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Cherri Z, Lau K, Nellums LB, Himmels J, Deal A, McGuire E, Mounier-Jack S, Norredam M, Crawshaw A, Carter J, Seedat F, Clemente NS, Bouaddi O, Friedland JS, Edelstein M, Hargreaves S. The immune status of migrant populations in Europe and implications for vaccine-preventable disease control: a systematic review and meta-analysis. J Travel Med 2024; 31:taae033. [PMID: 38423523 DOI: 10.1093/jtm/taae033] [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: 12/22/2023] [Revised: 02/10/2024] [Accepted: 02/15/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Ensuring vaccination coverage reaches established herd immunity thresholds (HITs) is the cornerstone of any vaccination programme. Diverse migrant populations in European countries have been associated with cases of vaccine-preventable diseases (VPDs) and outbreaks, yet it is not clear to what extent they are an under-immunized group. METHODS We did a systematic review and meta-analysis to synthesize peer-reviewed published primary research reporting data on the immune status of migrants in EU/EEA countries, the UK and Switzerland, calculating their pooled immunity coverage for measles, mumps, rubella and diphtheria using random-effects models. We searched on Web of Science, Embase, Global Health and MEDLINE (1 January 2000 to 10 June 2022), with no language restrictions. The protocol is registered with PROSPERO (CRD42018103666). FINDINGS Of 1103 abstracts screened, 62 met eligibility criteria, of which 39 were included in the meta-analysis. The meta-analysis included 75 089 migrants, predominantly from outside Europe. Pooled immunity coverage among migrant populations was well below the recommended HIT for diphtheria (n = 7, 57.4% [95% confidence interval (CI): 43.1-71.7%] I2 = 99% vs HIT 83-86%), measles (n = 21, 83.7% [95% CI: 79.2-88.2] I2 = 99% vs HIT 93-95%) and mumps (n = 8, 67.1% [95% CI: 50.6-83.6] I2 = 99% vs HIT 88-93%) and midway for rubella (n = 29, 85.6% [95% CI: 83.1-88.1%] I2 = 99% vs HIT 83-94%), with high heterogeneity across studies. INTERPRETATION Migrants in Europe are an under-immunized group for a range of important VPDs, with this study reinforcing the importance of engaging children, adolescents and adults in 'catch-up' vaccination initiatives on arrival for vaccines, doses and boosters they may have missed in their home countries. Co-designing strategies to strengthen catch-up vaccination across the life course in under-immunized groups is an important next step if we are to meet European and global targets for VPD elimination and control and ensure vaccine equity.
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Affiliation(s)
- Zeinab Cherri
- The Migrant Health Research Group, Institute for Infection and Immunity, St Georges, University of London, London, UK
| | - Karen Lau
- The Migrant Health Research Group, Institute for Infection and Immunity, St Georges, University of London, London, UK
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Lancet Migration European Regional Hub
| | - Laura B Nellums
- Faculty of Medicine and Heath Sciences, University of Nottingham, Nottingham, UK
| | - Jan Himmels
- The Migrant Health Research Group, Institute for Infection and Immunity, St Georges, University of London, London, UK
| | - Anna Deal
- The Migrant Health Research Group, Institute for Infection and Immunity, St Georges, University of London, London, UK
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Emma McGuire
- The Migrant Health Research Group, Institute for Infection and Immunity, St Georges, University of London, London, UK
| | - Sandra Mounier-Jack
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Marie Norredam
- Danish Research Centre for Migration, Ethnicity and Health, Section of Health Services Research, Department of Public Health, University of Copenhagen, Denmark
- Department of Infectious Diseases, Hvidovre Hospital, University of Copenhagen, Denmark
| | - Alison Crawshaw
- The Migrant Health Research Group, Institute for Infection and Immunity, St Georges, University of London, London, UK
| | - Jessica Carter
- The Migrant Health Research Group, Institute for Infection and Immunity, St Georges, University of London, London, UK
| | - Farah Seedat
- The Migrant Health Research Group, Institute for Infection and Immunity, St Georges, University of London, London, UK
| | - Nuria Sanchez Clemente
- The Migrant Health Research Group, Institute for Infection and Immunity, St Georges, University of London, London, UK
| | - Oumnia Bouaddi
- Lancet Migration European Regional Hub
- International School of Public Health, Mohammed VI University of Sciences and Health, Casablanca, Morocco
- Mohammed VI Center for Research and Innovation, Rabat, Morocco
| | - Jon S Friedland
- Institute for Infection and Immunity, St Georges, University of London, London, UK
| | | | - Sally Hargreaves
- The Migrant Health Research Group, Institute for Infection and Immunity, St Georges, University of London, London, UK
- Lancet Migration European Regional Hub
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Al-Shatanawi TN, Khader Y, Abdel Razeq N, Khader AM, Alfaqih M, Alkouri O, Alyahya M. Disparities in Obstetric, Neonatal, and Birth Outcomes Among Syrian Women Refugees and Jordanian Women. Int J Public Health 2023; 68:1605645. [PMID: 38024216 PMCID: PMC10654197 DOI: 10.3389/ijph.2023.1605645] [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: 12/01/2022] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives: To compare obstetric and neonatal characteristics and birth outcomes between Syrian refugees and native women in Jordan. Methods: We used the Jordan Stillbirths and Neonatal Deaths Surveillance System to extract sociodemographic and obstetric characteristics of the mothers and birth characteristics of newborns. Multivariate analysis was used to compare the characteristics of 26,139 Jordanian women (27,468 births) and 3,453 Syrian women refugees (3,638 births) who gave birth in five referral hospitals (May 2019 and December 2020). Results: The proportions of low birthweight (14.1% vs. 11.8%, p < 0.001) and small for gestational age (12.0% vs. 10.0%, p < 0.001) newborns were significantly higher for those born to Syrian women compared to those born to Jordanian women. The stillbirth rate (15.1 vs. 9.9 per 1,000 births, p = 0.003), the neonatal death rate (21.2 vs. 13.2 per 1,000 live births, p < 0.001), and perinatal death rate (21.2 vs. 13.2 per 1,000 births, p < 0.001) were significantly higher for the Syrian births. After adjusting for sociodemographic and obstetric characteristics of women, only perinatal death was statistically significantly higher among Syrian babies compared to Jordanian babies (OR = 1.3, 95% CI: 1.1-1.7, p = 0.035). Conclusion: Syrian refugee mothers had a significantly higher risk of adverse obstetric and neonatal outcomes including higher rate of perinatal death compared to Jordanian women.
