, Monte Alegre, Ribeirão Preto, 14040-902.
| | - Thaís Zamboni Berra
- Avenida dos Bandeirantes, University of São Paulo at Ribeirão Preto School of Nursing, São Paulo, Brazil, 3900, Monte Alegre, Ribeirão Preto, 14040-902
| | - Rander Junior Rosa
- Avenida dos Bandeirantes, University of São Paulo at Ribeirão Preto School of Nursing, São Paulo, Brazil, 3900, Monte Alegre, Ribeirão Preto, 14040-902
| | - Ruan Víctor Dos Santos Silva
- Avenida dos Bandeirantes, University of São Paulo at Ribeirão Preto School of Nursing, São Paulo, Brazil, 3900, Monte Alegre, Ribeirão Preto, 14040-902
| | - Débora de Almeida Soares
- Avenida dos Bandeirantes, University of São Paulo at Ribeirão Preto School of Nursing, São Paulo, Brazil, 3900, Monte Alegre, Ribeirão Preto, 14040-902
- Institute of Hygiene and Tropical Medicine, New University of Lisbon, Lisbon, Portugal, Rua da Junqueira, 100, 1349-008
| | - Juliana Soares Tenório de Araújo
- Avenida dos Bandeirantes, University of São Paulo at Ribeirão Preto School of Nursing, São Paulo, Brazil, 3900, Monte Alegre, Ribeirão Preto, 14040-902
| | - Fernanda Bruzadelli Paulino Costa
- Avenida dos Bandeirantes, University of São Paulo at Ribeirão Preto School of Nursing, São Paulo, Brazil, 3900, Monte Alegre, Ribeirão Preto, 14040-902
| | | | | | - Titilade Kehinde Ayandeyi Teibo
- Avenida dos Bandeirantes, University of São Paulo at Ribeirão Preto School of Nursing, São Paulo, Brazil, 3900, Monte Alegre, Ribeirão Preto, 14040-902
| | | | - Ricardo Alexandre Arcêncio
- Avenida dos Bandeirantes, University of São Paulo at Ribeirão Preto School of Nursing, São Paulo, Brazil, 3900, Monte Alegre, Ribeirão Preto, 14040-902
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Bulucu Büyüksoy GD. Failure to thrive among asylum-seeking children: A descriptive study from Turkey. Public Health Nurs 2023. [PMID: 37083040 DOI: 10.1111/phn.13199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 03/22/2023] [Accepted: 04/09/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVE The aim of the study was to determine failure to thrive among asylum-seeking children. DESIGN The study was a descriptive study. SAMPLE The sample of the study comprised of 187 children who were registered in an Afghan Association. The power of the study was found to be 97% at 0.5% (moderate) effect size and 95% confidence level. MEASUREMENTS The data was collected between November 8, 2021 and January 10, 2022 using a sociodemographic form and the children's anthropometric measurement. RESULTS 57.2% of children were male and 44.9% were 6-12 years old. It was determined that female and male infants less than 1 year of age were underweight (z-score = -2) and male infants were stunting (z-score ≤-1). CONCLUSIONS Childhood growth and development problems are significant issues among asylum-seeking families. Public health nurses need to develop their roles in organizing the healthcare service for vulnerable and underrepresented groups.
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Affiliation(s)
- Gizem Deniz Bulucu Büyüksoy
- Faculty of Health Sciences, Department of Public Health Nursing, Kırşehir Ahi Evran University, Kırşehir, Turkey
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Ningsih FF, Abdillah HZ, Nafianti S. Comparison of lipid profile values in pediatric patients with cyanotic and acyanotic congenital heart disease. PAEDIATRICA INDONESIANA 2022. [DOI: 10.14238/pi62.6.2022.404-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background Incidence of congenital heart disease (CHD) is about 0.8% of every child born. This heart defect is associated with dyslipidemia in children. Lipid profiles examination in patients with CHD can be used to determine risk factors for atherosclerosis.
Objective To examine differences in lipid profiles in children with cyanotic and acyanotic CHD.
Methods This was a cross-sectional study on 60 pediatric CHD patients at Haji Adam Malik Hospital, Medan, North Sumatera, from December 2020 to March 2021. Subjects were included by consecutive sampling. Data of patient’s age, gender, weight, height, complete blood count, blood glucose, and lipid profiles were recorded. Unpaired T-test analysis and Mann-Whitney test were then performed to analyze variables in cyanotic and acyanotic CHD patients.
Results Of a total of 60 CHD children, 26 subjects had a diagnosis of cyanotic CHD and 34 subjects had a diagnosis of acyanotic CHD. The most common cause of cyanotic CHD was tetralogy of Fallot (76.9%), while the most common cause of acyanotic CHD were ventricular septal defect and patent ductus arteriosus (32.4% each). Analysis of lipid profiles on both groups revealed that low density lipoprotein (LDL) was significantly lower in the cyanotic group than in the acyanotic group (P<0.05). However, other lipid profile values, were not significantly different between groups. In addition, there was no significant difference in incidence of dyslipidemia between cyanotic and acyanotic CHD.
