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Burr L, Dykxhoorn J, Hollander AC, Dalman C, Kirkbride JB. Refugee status and the incidence of affective psychotic disorders and non-psychotic bipolar disorder: A register-based cohort study of 1.3m people in Sweden. J Affect Disord 2024; 352:43-50. [PMID: 38360360 DOI: 10.1016/j.jad.2024.02.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 02/08/2024] [Accepted: 02/12/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Refugees are at increased risk of non-affective psychotic disorders, but it is unclear whether this extends to affective psychotic disorders [APD] or non-psychotic bipolar disorder [NPB]. METHODS We conducted a nationwide cohort study in Sweden of all refugees, non-refugee migrants and the Swedish-born population, born 1 Jan 1984-31 Dec 2016. We followed participants from age 14 years until first ICD-10 diagnosis of APD or NPB. We fitted Cox proportional hazards models to estimate hazard ratios [HR] and 95 % confidence intervals [95%CI], adjusted for age, sex and family income. Models were additionally stratified by region-of-origin. RESULTS We followed 1.3 million people for 15.1 million person-years, including 2428 new APD cases (rate: 16.0 per 100,000 person-years; 95%CI: 15.4-16.7) and 9425 NPB cases (rate: 63.8; 95%CI: 62.6-65.1). Rates of APD were higher in refugee (HRadjusted: 2.07; 95%CI: 1.55-2.78) and non-refugee migrants (HRadjusted: 1.40; 95%CI: 1.16-1.68), but lower for NPBs for refugee (HRadjusted: 0.24; 95%CI: 0.16-0.38) and non-refugee migrants (HRadjusted: 0.34; 95%CI: 0.28-0.41), compared with the Swedish-born. APD rates were elevated for both migrant groups from Asia and sub-Saharan Africa, but not other regions. Migrant groups from all regions-of-origin experienced lower rates of NPB. LIMITATIONS Income may have been on the causal pathway making adjustment inappropriate. CONCLUSIONS Refugees experience elevated rates of APD compared with Swedish-born and non-refugee migrants, but lower rates of NPB. This specificity of excess risk warrants clinical and public health investment in appropriate psychosis care for these vulnerable populations.
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Affiliation(s)
| | | | | | - Christina Dalman
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Wood JM, Leech RM, Margerison C. The prevalence of food insecurity amongst refugees and asylum seekers during, and prior to, their early resettlement period in Australia: A cross-sectional analysis of the 'Building a New Life in Australia' data. Appetite 2024; 196:107273. [PMID: 38373535 DOI: 10.1016/j.appet.2024.107273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/28/2024] [Accepted: 02/13/2024] [Indexed: 02/21/2024]
Abstract
With over 100 million humanitarian migrants globally, there is increasing pressure on high-income countries to offer resettlement opportunities. Humanitarian migrants face many challenges during pre-settlement and resettlement. One challenge is food insecurity (FI). The Building a New Life in Australia (BNLA) longitudinal cohort study gathered data from migrating units, that is, a group of humanitarian migrants included on the same visa application (n = 1599). Data were gathered in five annual waves (2013-2018). Data included food security status in four pre-settlement situations and during resettlement. The results of this secondary analysis of BNLA Wave One indicate that FI was highest in refugee camps (71%), followed by bridging visas (30%), community detention (17%), immigration detention (11%), and during early resettlement (9%). During early resettlement, respondents who were male, those from Afghanistan or Iran, and those living in a single person household reported the highest prevalence of FI. An association was found between having spent time on a bridging visa and FI during early resettlement (p < 0.01). This study's results are an important step in understanding the scale of FI and which sub-groups are most vulnerable, so the resources and policies of high-income countries can better meet food security needs during resettlement.
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Affiliation(s)
- Julie Maree Wood
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Australia; Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne Burwood Campus, 221 Burwood Highway, Burwood, Victoria, 3125, Australia.