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Affiliation(s)
- Tariq N. Al-Shatanawi
- Department of Public Health and Community Medicine, Al-Balqa Applied University, Al-Salt, Jordan
| | - Yousef Khader
- Department of Public Health, Jordan University of Science and Technology, Irbid, Jordan
| | - Nadin Abdel Razeq
- Department of Maternal and Child Health Nursing, School of Nursing, The University of Jordan, Amman, Jordan
| | - Ahmed M. Khader
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Mahmoud Alfaqih
- Department of Physiology and Biochemistry, Jordan University of Science and Technology, Irbid, Jordan
| | - Osama Alkouri
- Faculty of Nursing, Yarmouk University, Irbid, Jordan
| | - Mohammad Alyahya
- Department of Health Management and Policy, Jordan University of Science and Technology, Irbid, Jordan
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Ramadan M, Rukh-E-Qamar H, Yang S, Vang ZM. Fifty years of evidence on perinatal experience among refugee and asylum-seeking women in Organization for Economic Co-operation and Development (OECD) countries: A scoping review. PLoS One 2023; 18:e0287617. [PMID: 37883411 PMCID: PMC10602334 DOI: 10.1371/journal.pone.0287617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/08/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Members of the Organization for Economic Co-operation and Development (OECD) play a significant role in hosting and supporting refugees. Refugees and asylum seekers in OECD countries may face unique challenges in accessing perinatal healthcare. These challenges can impact their use of and experience with perinatal health services leading to poor maternal and infant outcomes. This scoping review describes the general trends in perinatal health research among refugees/asylum seekers in OECD countries over the past fifty years (1970 to 2021) as well as summarizes their perinatal experience. METHODS Databases including Embase and Medline were searched using relevant key words for "refugee/ asylum seeker", "perinatal ", and " OECD countries.". Articles were excluded if they only involved economic migrants or internally displaced persons, conducted in non-OECD countries, only assessed health behaviors and practices during pregnancy (e.g., smoking), or were published in a language other than English. The final list of articles included 82 unique studies. RESULTS In the 40 years between 1970 and 2009, very few studies (n = 9) examined perinatal health among refugees/ asylum seekers in OECD countries. However, an increasing trend was observed over the past decade. Early studies (1980 to 2009) focused more on traditional perinatal outcomes; however, from 2010 onwards, studies related to perinatal experience were more likely to emerge in the global health literature. Access to timely prenatal care remains a challenge with failure to address the root causes of the problem in several OECD countries including those with a long history of hosting refugees. The limited availability of interpretation services and the lack of a patient-centered approach to care have also interfered with the perceived quality of care. In addition, perceived isolation and the limited social support experienced by this vulnerable population have negatively impacted their perinatal experiences in several OECD countries. CONCLUSION Refugee/asylum seekers in OECD countries face a number of challenges during the perinatal period. Policy changes and further research are needed to address access barriers and identify specific interventions that can improve their well-being during this critical period.
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Affiliation(s)
- Marwa Ramadan
- Department of Sociology, McGill University, Montreal, Quebec, Canada
| | - Hani Rukh-E-Qamar
- Department of Sociology, McGill University, Montreal, Quebec, Canada
| | - Seungmi Yang
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Zoua M. Vang
- Department of Sociology, McGill University, Montreal, Quebec, Canada
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Poza-Méndez M, Bas-Sarmiento P, Erahmouni I, Fernández-Gutiérrez M. Assessment of health literacy among migrant populations in Southern Spain: A cross-sectional study. Nurs Open 2023; 10:2600-2610. [PMID: 36480226 PMCID: PMC10006600 DOI: 10.1002/nop2.1520] [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: 12/20/2021] [Revised: 10/24/2022] [Accepted: 11/20/2022] [Indexed: 12/14/2022] Open
Abstract
AIM The aim of this study was to measure of health literacy in the migrant population and establish a type of immigrant profile with a higher risk of presenting low levels of health literacy. DESIGN A cross-sectional descriptive study. METHODS Health literacy was measured in a total of 278 immigrants using HLS-EU-Q16. An inferential descriptive and multiple regression analysis was carried out. RESULTS 65.1% having inadequate and problematic health literacy. Significant correlations were found between health literacy and length of stay in Spain (r = .398), age (r = .178p) and perceived social status (r = .151). Participants with shorter length of stay (β = .405 1), without health sciences education (β = .205) and low education level (β = .182) had limited health literacy.