Conclusion Low density lipoprotein is significantly lower in the cyanotic CHD group than in the acyanotic CHD group. But there are no significant differences in the other lipid profiles measurement and incidence of dyslipidemia between groups.
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Meyer SC, Montez K, McClung R, Michael L, Namak S, Brown CL. Growth of Pediatric Refugees after Resettlement to the Southeastern United States. Acad Pediatr 2022; 22:777-781. [PMID: 34637931 PMCID: PMC8993936 DOI: 10.1016/j.acap.2021.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 09/25/2021] [Accepted: 10/04/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To compare weight status and body mass index z-scores (BMIz) of refugee children upon arrival to the Southeastern US and after resettlement with age- and sex-matched controls of nonrefugee children. METHODS We identified refugee children resettled between July 2014 and June 2018 to Forsyth County, NC. Refugees were assigned age- and sex-matched controls (3 controls:1 refugee) who received care at the same health care site, were Medicaid insured, and had height and weight recorded at time of their matched refugee's resettlement plus at least 2 additional visits. BMI and BMIz were calculated. Pearson chi-square test assessed differences in weight status at the time of refugee resettlement and at the last measured time point. Multilevel linear mixed-effects regression models assessed change in BMIz by refugee status, adjusting for sex, race/ethnicity, age, and time since resettlement. RESULTS This study examined 139 pediatric refugees and 417 nonrefugee controls; 46% were female. At the time of resettlement, refugees had a higher rate of underweight (3.3% vs 1.9%), higher rate of healthy weight (68.9% vs 48.2%), and lower rate of overweight/obesity (27.8% vs 50%), compared to controls P < .001. At the last available time point, compared to controls, refugees had higher rates of underweight (3.3% vs 3.0%) and healthy weight (69.5% vs 54.2%) and lower rates of overweight/obesity (27.2% vs 42.7%), P = .005. Refugees had a lower predicted BMIz compared with controls (adjusted β: -0.78; 95% confidence interval -0.91, -0.66). CONCLUSIONS Resettled pediatric refugees were found to have significantly lower predicted BMIz than their age- and sex-matched nonrefugee controls.
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Affiliation(s)
- Stephanie C Meyer
- Department of Student Affairs (SC Meyer), Wake Forest School of Medicine, Winston-Salem, NC
| | - Kimberly Montez
- Department of Pediatrics (K Montez and CL Brown), Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC
| | - Rachel McClung
- Novant Health, Robinhood Pediatrics (R McClung), Winston-Salem, NC
| | - Lemaat Michael
- Department of Student Affairs (L Michael), Wake Forest School of Medicine, Winston-Salem, NC
| | - Shahla Namak
- Department of Family and Community Medicine (S Namak), Wake Forest School of Medicine, Winston-Salem, NC
| | - Callie L Brown
- Department of Pediatrics (K Montez and CL Brown), Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC; Department of Epidemiology and Prevention (CL Brown), Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC.
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Grasser LR. Addressing Mental Health Concerns in Refugees and Displaced Populations: Is Enough Being Done? Risk Manag Healthc Policy 2022; 15:909-922. [PMID: 35573980 PMCID: PMC9094640 DOI: 10.2147/rmhp.s270233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 04/26/2022] [Indexed: 01/22/2023] Open
Abstract
There are over 82.4 million forcibly displaced people worldwide, about a quarter of whom are resettling as refugees. In the wake of the global refugee crisis spurred by conflict, religious and political persecution, human rights violations, and climate disasters, a mental health has crisis followed. Not only does trauma experienced in home countries and as part of forced migration affect mental health, so too do post-migration traumatic events, discrimination, lack of access to quality and affordable healthcare and housing, and acculturation. To address mental health concerns in refugees and displaced populations, collective action is needed not only from health care providers but also from mental health researchers, funders, journals, resettlement agencies, government entities, and humanitarian organizations. The present review highlights the work of numerous scholars and organizations with the goal of understanding the mental health concerns of forcibly displaced persons within and across ecological systems. The present review seeks to bring attention to the experiences of forcibly displaced persons, summarize the growing body of research understanding the acute and chronic effects of forced displacement and possible interventions, and give a call to action for all members of the global community at every level to engage in joint efforts to improve mental health in refugees and displaced persons. Notably, there is a need for more interventions at the familial and community level that serve not only as treatment but also as prevention. Smartphone-based interventions, mind-body modalities, and interventions delivered by lay and non-clinician community members hold promise. Numerous strides could be made in refugee mental health and treatment when funding agencies include these goals in their research priorities. Despite the challenges they have faced, persons who resettle as refugees are incredibly resilient and deserve to be afforded every right, opportunity, dignity, and respect.