| | - Rebecca M Leech
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Australia
| | - Claire Margerison
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Australia
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Galli C, Mazzola G, Arosio M, Pellegrinelli L, Boldrini A, Guarneri D, Lombarda E, Farina C, Cereda D, Pariani E. Real-time investigation of an influenza A(H3N2) virus outbreak in a refugee community, November 2022. Public Health 2024; 230:157-162. [PMID: 38554473 DOI: 10.1016/j.puhe.2024.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 02/02/2024] [Accepted: 02/27/2024] [Indexed: 04/01/2024]
Abstract
OBJECTIVES To report epidemiological and virological results of an outbreak investigation of influenza-like illness (ILI) among refugees in Northern Italy. STUDY DESIGN Outbreak investigation of ILI cases observed among nearly 100 refugees in Northern Italy unvaccinated for influenza. METHODS An epidemiological investigation matched with a differential diagnosis was carried out for each sample collected from ILI cases to identify 10 viral pathogens (SARS-CoV-2, influenza virus type A and B, respiratory syncytial virus, metapneumovirus, parainfluenza viruses, rhinovirus, enterovirus, parechovirus, and adenovirus) by using specific real-time PCR assays according to the Centers for Disease Control and Prevention (CDC) protocols. In cases where the influenza virus type was identified, complete hemagglutinin (HA) gene sequencing and the related phylogenetic analysis were conducted. RESULTS The outbreak was caused by influenza A(H3N2): the attack rate was 83.3% in children aged 9-14 years, 84.6% in those aged 15-24 years, and 28.6% in adults ≥25 years. Phylogenetic analyses uncovered that A(H3N2) strains were closely related since they segregated in the same cluster, showing both a high mean nucleotide identity (100%), all belonging to the genetic sub-group 3C.2a1b.2a.2, as those mainly circulating into the general population in the same period. CONCLUSIONS The fact that influenza outbreak strains as well as the community strains were genetically related to the seasonal vaccine strain suggests that if an influenza prevention by vaccination strategy had been implemented, a lower attack rate of A(H3N2) and ILI cases might have been achieved.
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Affiliation(s)
- C Galli
- Department of Biomedical Sciences for Health, University of Milan, Italy
| | - G Mazzola
- Department of Hygiene and Health Prevention (HPA of Bergamo/ATS of Bergamo), Italy
| | - M Arosio
- Microbiology and Virology Laboratory, ASST Papa Giovanni XXIII, Bergamo, Italy; Biobank, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - L Pellegrinelli
- Department of Biomedical Sciences for Health, University of Milan, Italy
| | - A Boldrini
- Department of Hygiene and Health Prevention (HPA of Bergamo/ATS of Bergamo), Italy
| | - D Guarneri
- Microbiology and Virology Laboratory, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - E Lombarda
- Department of Hygiene and Health Prevention (HPA of Bergamo/ATS of Bergamo), Italy
| | - C Farina
- Microbiology and Virology Laboratory, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - D Cereda
- Directorate General for Health, Lombardy Region, Milan, Italy
| | - E Pariani
- Department of Biomedical Sciences for Health, University of Milan, Italy.
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Nolan MB, Chrenka E, Walker P, Steiner A, Rodrigues KK, Michel JJ, Yun K, Payton C, Young J, Mamo B, Frumholtz M, DeSilva M. COVID-19 vaccine uptake among non-US-born populations in the United States, 2020-2022. Vaccine 2024; 42:3115-3121. [PMID: 38604910 DOI: 10.1016/j.vaccine.2024.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 04/06/2024] [Accepted: 04/08/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND In the United States (US), COVID-19 vaccination rates among non-US-born individuals (i.e., refugees, immigrants, and migrants [RIM]) are variable. Understanding baseline COVID-19 vaccine coverage among these populations and determining if disparities exist is essential for quality improvement initiatives and public health interventions. METHODS Baseline COVID-19 vaccination rates for both primary series and booster doses were calculated at four health systems located in Minnesota, Colorado, and Pennsylvania participating in the Minnesota Department of Health's Center of Excellence in Newcomer Health. Patients aged ≥5 years as of 1/1/22, seen for ≥1 primary care visit during 7/1/2019-6/30/22 were included. Descriptive statistics were calculated for three measures of COVID-19 vaccine coverage during 12/14/2020-6/30/2022: 1) initiation of primary series; 2) completion of primary series; 3) completion of first booster. We calculated vaccine coverage rates for the entire population and stratified by subgroup including country of origin, refugee status, and primary language preference. RESULTS We included 1,624,573 patients eligible for COVID-19 primary series vaccine and 907,749 eligible for COVID-19 booster vaccination. The percent of eligible patients who completed a COVID-19 primary series (63.4 %) and booster dose (66.2 %) were similar. Completion of the primary series was higher for non-US-born persons (72.7 %) compared with US born persons (65.4 %), similar among refugees (63.5 %) and non-refugees (63.4 %), and lower in patients with language preference other than English (62.7 %) compared with English preferring patients (63.6 %). Booster completion was lower for non-US-born persons (61.8 %), refugees (46.7 %), and patients with language preference other than English (55.3 %) compared with US-born (70 %), non-refugees (66.3 %), and English preferring patients (67.3 %) respectively. CONCLUSIONS This evaluation identified disparities in COVID-19 vaccination rates among non-US-born persons and persons with a language preference other than English living in the US. Targeted outreach efforts may be beneficial in reaching these populations.