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Affiliation(s)
- Miriam Poza-Méndez
- Department of Nursing and Physiotherapy, University of Cadiz, Cádiz, Spain
| | - Pilar Bas-Sarmiento
- Department of Nursing and Physiotherapy, University of Cadiz, Cádiz, Spain.,Institute of Research and Innovation in Biomedical Sciences of the Province of Cadiz, INIBICA, Cádiz, Spain.,The University Research Institute for Sustainable Social Development (INDESS), Cádiz, Spain
| | | | - Martina Fernández-Gutiérrez
- Department of Nursing and Physiotherapy, University of Cadiz, Cádiz, Spain.,Institute of Research and Innovation in Biomedical Sciences of the Province of Cadiz, INIBICA, Cádiz, Spain.,The University Research Institute for Sustainable Social Development (INDESS), Cádiz, Spain
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The global burden of perinatal common mental health disorders and substance use among migrant women: a systematic review and meta-analysis. Lancet Public Health 2023; 8:e203-e216. [PMID: 36841561 DOI: 10.1016/s2468-2667(22)00342-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 02/25/2023]
Abstract
BACKGROUND There are one billion migrants globally, of whom 82 million are forced migrants. Pregnant migrants face pre-migration stressors such as conflict, transit stressors including poverty, and post-migration stressors including navigating the immigration system; these stressors can make them vulnerable to mental illness. We aimed to assess the global prevalence of and risk factors for perinatal mental health disorders or substance use among women who are migrants. METHODS In this systematic review and meta-analysis, we searched OVID MEDLINE, Embase, PsycINFO, CENTRAL, Global Health, Scopus, and Web of Science for studies published from database inception until July 8, 2022. Cohort, cross-sectional, and interventional studies with prevalence data for any mental illness in pregnancy or the postnatal period (ie, up to a year after delivery) or substance use in pregnancy were included. The primary outcome was the prevalence of perinatal common mental health disorders among women who are migrants, globally. Data for study quality and risk factors were also extracted. A random-effects meta-analysis was used to calculate pooled prevalence estimates, when appropriate. Sensitivity analyses were conducted according to study quality, sample representativeness, and method of outcome assessment. Risk factor data were synthesised narratively. This study is registered with PROSPERO, CRD42021226291. FINDINGS 18 650 studies were retrieved, of which 135 studies comprising data from 621 995 participants met the inclusion criteria. 123 (91%) of 135 studies were conducted in high-income host countries. Five (4%) of 135 studies were interventional, 40 (30%) were cohort, and 90 (66%) were cross-sectional. The most common regions of origin of participants were South America, the Middle East, and north Africa. Only 26 studies presented disaggregated data for forced migrants or economic migrants. The pooled prevalence of perinatal depressive disorders was 24·2% (range 0·5-95·5%; I2 98·8%; τ2 0·01) among all women who are migrants, 32·5% (1·5-81·6; 98·7%; 0·01) among forced migrants, and 13·7% (4·7-35·1; 91·5%; 0·01) among economic migrants (p<0·001). The pooled prevalence of perinatal anxiety disorders was 19·6% (range 1·2-53·1; I2 96·8%; τ2 0·01) among all migrants. The pooled prevalence of perinatal post-traumatic stress disorder (PTSD) among all migrant women was 8·9% (range 3·2-33·3; I2 97·4%; τ2 0·18). The pooled prevalence of perinatal PTSD among forced migrants was 17·1% (range 6·5-44·3; I2 96·6%; τ2 0·32). Key risk factors for perinatal depression were being a recently arrived immigrant (ie, approximately within the past year), having poor social support, and having a poor relationship with one's partner. INTERPRETATION One in four women who are migrants and who are pregnant or post partum experience perinatal depression, one in five perinatal anxiety, and one in 11 perinatal PTSD. The burden of perinatal mental illness appears higher among women who are forced migrants compared with women who are economic migrants. To our knowledge, we have provided the first pooled estimate of perinatal depression and PTSD among women who are forced migrants. Interpreting the prevalence estimate should be observed with caution due to the very wide range found within the included studies. Additionally, 66% of studies were cross-sectional representing low quality evidence. These findings highlight the need for community-based routine perinatal mental health screening for migrant communities, and access to interventions that are culturally sensitive, particularly for forced migrants who might experience a higher burden of disease than economic migrants. FUNDING UK National Institute for Health Research (NIHR); March of Dimes European Preterm Birth Research Centre, Imperial College; Imperial College NIHR Biomedical Research Centre; and Nuffield Department of Population Health, University of Oxford.
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Erausquin JT, Sánchez J, Yu Pon A, Jhangimal M, Millender E, Peña Y, Ng W, Reina A, Nakad C, Quintana J, Herrera Veces R, Vistica G, Pinzón-Espinosa J, Cabezas-Talavero G, Katz J, Pascale JM, Rodríguez-Álvarez F, Gabster A. Sexual and reproductive health and access: Results of a rapid epidemiological assessment among migrant peoples in transit through Darién, Panamá. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 4:953979. [PMID: 36523789 PMCID: PMC9745017 DOI: 10.3389/frph.2022.953979] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 10/31/2022] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND The foot transit of migrant peoples originating from the Caribbean, South America, Asia, and Sub-Saharan Africa through the Darién Forest (DF) in Eastern Panamá towards North America has increased in recent years from approximately 30,000 people/year to >133,000 in 2021. In the DF, there is no food/housing provision nor healthcare access. Very little is known of sexual and reproductive health (SRH) among this population. This study used rapid epidemiological methods to describe the SRH situation among migrant peoples in transit through the DF. METHODS This cross-sectional study randomly selected migrant people in transit (men and women) at a Migrant Reception Station in Darién, Panamá, between January 4-11, 2022. Data collection included a self-applied questionnaire (≥18 years); clinical screening (≥12 years); and HCG, treponemal antibodies, and HIV(I/II) lateral-flow tests with blood samples (≥12 years). Descriptive analyses were used to report findings. RESULTS In all, 69 men and 55 women participated in the self-applied questionnaire, 70 men and 51 women in clinical screening; 78 men and 63 women in HCG, treponemal antibody and HIV testing. Overall, 26.1% (18/69) men and 36.4% (20/55) women reported sexual intercourse within the past month. The last sex partner was casual among 43.0% (21/49) of men and 27.8% (10/36) of women; of those, 42.9% (9/21) of men and 80.0% (8/10) of women reported this sex was condomless. Among women, 20.0% (11/55) tested positive for pregnancy; 5 of these pregnancies were planned. Of those screened, a reproductive tract infection symptom was reported by 5.7% (4/70) of men and 58.8% (30/51) of women. A total of 32.7% (18/55) of men and 18.2% (8/44) of women reported no prior HIV testing. Of 78 men, HIV and treponemal antibodies were found among 1.3% (n = 1) and 2.6% (n = 2), and among 63 women, 3.2% (n = 2) and 3.2% (n = 2), respectively. CONCLUSIONS This rapid epidemiological assessment found high recent sexual activity, low condom use with casual partners, and a need for increased HIV and syphilis testing and treatment. There is a need for increased testing, condom provision, and SRH healthcare access at migrant reception stations that receive migrant peoples in transit through Panamá.