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Affiliation(s)
- Lana Ruvolo Grasser
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
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Salami B, Fernandez-Sanchez H, Fouche C, Evans C, Sibeko L, Tulli M, Bulaong A, Kwankye SO, Ani-Amponsah M, Okeke-Ihejirika P, Gommaa H, Agbemenu K, Ndikom CM, Richter S. A Scoping Review of the Health of African Immigrant and Refugee Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073514. [PMID: 33800663 PMCID: PMC8038070 DOI: 10.3390/ijerph18073514] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/18/2021] [Accepted: 03/22/2021] [Indexed: 12/02/2022]
Abstract
Migration is a growing phenomenon around the world, including within the African continent. Many migrants, especially African children, face challenges related to health and social inclusion and can face increased health risks. A systematic scoping review of available literature on the health of African migrant children across the globe was conducted to offer insight into these health risks. The review was conducted over a 15-month period from January 2019 to April 2020, yielding 6602 articles once duplicates were removed. This search included electronic databases, reference lists of articles reviewed, and searches of libraries of relevant organisations. A total of 187 studies met the inclusion criteria, of which 159 were quantitative, 22 were qualitative, and 6 used mixed methods. The findings reveal decreased health in this population in areas of nutrition, infectious diseases, mental health, birth outcomes, sexual and reproductive health, physical and developmental health, parasitic infections, oral health, respiratory health, preventative health, endocrine disorders, health care services, and haematological conditions. The findings offer insights into factors influencing the health of African immigrant and refugee children. Further studies, especially qualitative studies, are needed to determine barriers to service access after migration and to investigate other underexplored and overlooked health concerns of African migrant children, including pneumonia and child maltreatment.
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Affiliation(s)
- Bukola Salami
- Faculty of Nursing, University of Alberta, 11405 87 Avenue, Edmonton, AB T6G 0Z7, Canada; (H.F.-S.); (M.T.); (A.B.); (S.R.)
- Correspondence:
| | - Higinio Fernandez-Sanchez
- Faculty of Nursing, University of Alberta, 11405 87 Avenue, Edmonton, AB T6G 0Z7, Canada; (H.F.-S.); (M.T.); (A.B.); (S.R.)
| | - Christa Fouche
- Faculty of Education and Social Work, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand;
| | - Catrin Evans
- School of Health Sciences, University of Nottingham, University Park, Nottingham NG7 2RD, UK;
| | - Lindiwe Sibeko
- Department of Nutrition, School of Public Health and Health Sciences, University of Massachusetts, 204 Chenoweth Laboratory, Amherst, MA 01003-9282, USA;
| | - Mia Tulli
- Faculty of Nursing, University of Alberta, 11405 87 Avenue, Edmonton, AB T6G 0Z7, Canada; (H.F.-S.); (M.T.); (A.B.); (S.R.)
| | - Ashley Bulaong
- Faculty of Nursing, University of Alberta, 11405 87 Avenue, Edmonton, AB T6G 0Z7, Canada; (H.F.-S.); (M.T.); (A.B.); (S.R.)
| | - Stephen Owusu Kwankye
- Regional Institute for Population Studies, University of Ghana, P.O. Box LG 96, Legon, Accra GA184, Ghana;
| | - Mary Ani-Amponsah
- School of Nursing, University of Ghana, P.O. Box LG 43, Legon, Accra GA184, Ghana;
| | | | - Hayat Gommaa
- Department of Nursing Science, Ahmadu Bello University, Sokoto Road, PMB 06, Zaria 810107, Nigeria;
| | - Kafuli Agbemenu
- School of Nursing, The State University of New York (SUNY), University at Buffalo, 3435 Main Street, Buffalo, NY 14214, USA;
| | | | - Solina Richter
- Faculty of Nursing, University of Alberta, 11405 87 Avenue, Edmonton, AB T6G 0Z7, Canada; (H.F.-S.); (M.T.); (A.B.); (S.R.)
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Pehlivanturk-Kizilkan M, Ozmert EN, Derman O, Okur İ, Kaynak MO, Adiguzel A, Sahan-Seref I, Kurekci F, Bideci A, Hasanoglu E. Nutritional Status of Syrian Refugees in Early Adolescence Living in Turkey. J Immigr Minor Health 2020; 22:1149-1154. [PMID: 32124154 DOI: 10.1007/s10903-020-00991-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study evaluated the nutritional status of Syrian refugees in the early adolescent period living in different vulnerable settings. Nutritional assessment of Syrian refugee adolescents is often neglected but essential for a healthy physical, pubertal and mental development. Growth parameters of Syrian refugee adolescents going to a public school in an urban area and in a temporary protection center (TPC) were recorded along with the Turkish adolescents. Stunting percentages were similar between the groups (p = 0.811). While the proportion of children with a BMI over 85th percentile were significantly higher among Syrian adolescents living in TPC, Turkish children have the highest percentage of underweight (p = 0.01). Both food insecurity and unhealthy weight gain continue to be major concerns for refugee adolescents after their resettlement to a host country. The findings suggest that nutritional assessment and intervention at early adolescence is critical for Syrian refugees depending on their living conditions.