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Affiliation(s)
- Margaret B Nolan
- HealthPartners Institute, 8170 33rd Ave S, Bloomington, MN 55425, USA.
| | - Ella Chrenka
- HealthPartners Institute, 8170 33rd Ave S, Bloomington, MN 55425, USA
| | - Patricia Walker
- HealthPartners Institute, 8170 33rd Ave S, Bloomington, MN 55425, USA
| | - Abigail Steiner
- Denver Health & Hospital Authority, 777 Bannock Street, Denver, CO 80204, USA
| | | | - Jeremy J Michel
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104, USA
| | - Katherine Yun
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104, USA
| | - Colleen Payton
- Thomas Jefferson University, 4201 Henry Ave, Philadelphia, PA 19144, USA; Moravian University, Bethlehem, PA, USA
| | - Janine Young
- UC San Diego School of Medicine, San Diego, CA, USA
| | - Blain Mamo
- Minnesota Department of Health, St. Paul, MN, USA
| | | | - Malini DeSilva
- HealthPartners Institute, 8170 33rd Ave S, Bloomington, MN 55425, USA
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Ziersch A, Walsh M, Due C. Housing and health for people from refugee and asylum-seeking backgrounds: findings from an Australian qualitative longitudinal study. BMC Public Health 2024; 24:1138. [PMID: 38654272 DOI: 10.1186/s12889-024-18616-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 04/16/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND For people from asylum-seeking and refugee backgrounds, housing and the re-establishment of home are key social determinants of health. Research highlights the inequities faced by asylum seekers and refugees in the housing markets of high-income resettlement countries, resulting in their overrepresentation in precarious housing. There is also emerging evidence of the relationship between housing and health for this population relating to lack of affordability, insecurity of tenure, and poor suitability (physical and social). The mechanisms by which housing impacts health for this group within these housing contexts, is however, understudied - especially overtime. This qualitative longitudinal study aimed to address this gap. METHODS Semi-structured interviews were conducted with 25 people from asylum-seeking and refugee backgrounds in South Australia, recruited through a community survey. Thematic analysis of interview data across three time points over three years identified four material and psychosocial mechanisms through which housing contributed to health outcomes via psychological and physical stressors - physical environment; stability; safety; and social connections, support and services. The study also identified additional health promoting resources, particularly elements of ontological security. The dynamics of these indirect and direct mechanisms were further illuminated by considering the impact of international, national and local contexts and a range of intersecting social factors including gender, country/culture of origin, family circumstances, immigration status, language skills, income, and health status. CONCLUSIONS Rebuilding a sense of home and ontological security is a key resettlement priority and crucial for wellbeing. More comprehensive strategies to facilitate this for refugees and asylum seekers are required.
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Affiliation(s)
- Anna Ziersch
- Flinders University, College of Medicine and Public Health, Flinders Health and Medical Research Institute, Adelaide, Australia.