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Affiliation(s)
- Jennifer Toller Erausquin
- Department of Public Health Education, School of Health and Human Sciences, University of North Carolina Greensboro, Greensboro, NC, United States
- Center of Population Sciences for Health Equity, College of Nursing, Florida State University, Tallahassee, FL, United States
| | - Joanne Sánchez
- Complejo Hospitalario Arnufo Arias de Madrid, Panamá City, Panamá
| | - Anyi Yu Pon
- Gorgas Memorial Institute of Health Studies, Panamá City, Panamá
| | - Mónica Jhangimal
- Gorgas Memorial Institute of Health Studies, Panamá City, Panamá
| | - Eugenia Millender
- Center of Population Sciences for Health Equity, College of Nursing, Florida State University, Tallahassee, FL, United States
| | - Yudith Peña
- Community Development Network of the Americas, Panamá City, Panamá
| | - Winroy Ng
- Gorgas Memorial Institute of Health Studies, Panamá City, Panamá
| | - Adelys Reina
- Gorgas Memorial Institute of Health Studies, Panamá City, Panamá
| | - Candy Nakad
- Instituto de Medicina Tropical, Laboratorio de Protozoarios de Biología Molecular, Universidad Central de Venezuela, Caracas, Venezuela
| | - Joselid Quintana
- Community Development Network of the Americas, Panamá City, Panamá
| | | | - Grace Vistica
- Gorgas Memorial Institute of Health Studies, Panamá City, Panamá
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States
| | - Justo Pinzón-Espinosa
- Center of Population Sciences for Health Equity, College of Nursing, Florida State University, Tallahassee, FL, United States
- Sant Pau Mental Health Group, Institut d’Investigació Biomèdica Sant Pau (IBB-San Pau), Hospital de la San Creu i Sant Pau, Universisat Autònoma de Barcelona, Barcelona, Spain
- Department of Medicine, School of Medicine, University of Barcelona, Barcelona, Spain
- Department of Clinical Psychiatry, School of Medicine, University of Panamá, Panamá City, Panamá
- Institut d’Investigació i Innovació Parc Tauli (I3PT), Sabadell, Spain
| | | | - Jennifer Katz
- Community Development Network of the Americas, Panamá City, Panamá
| | - Juan Miguel Pascale
- Gorgas Memorial Institute of Health Studies, Panamá City, Panamá
- Faculty of Medicine, University of Panamá, Panamá City, Panamá
| | | | - Amanda Gabster
- Center of Population Sciences for Health Equity, College of Nursing, Florida State University, Tallahassee, FL, United States
- Gorgas Memorial Institute of Health Studies, Panamá City, Panamá
- National Research System of Panamá (SNI), Panamá, Panamá
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Behboudi-Gandevani S, Bidhendi-Yarandi R, Panahi MH, Mardani A, Prinds C, Vaismoradi M. Perinatal and Neonatal Outcomes in Immigrants From Conflict-Zone Countries: A Systematic Review and Meta-Analysis of Observational Studies. Front Public Health 2022; 10:766943. [PMID: 35359776 PMCID: PMC8962623 DOI: 10.3389/fpubh.2022.766943] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 02/03/2022] [Indexed: 12/16/2022] Open
Abstract
Objectives There are controversies regarding the risk of adverse pregnancy outcomes among immigrants from conflict-zone countries. This systematic review and meta-analysis aimed to investigate the risk of perinatal and neonatal outcomes among immigrants from conflict-zone countries compared to native-origin women in host countries. Methods A systematic search on the databases of PubMed/MEDLINE, Scopus, and Web of Science was carried out to retrieve studies on perinatal and neonatal outcomes among immigrants from Somalia, Iraq, Afghanistan, Yemen, Syria, Nigeria, Sudan, Ethiopia, Eritrea, Kosovo, Ukraine, and Pakistan. Only peer-reviewed articles published in the English language were included in the data analysis and research synthesis. The odds ratio and forest plots were constructed for assessing the outcomes of interests using the DerSimonian and Laird, and the inverse variance methods. The random-effects model and the Harbord test were used to account for heterogeneity between studies and assess publication bias, respectively. Further sensitivity analysis helped with the verification of the reliability and stability of our review results. Results The search process led to the identification of 40 eligible studies involving 215,718 pregnant women, with an immigration background from the conflict zone, and 12,806,469 women of native origin. The adverse neonatal outcomes of the risk of small for gestational age (Pooled OR = 1.8, 95% CI = 1.6, 2.1), a 5-min Apgar score <7 (Pooled OR = 1.4, 95% CI = 1.0, 2.1), stillbirth (Pooled OR = 1.9, 95% CI = 1.2, 3.0), and perinatal mortality (Pooled OR = 2, 95% CI = 1.6, 2.5) were significantly higher in the immigrant women compared to the women of native-origin. The risk of maternal outcomes, including the cesarean section (C-S) and emergency C-S, instrumental delivery, preeclampsia, and gestational diabetes was similar in both groups. Conclusion Although the risk of some adverse maternal outcomes was comparable in the groups, the immigrant women from conflict-zone countries had a higher risk of neonatal mortality and morbidity, including SGA, a 5-min Apgar score <7, stillbirth, and perinatal mortality compared to the native-origin population. Our review results show the need for the optimization of health care and further investigation of long-term adverse pregnancy outcomes among immigrant women.