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Affiliation(s)
- Melis Pehlivanturk-Kizilkan
- Division of Adolescent Medicine, Department of Pediatrics, Hacettepe University Medical School, 06610, Ankara, Turkey.
| | - Elif N Ozmert
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Hacettepe University Medical School, Ankara, Turkey
| | - Orhan Derman
- Division of Adolescent Medicine, Department of Pediatrics, Hacettepe University Medical School, 06610, Ankara, Turkey
| | - İlyas Okur
- Division of Pediatric Metabolism and Nutrition, Department of Pediatrics, Gazi University Medical School, Ankara, Turkey
| | - Mustafa Oguz Kaynak
- Department of Pediatrics, Hacettepe University Medical School, Ankara, Turkey
| | - Aydin Adiguzel
- Department of Pediatrics, Hacettepe University Medical School, Ankara, Turkey
| | - Irem Sahan-Seref
- Department of Pediatrics, Gazi University Medical School, Ankara, Turkey
| | - Fulya Kurekci
- Department of Pediatrics, Gazi University Medical School, Ankara, Turkey
| | - Aysun Bideci
- Division of Pediatric Endocrinology, Department of Pediatrics, Gazi University Medical School, Ankara, Turkey
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Wien SS, Kumar GS, Bilukha OO, Slim W, Burke HM, Jentes ES. Health profile of pediatric Special Immigrant Visa holders arriving from Iraq and Afghanistan to the United States, 2009-2017: A cross-sectional analysis. PLoS Med 2020; 17:e1003069. [PMID: 32182237 PMCID: PMC7077800 DOI: 10.1371/journal.pmed.1003069] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 02/12/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The United States has admitted over 80,000 Special Immigrant Visa holders (SIVH), which include children. Despite the increase in the proportion of SIVH admissions to the US over recent years, little is known about health conditions in SIV children. We report the frequency of selected diseases identified overseas and assess differences in selected conditions between SIV children from Iraq and Afghanistan. METHODS AND FINDINGS We analyzed 15,729 overseas medical exam data in Centers for Disease Control and Prevention's Electronic Disease Notification system (EDN) for children less than 18 years of age from Iraq (29.1%) and Afghanistan (70.9%) who were admitted to the US from April 2009 through December 2017 in a cross-sectional analysis. Variables included age, sex, native language, measured height and weight, and results of the overseas medical examination. From our analysis, less than 1% of SIV children (Iraqi: 0.1%; Afghan: 0.12%) were reported to have abnormal tuberculosis test findings, less than 1% (Iraqi: 0.3%; Afghan: 0.7%) had hearing abnormalities, and about 4% (Iraqi: 6.0% Afghan: 2.9%) had vision abnormalities, with a greater prevalence of vision abnormalities noted in Iraqis (OR: 1.9, 95% CI 1.6-2.2, p <0.001). Seizure disorders were noted in 46 (0.3%) children, with Iraqis more likely to have a seizure disorder (OR: 7.6, 95% CI 3.8-15.0, p < 0.001). On average, children from Afghanistan had a lower mean height-for-age z-score (Iraqi: -0.28; Afghan: -0.68). Only the data quality assessment for height for age for children ≥5 years fell within WHO recommendations. Limitations included the inability to obtain all SIVH records and self-reported medical history of noncommunicable diseases. CONCLUSION In this investigation, we found that less than 1% of SIV children were reported to have abnormal tuberculosis test findings and 4% of SIV children had reported vision abnormalities. Domestic providers caring for SIVH should follow the US Centers for Disease Control and Prevention (CDC) Guidelines for the US Domestic Medical Examination for Newly Arriving Refugees, including an evaluation for malnutrition. Measurement techniques and anthropometric equipment used in panel site clinics should be assessed, and additional training in measurement techniques should be considered. Future analyses could further explore the health of SIV children after resettlement in the US.
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Affiliation(s)
- Simone S. Wien
- Immigrant, Refugee, and Migrant Health Branch, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, United States of America
| | - Gayathri S. Kumar
- Immigrant, Refugee, and Migrant Health Branch, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Oleg O. Bilukha
- Emergency Response and Recovery Branch, Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Walid Slim
- Migration Health Division, International Organization for Migration, Erbil, Iraq
| | - Heather M. Burke
- Immigrant, Refugee, and Migrant Health Branch, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Migration Health Division, International Organization for Migration, Amman, Jordan
| | - Emily S. Jentes
- Immigrant, Refugee, and Migrant Health Branch, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
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Data Collection Tools for Maternal and Child Health in Humanitarian Emergencies: An Updated Systematic Review. Disaster Med Public Health Prep 2019; 14:601-619. [PMID: 31818343 DOI: 10.1017/dmp.2019.103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The worst rates of preventable mortality and morbidity among women and children occur in humanitarian settings. Reliable, easy-to-use, standardized, and efficient tools for data collection are needed to enable different organizations to plan and act in the most effective way. In 2015, the World Health Organization (WHO) commissioned a review of tools for data collection on the health of women and children in humanitarian emergencies. An update of this review was conducted to investigate whether the recommendations made were taken forward and to identify newly developed tools. Fifty-three studies and 5 new tools were identified. Only 1 study used 1 of the tools identified in our search. Little has been done in terms of the previous recommendations. Authors may not be aware of the availability of such tools and of the importance of documenting their data using the same methods as other researchers. Currently used tools may not be suitable for use in humanitarian settings or may not include the domains of the authors' interests. The development of standardized instruments should be done with all key workers in the area and could be coordinated by the WHO.