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Affiliation(s)
- Samira Behboudi-Gandevani
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- *Correspondence: Samira Behboudi-Gandevani
| | - Razieh Bidhendi-Yarandi
- Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohammad Hossein Panahi
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Mardani
- Nursing Care Research Center, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Christina Prinds
- Department of Clinical Research, University South Denmark, Odense, Denmark
- Department of Midwifery Education, University College South Denmark, Esbjerg, Denmark
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Hepatitis E, Schistosomiasis and Echinococcosis-Prevalence in a Cohort of Pregnant Migrants in Germany and Their Influence on Fetal Growth Restriction. Pathogens 2022; 11:pathogens11010058. [PMID: 35056006 PMCID: PMC8780214 DOI: 10.3390/pathogens11010058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/21/2021] [Accepted: 12/30/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Infections, as well as adverse birth outcomes, may be more frequent in migrant women. Schistosomiasis, echinococcosis, and hepatitis E virus (HEV) seropositivity are associated with the adverse pregnancy outcomes of fetal growth restriction and premature delivery. Methods: A cohort study of 82 pregnant women with a history of migration and corresponding delivery of newborns in Germany was conducted. Results: Overall, 9% of sera tested positive for anti-HEV IgG. None of the patients tested positive for anti-HEV IgM, schistosomiasis, or echinococcus serology. Birth weights were below the 10th percentile for gestational age in 8.5% of the neonates. No association between HEV serology and fetal growth restriction (FGR) frequency was found. Conclusions: In comparison to German baseline data, no increased risk for HEV exposure or serological signs of exposure against schistosomiasis or echinococcosis could be observed in pregnant migrants. An influence of the anti-HEV serology status on fetal growth restriction could not be found.
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Riza E, Lazarou A, Karnaki P, Zota D, Nassi M, Kantzanou M, Linos A. Using an IT-Based Algorithm for Health Promotion in Temporary Settlements to Improve Migrant and Refugee Health. Healthcare (Basel) 2021; 9:1284. [PMID: 34682964 PMCID: PMC8535268 DOI: 10.3390/healthcare9101284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/19/2021] [Accepted: 09/24/2021] [Indexed: 11/16/2022] Open
Abstract
The application of the electronic algorithm developed by the Mig-Healthcare project was pilot tested in a sample of migrants and refugees in 2 Reception and Identification Centres (RICs), temporary settlements, in Greece using portable devices. The questions relate to health literacy issues, to mental health, to vaccination history, to lifestyle habits such as smoking, alcohol intake, diet, to the presence of diseases such as heart disease or diabetes, to the use of prevention services and to dental care. A total of 82 adults, 50 women and 32 men, participated. Data analysis showed that 67.1% (55) of the respondents had difficulty in understanding medical information and 57.3% (47) did not know where to seek medical help for a specific health problem. Four main areas of health problems were identified and further action is required: (A) mental health concerns, (B) vaccinations, (C) obesity, and (D) dental hygiene. Direct linkage with the "Roadmap and Toolbox" section of the project's website gave the respondents access to many sources and tools, while through the use of the interactive map, specific referral points of healthcare delivery in their area were identified. IT-based intervention in migrant and refugee populations in Greece are effective in increasing health literacy levels and identifying areas for health promotion interventions in these groups. Through linkage with the project's database, access to healthcare provision points and action to seek appropriate healthcare when necessary are encouraged. Given the attenuated vulnerability profile of people living in temporary settlements, this algorithm can be easily used in primary care settings to improve migrant and refugee health.
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Affiliation(s)
- Elena Riza
- Department of Hygiene, Epidemiology & Medical Statistics, Medical School National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.L.); (M.N.); (M.K.)
| | - Achilleas Lazarou
- Department of Hygiene, Epidemiology & Medical Statistics, Medical School National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.L.); (M.N.); (M.K.)
| | - Pania Karnaki
- Prolepsis Institute for Preventive Medicine and Environmental and Occupational Health, 15121 Marousi, Greece; (P.K.); (D.Z.); (A.L.)
| | - Dina Zota
- Prolepsis Institute for Preventive Medicine and Environmental and Occupational Health, 15121 Marousi, Greece; (P.K.); (D.Z.); (A.L.)
| | - Margarita Nassi
- Department of Hygiene, Epidemiology & Medical Statistics, Medical School National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.L.); (M.N.); (M.K.)
| | - Maria Kantzanou
- Department of Hygiene, Epidemiology & Medical Statistics, Medical School National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.L.); (M.N.); (M.K.)
| | - Athena Linos
- Prolepsis Institute for Preventive Medicine and Environmental and Occupational Health, 15121 Marousi, Greece; (P.K.); (D.Z.); (A.L.)
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10
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Newly Arrived Migrant Women's Experience of Maternity Health Information: A Face-to-Face Questionnaire Study in Norway. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147523. [PMID: 34299974 PMCID: PMC8307311 DOI: 10.3390/ijerph18147523] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 01/23/2023]
Abstract
Limited understanding of health information may contribute to an increased risk of adverse maternal outcomes among migrant women. We explored factors associated with migrant women's understanding of the information provided by maternity staff, and determined which maternal health topics the women had received insufficient coverage of. We included 401 newly migrated women (≤5 years) who gave birth in Oslo, excluding migrants born in high-income countries. Using a modified version of the Migrant Friendly Maternity Care Questionnaire, we face-to-face interviewed the women postnatally. The risk of poor understanding of the information provided by maternity staff was assessed in logistic regression models, presented as adjusted odds ratios (aORs), with 95% confidence intervals (CI). The majority of the 401 women were born in European and Central Asian regions, followed by South Asia and North Africa/the Middle East. One-third (33.4%) reported a poor understanding of the information given to them. Low Norwegian language proficiency, refugee status, no completed education, unemployment, and reported interpreter need were associated with poor understanding. Refugee status (aOR 2.23, 95% CI 1.01-4.91), as well as a reported interpreter need, were independently associated with poor understanding. Women who needed but did not get a professional interpreter were at the highest risk (aOR 2.83, 95% CI 1.59-5.02). Family planning, infant formula feeding, and postpartum mood changes were reported as the most frequent insufficiently covered topics. To achieve optimal understanding, increased awareness of the needs of a growing, linguistically diverse population, and the benefits of interpretation services in health service policies and among healthcare workers, are needed.