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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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Linton JM, Green A, Chilton LA, Duffee JH, Dilley KJ, Gutierrez JR, Keane VA, Krugman SD, McKelvey CD, Nelson JL. Providing Care for Children in Immigrant Families. Pediatrics 2019; 144:peds.2019-2077. [PMID: 31427460 DOI: 10.1542/peds.2019-2077] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Children in immigrant families (CIF), who represent 1 in 4 children in the United States, represent a growing and ever more diverse US demographic that pediatric medical providers nationwide will increasingly encounter in clinical care. Immigrant children are those born outside the United States to non-US citizen parents, and CIF are defined as those who are either foreign born or have at least 1 parent who is foreign born. Some families immigrate for economic or educational reasons, and others come fleeing persecution and seeking safe haven. Some US-born children with a foreign-born parent may share vulnerabilities with children who themselves are foreign born, particularly regarding access to care and other social determinants of health. Therefore, the larger umbrella term of CIF is used in this statement. CIF, like all children, have diverse experiences that interact with their biopsychosocial development. CIF may face inequities that can threaten their health and well-being, and CIF also offer strengths and embody resilience that can surpass challenges experienced before and during integration. This policy statement describes the evolving population of CIF in the United States, briefly introduces core competencies to enhance care within a framework of cultural humility and safety, and discusses barriers and opportunities at the practice and systems levels. Practice-level recommendations describe how pediatricians can promote health equity for CIF through careful attention to core competencies in clinical care, thoughtful community engagement, and system-level support. Advocacy and policy recommendations offer ways pediatricians can advocate for policies that promote health equity for CIF.
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Affiliation(s)
- Julie M. Linton
- Departments of Pediatrics and Public Health, School of Medicine Greenville, University of South Carolina, Greenville, South Carolina
- Department of Pediatrics, School of Medicine, Wake Forest University, Winston-Salem, North Carolina; and
| | - Andrea Green
- Larner College of Medicine, The University of Vermont, Burlington, Vermont
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14
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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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15
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Abstract
Immigrant and refugee children are at increased risk for physical, developmental, and behavioral health challenges. This article provides an overview of physical, developmental, and behavioral health considerations for immigrant and refugee children within an ecological framework that highlights family, community, and sociocultural influences. Experiences and exposures relevant to immigrant and refugee children are discussed. Clinical pearls are provided for topics of chronic disease, nutrition, infectious disease, developmental screening, and mental health assessment. Interdisciplinary and community partnerships are emphasized as a means to decrease barriers to care and facilitate family navigation of complex social, educational, and health care systems.
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Affiliation(s)
- Abigail L H Kroening
- Division of Developmental and Behavioral Pediatrics, Golisano Children's Hospital, University of Rochester, 601 Elmwood Avenue Box #671, Rochester, NY 14623, USA.
| | - Elizabeth Dawson-Hahn
- Division of General Pediatrics, University of Washington, 6200 Northeast 74th Street Suite 110, Seattle, WA 98115-81860, USA
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16
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Grammatikopoulou MG, Theodoridis X, Poulimeneas D, Maraki MI, Gkiouras K, Tirodimos I, Dardavessis T, Chourdakis M. Malnutrition surveillance among refugee children living in reception centres in Greece: a pilot study. Int Health 2019; 11:30-35. [PMID: 30053024 DOI: 10.1093/inthealth/ihy053] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 06/20/2018] [Indexed: 11/13/2022] Open
Abstract
Background The health of asylum seekers is of cardinal importance for the future health of Europe. The aim of the present cross-sectional study was to assess malnutrition prevalence among refugee children living in reception areas in northern Greece. Methods A total of 192 refugee children (1-18 y old), inhabitants of the refugee reception centres in Drama and Kavala, were evaluated for acute and chronic malnutrition according to the WHO growth standards and charts. Results In the total sample, 13.0% of the participants had at least one form of malnutrition, the prevalence of underweight was 7.8% and stunting affected 7.3% of the children. Moreover, a greater proportion of adolescent girls from the Drama centre (38.5%) demonstrated at least one form of malnutrition compared with the children in Kavala (p=0.046). Girls demonstrated an increased prevalence of malnutrition compared with boys, while children <5 y of age appeared more vulnerable. Conclusions The present data underscore the necessity for malnutrition screening among refugees in order to have an early assessment of their nutritional status and address the direct and root causes of this substantial problem.