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11
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Ankert J, Groten T, Pletz MW, Mishra S, Seliger G, Lobmaier SM, da Costa CP, Seidel V, von Weizsäcker K, Jablonka A, Dopfer C, Schleenvoigt BT. Fetal growth restriction in a cohort of migrants in Germany. BMC Pregnancy Childbirth 2021; 21:145. [PMID: 33596847 PMCID: PMC7890902 DOI: 10.1186/s12884-021-03620-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 02/04/2021] [Indexed: 11/16/2022] Open
Abstract
Background Migrant women may have an increased risk of adverse birth outcomes. This study analyses the occurrence of low birth weight, preterm birth and intrauterine growth restriction / fetal growth restriction (IUGR/FGR) in pregnant migrants. Method Cross-sectional study of 82 mother-child pairs of pregnant migrants attending medical care in Germany. Results The Median age was 27 years, 49% of patients were of oriental-asian ethnicity and median year of migration was 2015. At least one previous pregnancy was reported in 76% of patients, in 40% the delivery mode was caesarian section. Median gestational age was 39.7 weeks. Preterm birth occurred in 6.1% of pregnancies. Median gestational age for preterm birth was 32.3 weeks. Low birth weight (< 2500 g) occurred in 6.1%. Birth weights below the 10th percentile of birth weight for gestational age were observed in 8.5% of the total cohort. Conclusions Compared to German data no increased occurrence of low birth weight, preterm birth or IUGR/FGR was found. We note that the rate of caesarian section births was higher than in the general population for reasons yet to be identified. The authors propose stratification according to migration status for the national documentation of birth outcomes in Germany. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03620-z.
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Affiliation(s)
- Juliane Ankert
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - Tanja Groten
- Department of Obstetrics, University Hospital Jena, Jena, Germany
| | - Mathias W Pletz
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - Sasmita Mishra
- Department of Obstetrics and Gynaecology, Heidekreis Klinikum, Walsrode, Germany
| | - Gregor Seliger
- Polyclinic of Obstetrics and Prenatal Medicine, Halle University Hospital, Halle (Saale), Germany
| | - Silvia M Lobmaier
- Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Clarissa Prazeres da Costa
- Institute for Medical Microbiology, Immunology and Hygiene, Center for Global Health, Technical University of Munich, Munich, Germany
| | - Vera Seidel
- Clinic for Obstetrics, Charité, University Hospital, Berlin, Germany
| | | | - Alexandra Jablonka
- Department of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany.,German Center for Infection Research, Site Hannover-Brunswick, Hannover, Germany
| | - Christian Dopfer
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Benjamin T Schleenvoigt
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany.
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12
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Müller F, Kleinert E, Hillermann N, Simmenroth A, Hummers E, Scharff AZ, Dopfer C, Happle C, Jablonka A. Disease burden in a large cohort of asylum seekers and refugees in Germany. J Glob Health 2021; 11:04002. [PMID: 33643633 PMCID: PMC7897448 DOI: 10.7189/jogh.11.04002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Currently, health care systems worldwide are challenged with providing care to an increasing number of migrants, refugees, and displaced persons. In this article, we report on disease burden and drug prescription patterns in a large refugee cohort in Germany. Methods We conducted a cross-sectional study of anonymized medical records including demographic data, diagnoses, and drug prescriptions in two refugee reception centres between 2015 and 2019. Refugees and migrants received medical assistance exclusively through the on-site clinics. Thus, this study represents all medical visits of the housed residents. Results In total, n = 15531 diagnoses from n = 4858 patients in a cohort of n = 10431 accommodated refugees were recorded. N = 11898 medications were prescribed. Overall, 29.8% of all refugees sought medical attention. Half of the patients were female (49.6%), the average age was 23.8 years (SD [standard deviation] 17.0, min 0, max 81), and 41.5% were minors (<18 years). Most patients had Middle Eastern or Northern African origin (63.9%). The largest proportion of diagnoses belonged to the ICD (International Statistical Classification of Diseases and Related Health Problems) category “R” (miscellaneous, 33.5%), followed by diseases of the respiratory system (category “J”, 16.5%), or the musculoskeletal system (category “M”, 7.1%). Non-steroidal anti-inflammatory drugs were most frequently prescribed. Conclusions This analysis in two large refugee centres in Germany shows that about one third of refugees seek medical attention upon initial arrival. Complaints are manifold, with a high prevalence of respiratory infections.
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Affiliation(s)
- Frank Müller
- Department of General Practice, University Medical Centre Goettingen, Goettingen, Germany
| | - Evelyn Kleinert
- Department of General Practice, University Medical Centre Goettingen, Goettingen, Germany
| | - Nele Hillermann
- Department of General Practice, University Medical Centre Goettingen, Goettingen, Germany
| | - Anne Simmenroth
- Department of General Practice, University Medical Centre Goettingen, Goettingen, Germany.,Department of General Practice, University Medical Centre Wuerzburg, Wuerzburg, Germany
| | - Eva Hummers
- Department of General Practice, University Medical Centre Goettingen, Goettingen, Germany
| | | | - Christian Dopfer
- Department of Paediatric Pneumology, Allergology, and Neonatology, Hannover Medical School, Hannover, Germany
| | - Christine Happle
- Department of Paediatric Pneumology, Allergology, and Neonatology, Hannover Medical School, Hannover, Germany.,German Centre for Lung Research, Biomedical Research in End Stage and Obstructive Lung Disease/ BREATH, Hannover, Germany
| | - Alexandra Jablonka
- German Centre for Infection Research (DZIF), Partner Site Hannover-Brunswick, Braunschweig, Germany.,Department of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
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13
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Schäfer I, Oltrogge JH, Pruskil S, Mews C, Schlichting D, Jahnke M, Wagner HO, Lühmann D, Scherer M. Referrals to secondary care in an outpatient primary care walk-in clinic for refugees in Germany: results from a secondary data analysis based on electronic medical records. BMJ Open 2020; 10:e035625. [PMID: 33093028 PMCID: PMC7583080 DOI: 10.1136/bmjopen-2019-035625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES The aims of our study were to describe the disease spectrum of refugees, to analyse to what extent their healthcare needs could be met in an outpatient primary care walk-in clinic and which cases required additional services from secondary care (ie, outpatient specialists or hospitals). DESIGN Retrospective longitudinal observational study. SETTING The study was based on routine data from a walk-in clinic in the largest central first reception centre in Hamburg, Germany between 4 November 2015 and 21 July 2016. PARTICIPANTS 1467 asylum seekers with 4006 episodes of care (ie, distinctive health problems) resulting in 5545 consultations. The patients were 60% men and had a mean age of 23.2 years. About 90% of the patients were from Central Asia or from the Middle East and North Africa. PRIMARY AND SECONDARY OUTCOME MEASURES The endpoint of our analyses was referral to secondary care. Time to event was defined as days under treatment until the first referral. Predictor variables were the patients' diagnoses grouped in 46 categories. The data set was analysed by Cox regression allowing for multiple failure times per patient. This analysis was adjusted for age, sex and country of origin. RESULTS Referrals to secondary care occurred in 15.5% of the episodes. The diagnosis groups with the highest referral rates were 'eye' (HR 4.9; 95% CI 3.12 to 7.8; p≤0.001), 'teeth/gum symptom/complaint or disease' (3.51; 2.52 to 4.9; p≤0.001) and 'urological system/female or male genital' (2.50; 1.66 to 3.77; p≤0.001). Age, sex and country of origin had no significant effect on time until referral. CONCLUSIONS In most cases, the walk-in clinic physicians could provide first-line medical care for the health problems of patients not integrated in the German healthcare system. Additional resources were needed particularly not only for visual impairment and dental problems but also for psychological disorders, antenatal care and certain infections and injuries.
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Affiliation(s)
- Ingmar Schäfer
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Hendrik Oltrogge
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Pruskil
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Local Health Authority Altona, Free and Hanseatic City of Hamburg, Hamburg, Germany
| | - Claudia Mews
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dana Schlichting
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Jahnke
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Otto Wagner
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dagmar Lühmann
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Scherer
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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14
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Factors Influencing the Frequency of Airway Infections in Underage Refugees: A Retrospective, Cross Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186823. [PMID: 32962038 PMCID: PMC7557950 DOI: 10.3390/ijerph17186823] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/13/2020] [Accepted: 09/15/2020] [Indexed: 11/16/2022]
Abstract
Background: Infections are a leading cause of refugee morbidity. Recent data on the rate of airway infections and factors influencing their spread in refugee reception centers is scarce. Methods: A retrospective, cross-sectional study of de-identified medical records with a focus on respiratory infections in underage refugees was conducted at two large German refugee reception centers. Results: In total, medical data from n = 10,431 refugees over an observational period of n = 819 days was analyzed. Among pediatric patients (n = 4289), 55.3% presented at least once to the on-site medical ward with an acute respiratory infection or signs thereof. In 38.4% of pediatric consultations, acute airway infections or signs thereof were present. Airway infections spiked during colder months and were significantly more prevalent amongst preschool and resettled children. Their frequency displayed a positive correlation with the number of refugees housed at the reception centers. Conclusions: We show that respiratory infections are a leading cause for morbidity in young refugees and that their rate is influenced age, season, status, and residential density. This illustrates the need to protect refugee children from contracting airway infections which may also reduce the spread of coronavirus disease 2019 (COVID-19) during the current pandemic.
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15
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Müller F, Hummers E, Noack EM. Medical Characteristics of Foreign Language Patients in Paramedic Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176306. [PMID: 32872563 PMCID: PMC7503963 DOI: 10.3390/ijerph17176306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/24/2020] [Accepted: 08/28/2020] [Indexed: 12/24/2022]
Abstract
Background: In this study, medical and socio-demographic characteristics of foreign language patients in prehospital emergency medical care are analyzed and compared with non-foreign language patients. Methods: We performed retrospective chart review of rescue operations in four emergency medical service stations in Northern Germany over seven months as part of the DICTUM Rescue study (DRKS00016719). We performed descriptive analyses including test statistics and used partial correlation to adjust for patients’ sex and age. Results: Patients with limited German proficiency were served in 2.2% of all 7494 covered rescue operations. On average, these patients were two decades younger than their German speaking counterparts. There were significantly more patients with limited German proficiency with gynecological and obstetric problems, especially births, as well as psychiatric disorders, especially suicide attempts. Conclusions: Our findings suggest that the existing preventive programs for pregnant women and people at risk of suicide do not sufficiently reach patients with limited German proficiency. Additionally, giving birth and psychiatric breakdowns are exceptional and sensitive situations, both for patients and the paramedic staff, where the ability to communicate safely appears to be of enormous importance to enable safe treatment.