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Affiliation(s)
- Maria G Grammatikopoulou
- Department of Nutrition & Dietetics, Alexander Technological Educational Institute, Sindos, Thessaloniki, Greece.,Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, Thessaloniki, Greece
| | | | - Dimitrios Poulimeneas
- Department of Nutrition & Dietetics, Harokopio University, Eleftheriou Venizelou 70, Kallithea, Athens, Greece
| | - Maria I Maraki
- Department of Nutrition & Dietetics, Harokopio University, Eleftheriou Venizelou 70, Kallithea, Athens, Greece
| | - Konstantinos Gkiouras
- Laboratory of Clinical Pharmacology, Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, Thessaloniki, Greece
| | - Ilias Tirodimos
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, Thessaloniki, Greece
| | - Theodore Dardavessis
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, Thessaloniki, Greece
| | - Michael Chourdakis
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, Thessaloniki, Greece
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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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18
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Smock L, Martelon M, Metallinos-Katsaras E, Nguyen T, Cochran J, Geltman PL. Recovery From Malnutrition Among Refugee Children Following Participation in the Special Supplemental Nutrition for Women, Infants, and Children (WIC) Program in Massachusetts, 1998-2010. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2019; 26:71-79. [PMID: 30969273 DOI: 10.1097/phh.0000000000000995] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES (1) To examine patterns of catch-up growth and anemia correction in refugee children younger than 5 years after participation in the Special Supplemental Nutrition for Women, Infants, and Children (WIC) program, and (2) to identify factors associated with recovery from growth abnormalities. DESIGN Records on 1731 refugee children younger than 5 years who arrived in Massachusetts between 1998-2010 were matched to WIC program records and then restricted to 779 children who had at least 2 WIC visits. Kaplan-Meier curves and Cox proportional hazards models were used to examine how sex affected time to recovery from malnutrition and anemia. Factors associated with recovery were analyzed in SAS using multivariate logistic regression. SETTING Massachusetts. PARTICIPANTS Refugee children younger than 5 years on arrival, who visited a WIC program at least twice between 1998 and 2010. MAIN OUTCOME MEASURES (1) Proportion of children who recovered from low height-for-age (stunting), low weight-for-age, low weight-for-height (wasting), and anemia; (2) odds ratios for factors associated with recovery; and (3) Kaplan-Meier curves showing recovery over time from low height-for-age, low weight-for-age, and low weight-for-height. RESULTS The number of WIC visits was associated with recovery from stunting, wasting, low weight-for-age, and anemia; results reached statistical significance for stunting (odds ratio [OR] = 8.64; 95% confidence interval [CI], 2.25-33.19), low weight-for-age (OR = 5.28; 95% CI, 1.35-20.73), and anemia (OR = 6.50; 95% CI, 2.69-15.69). Female sex was associated with recovery from stunting, wasting, and low weight-for-age, whereas male sex was associated with recovery from anemia; the associations were statistically significant between female sex and stunting (OR = 9.14; 95% CI, 1.93-43.29), wasting (OR = 14.78; 95% CI, 1.57-138.85), and low weight-for-age (OR = 4.29; 95% CI, 1.09-16.79). CONCLUSIONS Children who remained engaged in WIC may recover better from malnutrition than children with fewer WIC visits, although there are limitations to the available data.These findings suggest that those working with refugee families should prioritize outreach toward initiating and maintaining WIC program enrollment for eligible refugee children.
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Affiliation(s)
- Laura Smock
- Division of Global Populations and Infectious Disease Prevention (Mss Smock, Nguyen and Cochran, and Dr Geltman) and Office of Integrated Surveillance and Informatics Services (Ms Martelon), Bureau of Infectious Disease and Laboratory Sciences, and Division of Nutrition (Dr Metallinos-Katsaras), Massachusetts Department of Public Health, Boston, Massachusetts; Department of Nutrition, School of Nursing and Health Sciences, Simmons College, Boston, Massachusetts (Dr Metallinos-Katsaras); and Franciscan Children's Hospital, Boston, Massachusetts (Dr Geltman)
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19
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Refugee Children's Participation in the Women, Infants, and Children Supplemental Nutrition (WIC) Program in Massachusetts, 1998-2010. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2019; 25:69-77. [DOI: 10.1097/phh.0000000000000789] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Abstract
BACKGROUND Recently the United States has experienced an increase in refugees. Pediatric refugees are at risk for health and nutrition problems. Literature on longitudinal change in nutritional status of resettled pediatric refugees is scant. OBJECTIVE The present study reports the health and nutritional status of pediatric refugees and tracks changes in nutritional status. METHODS Data were extracted retrospectively from the records of a community health center in Buffalo, NY. Two cohorts of refugees (0-18 years) were selected. Cohort A was followed during 5 years and consisted of 225 subjects whose initial visit occurred between January 1, 2007 and December 31, 2009. The 199 subjects in cohort B had an initial visit between January 1, 2013 and December 31, 2013 and were followed for 1 year. Cohort B was chosen because vitamin levels were available only for this group. Descriptive and anthropometric data, infectious disease status, and initial vitamin and hemoglobin levels were recorded. Height-for-age (HFA) z scores and body mass index (BMI) z scores were computed. Longitudinal changes were analyzed. RESULTS The cohorts A and B differed in country of origin and infectious disease burden. On arrival, both cohorts exhibited HFA z scores reflecting short stature. BMI z scores were normal. HFA and BMI z scores increased during 5 years and 1 year for cohorts A and B, respectively. Anemia, vitamin D deficiency, and lead toxicity were identified. CONCLUSIONS Resettled pediatric refugees were short. Some were stunted. Catch-up growth, however, occurred. There were increases in HFA and BMI z scores. Vitamin D deficiency, anemia, and lead toxicity were documented.
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21
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Novotny R, Li F, Leon Guerrero R, Coleman P, Tufa AJ, Bersamin A, Deenik J, Wilkens LR. Dual burden of malnutrition in US Affiliated Pacific jurisdictions in the Children's Healthy Living Program. BMC Public Health 2017; 17:483. [PMID: 28532446 PMCID: PMC5440961 DOI: 10.1186/s12889-017-4377-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 05/07/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Few data are available on dual burden of under and over nutrition of children in the Pacific region. The objective was to examine prevalence of stunting at birth and current stunting and their relationship to obesity in US Affiliated Pacific (USAP) jurisdictions. METHODS Cross sectional survey with cluster sampling by community. 5558, 2-8 years olds were measured in 51 communities in 11 USAP jurisdictions. The main outcome measures were stunting at birth, current stunting and obesity by body mass index. Prevalences of stunting at birth, current stunting and obesity were determined, adjusting for age distribution and community clustering. Differences by among age, sex, race and jurisdiction income levels were evaluated by chi-square analysis. Relationships of stunting at birth and current stunting with obesity were examined using a hierarchical model accounting for the study design. RESULTS Prevalences were stunting at birth 6.8% (Standard Error, SE = 0.9%), current stunting 1.4% (SE = 0.2%) and obesity 14.03.8% (SE = 0.9%). Obesity was highest in upper middle income jurisdictions (UMIJ) at 17.5%. Stunting at birth differed by race (p = 0.0001) with highest prevalence among Native Hawaiian/Pacific Islanders (10.7%). Prevalence of stunting at birth was different by jurisdiction income level with 27.5% in lower middle income jurisdictions (LMIJ), and 22.2% in UMIJ, and 5.5% in higher than high income jurisdictions (HIJ) at 5.5% (p < 0.0001). Prevalence of current stunting was higher in LMIJ than HIJ (p = 0.001), although children with current stunting were less likely to have been stunted at birth. The association between stunting at birth and current stunting was negative (OR = 0.19, 95% CI: 0.05-0.69). CONCLUSIONS Currently stunted children were marginally less likely to be obese than not stunted children in the USAP, where the prevalence of current stunting is low. Stunting (at birth and current) was highest in LMIJ, while UMIJ jurisdictions had the highest dual burden of malnutrition (that is the highest combination of both stunting at birth and obesity). TRIAL REGISTRATION National Institutes for Health clinical trial # NCT01881373 (clinicaltrials.gov).
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Affiliation(s)
- Rachel Novotny
- University of Hawaii, 1955 East West Road, Honolulu, HI 96822 USA
| | - Fenfang Li
- University of Hawaii, 1955 East West Road, Honolulu, HI 96822 USA
| | | | - Patricia Coleman
- Nutrition & Health Programs, Building F, PO Box 501250, Saipan, MP 96950 Northern Mariana Islands
- Northern Marianas College, Saipan, Northern Mariana Islands
| | - Aifili J. Tufa
- University of Hawaii, 1955 East West Road, Honolulu, HI 96822 USA
| | | | - Jonathan Deenik
- University of Hawaii, 1955 East West Road, Honolulu, HI 96822 USA
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Dawson-Hahn E, Pak-Gorstein S, Matheson J, Zhou C, Yun K, Scott K, Payton C, Stein E, Holland A, Grow HM, Mendoza JA. Growth Trajectories of Refugee and Nonrefugee Children in the United States. Pediatrics 2016; 138:peds.2016-0953. [PMID: 27940678 PMCID: PMC5127061 DOI: 10.1542/peds.2016-0953] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/26/2016] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Limited data examine longitudinal nutrition outcomes of refugee children after United States resettlement. Among refugee children, our aims were to (1) assess the changes in weight-based nutritional status between baseline (0-3 months) and 10-24 months after arrival and (2) compare the BMI (BMIz) or weight-for-length z score (WFLz) trajectories to nonrefugee children for up to 36 months after arrival. METHODS We conducted a retrospective study of refugees aged 0-16 years from Washington and Pennsylvania and compared them with an age and sex-matched nonrefugee low-income sample from Washington. Data included anthropometric measurements from the initial screening medical visit and subsequent primary care visits. Multilevel linear mixed-effects regression models evaluated the change in BMIz or WFLz trajectory. RESULTS The study included 512 refugee and 1175 nonrefugee children. The unadjusted prevalence of overweight/obesity increased from 8.9% to 20% (P < .001) for 2- to 16-year-old refugees from baseline to 10-24 months. Refugees (2-16 years old) had a steeper increase in their BMIz per 12 months compared with nonrefugees (coefficient 0.18 vs 0.03; P < .001). Refugees <2 years old had a less steep increase in their WFLz per 12 months compared with nonrefugees (coefficient 0.12 vs 0.36, P = .002). CONCLUSIONS Older refugee children exhibited a higher risk of obesity than nonrefugees, whereas refugees <2 years old exhibited a slower increase in their risk of obesity than nonrefugee children. All age groups experienced increasing obesity prevalence. Targeted and culturally tailored obesity prevention interventions may mitigate health and nutrition inequities among refugee children.