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16
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López-Domene E, Granero-Molina J, Fernández-Sola C, Hernández-Padilla JM, López-Rodríguez MDM, Fernández-Medina IM, Guerra-Martín MD, Del Mar Jiménez-Lasserrrotte M. Emergency Care for Women Irregular Migrants Who Arrive in Spain by Small Boat: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3287. [PMID: 31500213 PMCID: PMC6765787 DOI: 10.3390/ijerph16183287] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 08/31/2019] [Accepted: 09/05/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND this study aimed to describe and understand the experiences and health needs of women irregular migrants during emergency care provision upon arrival in Spain by small boat. METHODS a qualitative study based on Gadamer's phenomenology was used. The data collection included 13 in-depth interviews with women irregular migrants and 10 in-depth interviews with key informants. The study took place in the Spanish Red Cross' facilities between February 2017 and April 2018. RESULTS two main themes emerged from the data analysis: the need for emergency care focused on women irregular migrants with the sub-themes 'Women irregular migrants as objects of sexual exploitation' and 'The mother-child dyad as the axis in human trafficking'; and developing an emergency care gender policy for women irregular migrants, with the subthemes 'Healthcare in a police-controlled setting: detecting weaknesses' and 'Promoting screening and safety protocols focused on women irregular migrants'. CONCLUSIONS women irregular migrants who arrive in Spain by small boat have specific needs and healthcare problems. Due to strict safety conditions during emergency care provision, rape and human trafficking can go unnoticed. IMPLICATIONS interdisciplinary care protocols and new health policies that have a gender perspective are needed to improve the emergency care provided to women irregular migrants.
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Affiliation(s)
| | - José Granero-Molina
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, 04120 Almería, Spain.
- Faculty of Health Sciences, Universidad Autónoma de Chile, Temuco 4780000, Chile.
| | - Cayetano Fernández-Sola
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, 04120 Almería, Spain.
- Faculty of Health Sciences, Universidad Autónoma de Chile, Temuco 4780000, Chile.
| | - José Manuel Hernández-Padilla
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, 04120 Almería, Spain.
- School of Health and Education, Middlesex University, London, NW4 4BT, UK.
| | | | | | | | - María Del Mar Jiménez-Lasserrrotte
- Cruz Roja Española, 04002 Almería, Spain.
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, 04120 Almería, Spain.
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17
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Health of Refugees and Migrants-Where Do We Stand and What Directions Should We Take? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16081319. [PMID: 31013733 PMCID: PMC6518249 DOI: 10.3390/ijerph16081319] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 04/03/2019] [Indexed: 12/12/2022]
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18
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Wetzke M, Happle C, Vakilzadeh A, Ernst D, Sogkas G, Schmidt RE, Behrens GMN, Dopfer C, Jablonka A. Healthcare Utilization in a Large Cohort of Asylum Seekers Entering Western Europe in 2015. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15102163. [PMID: 30275412 PMCID: PMC6210699 DOI: 10.3390/ijerph15102163] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 07/16/2018] [Accepted: 09/26/2018] [Indexed: 11/16/2022]
Abstract
During the current period of immigration to Western Europe, national healthcare systems are confronted with high numbers of asylum seekers with largely unknown health status. To improve care taking strategies, we assessed healthcare utilization in a large, representative cohort of newly arriving migrants consisting of n = 1533 residents of a reception center in Northern Germany in 2015. Most asylum seekers were young, male adults, and the majority came from the Eastern Mediterranean region. Overall, we observed a frequency of 0.03 visits to the onsite primary healthcare ward per asylum seeker and day of camp residence (IQR 0.0–0.07, median duration of residence 38.0 days, IQR 30.0–54.25). Female asylum seekers showed higher healthcare utilization rates than their male counterparts, and healthcare utilization was particularly low in asylum seekers in their second decade of life. Furthermore, a significant correlation between time after camp entrance and healthcare utilization behavior occurred: During the first week of camp residence, 37.1 visits/100 asylum seekers were observed, opposed to only 9.5 visits/100 asylum seekers during the sixth week of camp residence. This first data on healthcare utilization in a large, representative asylum seeker cohort entering Western Europe during the current crisis shows that primary care is most needed in the first period directly after arrival. Our dataset may help to raise awareness for refugee and migrant healthcare needs and to adapt care taking strategies accordingly.
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Affiliation(s)
- Martin Wetzke
- Department of Pediatric Pneumology, Allergology, and Neonatology, Hannover Medical School, 30625 Hannover, Germany.
- German Center for Infection Research (DZIF), Partner Site Hannover-Braunschweig, 38124 Braunschweig, Germany.
| | - Christine Happle
- Department of Pediatric Pneumology, Allergology, and Neonatology, Hannover Medical School, 30625 Hannover, Germany.
- German Center for Lung Research, Biomedical Research in End Stage and Obstructive Lung Disease/BREATH Hannover, 30625 Hannover, Germany.
| | | | - Diana Ernst
- Department of Clinical Immunology and Rheumatology, Hannover Medical School, 30625 Hannover, Germany.
| | - Georgios Sogkas
- Department of Clinical Immunology and Rheumatology, Hannover Medical School, 30625 Hannover, Germany.
| | - Reinhold E Schmidt
- German Center for Infection Research (DZIF), Partner Site Hannover-Braunschweig, 38124 Braunschweig, Germany.
- Department of Clinical Immunology and Rheumatology, Hannover Medical School, 30625 Hannover, Germany.
| | - Georg M N Behrens
- German Center for Infection Research (DZIF), Partner Site Hannover-Braunschweig, 38124 Braunschweig, Germany.
- Department of Clinical Immunology and Rheumatology, Hannover Medical School, 30625 Hannover, Germany.
| | - Christian Dopfer
- Department of Pediatric Pneumology, Allergology, and Neonatology, Hannover Medical School, 30625 Hannover, Germany.
- German Center for Lung Research, Biomedical Research in End Stage and Obstructive Lung Disease/BREATH Hannover, 30625 Hannover, Germany.
| | - Alexandra Jablonka
- German Center for Infection Research (DZIF), Partner Site Hannover-Braunschweig, 38124 Braunschweig, Germany.
- Department of Clinical Immunology and Rheumatology, Hannover Medical School, 30625 Hannover, Germany.
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