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Affiliation(s)
- Elizabeth Dawson-Hahn
- Departments of Pediatrics and .,Seattle Children's Research Institute, Center for Child Health, Behavior and Development, Seattle, Washington
| | - Suzinne Pak-Gorstein
- Departments of Pediatrics and,Global Health, University of Washington, Seattle, Washington
| | - Jasmine Matheson
- Refugee Health Program, Washington State Department of Health, Shoreline, Washington
| | - Chuan Zhou
- Seattle Children’s Research Institute, Center for Child Health, Behavior and Development, Seattle, Washington
| | - Katherine Yun
- PolicyLab, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kevin Scott
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania; and
| | - Colleen Payton
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania; and
| | - Elizabeth Stein
- Seattle Children’s Research Institute, Center for Child Health, Behavior and Development, Seattle, Washington
| | - Annette Holland
- Refugee Screening Clinic, Seattle-King County Public Health, Seattle, Washington
| | | | - Jason A. Mendoza
- Departments of Pediatrics and,Seattle Children’s Research Institute, Center for Child Health, Behavior and Development, Seattle, Washington
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Shapiro A, Datto GA, Hossain J, Hassink SG, Raab C, Phan TLT. Weight Trajectory in Refugee Children after Resettling in the United States: A Pilot Study. JOURNAL OF PEDIATRICS AND CHILD NUTRITION 2016; 2:100115. [PMID: 30854525 PMCID: PMC6405209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND The objective of this study is to describe the weight trajectory of refugee children after resettlement in the US. METHODS A pilot study was conducted, utilizing longitudinal data obtained from the electronic health record of 129 children between 2 and 18 years of age (54% female, mean age 10 years) from the 3 primary countries of origin presenting to a refugee clinic (Bhutan, N = 71; Burma, N = 36, and Iraq, N = 22).. Mixed effects model analyses were utilized to characterize weight trajectory with calculation of a per year change in BMI-z score, adjusting for baseline BMI-z score, age, and time. RESULTS There was a significant increase in BMI-z (mean 0.15 units/year, p=0.04) among refugee children during their initial period after resettlement. Female children from Bhutan demonstrated the most rapid increase in weight, with a mean BMI-z gain of 1.00 units/year. CONCLUSION Female children from Bhutan demonstrated rapid weight gain after resettlement in the US. Further studies are needed to describe weight trajectory trends and evaluate possible reasons for rapid weight gain in this population.
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Affiliation(s)
- Akhila Shapiro
- Department of General Pediatrics, The Children’s Hospital of Philadelphia, USA
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Shah S, Yun K. Interest in Collaborative, Practice-Based Research Networks in Pediatric Refugee Health Care. J Immigr Minor Health 2016; 20:245-249. [PMID: 27696272 DOI: 10.1007/s10903-016-0500-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Over the last decade, approximately 200,000 refugee children have resettled across the United States. This population is dispersed, resulting in limited data. Collaborative research networks, where clinicians across distinct practice sites work together to answer research questions, can improve the evidence base regarding clinical care. We distributed a web-based survey to pediatric refugee providers around North America to assess priorities, perceived barriers and benefits to collaborative research. We recruited 57 participants. Of respondents, 89 % were interested in collaborative research, prioritizing: (1) access to health care (33 %), (2) mental health (24 %) and (3) nutrition/growth (24 %). Perceived benefits were "improving clinical practice" (98 %) and "raising awareness about the needs of pediatric refugees" (94 %). Perceived barriers were "too many other priorities" (89 %) and "lack of funding for data entry" (78 %). There is widespread interest in collaborative networks around pediatric refugee healthcare. A successful network will address barriers and emphasize priorities.
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Affiliation(s)
- Sural Shah
- Departments of Internal Medicine and Pediatrics, Harvard Medical School, Cambridge Health Alliance, Cambridge, MA, USA.
- Kraft Center for Community Health, Partners HealthCare, Boston, MA, USA.
- Department of Medicine, University of California at Los Angeles, 1245 16th St Ste 125, Santa Monica, CA, 90404, USA.
| | - Katherine Yun
- Policy Lab, Division of General Pediatrics, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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