| | - Moira Walsh
- Flinders University, College of Medicine and Public Health, Flinders Health and Medical Research Institute, Adelaide, Australia
| | - Clemence Due
- Flinders University, College of Medicine and Public Health, Flinders Health and Medical Research Institute, Adelaide, Australia
- School of Psychology; University of Adelaide, Adelaide, Australia
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Brooks SP, Sidhu K, Cooper E, Michelle Driedger S, Gisenya L, Kaur G, Kniseley M, Jardine CG. The influence of health service interactions and local policies on vaccination decision-making in immigrant women: A multi-site Canadian qualitative study. Vaccine 2024; 42:2793-2800. [PMID: 38514354 DOI: 10.1016/j.vaccine.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 02/15/2024] [Accepted: 03/05/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVES Research on immigrant and refugee vaccination uptake in Canada shows that immunization decisions vary by vaccine type, location, age and migration status. Despite their diversity, these studies often treat immigrant and refugee populations as a single group relative to other Canadians. In this comparative study, we explored how previous risk communication and immunization experiences influence immunization decisions by immigrant and refugee women from three communities across Canada. METHODS Participants included women from the Punjabi immigrant community located in Surrey and Abbotsford, British Columbia (n = 36), the Nigerian immigrant community located in Winnipeg, Manitoba (n = 43), and the Congolese refugee community in Edmonton, Alberta (n = 18). Using focus groups guided by focused ethnography methodology, we sought to understand immunization experiences in Canada and before arrival, and what information sources influenced the immunization decision-making process by the women in the three communities. RESULTS Participants had differing past experiences in Canada and before their arrival that influenced how they used information in their vaccination decisions. Clear vaccination communications and dialogue with Canadian health care providers increased trust in Canadian health care and the likelihood of vaccine uptake. By contrast, weak vaccine recommendations and antivaccination information in the community prompted participants to decline future vaccines. CONCLUSION Given our participants' different communication preferences and needs, we argue that a one-size-fits-all communication approach is inappropriate for immigrant and refugee populations. Instead, multi-pronged communication strategies are required to reach participants and respond to previous experiences and information that may lead to vaccination hesitancy.
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Affiliation(s)
- Stephanie P Brooks
- School of Public Health, University of Alberta, 3-300 Edmonton Clinical Health Academy, 11405 - 87 Ave NW, Edmonton, Alberta T6G 1C9, Canada.
| | - Kamaljit Sidhu
- Faculty of Health Sciences, University of the Fraser Valley, 45190 Caen Ave, Chilliwack, B.C. V2R 0N3, Canada.
| | - Elizabeth Cooper
- Faculty of Kinesiology and Health Sciences, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada.
| | - S Michelle Driedger
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, S113-750 Bannatyne Ave, Winnipeg, MB R3E 0W3, Canada.
| | - Linda Gisenya
- School of Public Health, University of Alberta, 3-300 Edmonton Clinical Health Academy, 11405 - 87 Ave NW, Edmonton, Alberta T6G 1C9, Canada.
| | - Gagandeep Kaur
- Faculty of Health Sciences, University of the Fraser Valley, 45190 Caen Ave, Chilliwack, B.C. V2R 0N3, Canada.
| | - Marinel Kniseley
- Faculty of Health Sciences, University of the Fraser Valley, 45190 Caen Ave, Chilliwack, B.C. V2R 0N3, Canada.
| | - Cynthia G Jardine
- Faculty of Health Sciences, University of the Fraser Valley, 45190 Caen Ave, Chilliwack, B.C. V2R 0N3, Canada.
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Logie CH, MacKenzie F, Malama K, Lorimer N, Lad A, Zhao M, Narasimhan M, Fahme S, Turan B, Kagunda J, Konda K, Hasham A, Perez-Brumer A. Sexual and reproductive health among forcibly displaced persons in urban environments in low and middle-income countries: scoping review findings. Reprod Health 2024; 21:51. [PMID: 38609975 PMCID: PMC11010352 DOI: 10.1186/s12978-024-01780-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Most forcibly displaced persons are hosted in low- and middle-income countries (LMIC). There is a growing urbanization of forcibly displaced persons, whereby most refugees and nearly half of internally displaced persons live in urban areas. This scoping review assesses the sexual and reproductive health (SRH) needs, outcomes, and priorities among forcibly displaced persons living in urban LMIC. METHODS Following The Joanna Briggs Institute scoping review methodology we searched eight databases for literature published between 1998 and 2023 on SRH needs among urban refugees in LMIC. SHR was operationalized as any dimension of sexual health (comprehensive sexuality education [CSE]; sexual and gender based violence [GBV]; HIV and STI prevention and control; sexual function and psychosexual counseling) and/or reproductive health (antental, intrapartum, and postnatal care; contraception; fertility care; safe abortion care). Searches included peer-reviewed and grey literature studies across quantitative, qualitative, or mixed-methods designs. FINDINGS The review included 92 studies spanning 100 countries: 55 peer-reviewed publications and 37 grey literature reports. Most peer-reviewed articles (n = 38) discussed sexual health domains including: GBV (n = 23); HIV/STI (n = 19); and CSE (n = 12). Over one-third (n = 20) discussed reproductive health, including: antenatal, intrapartum and postnatal care (n = 13); contraception (n = 13); fertility (n = 1); and safe abortion (n = 1). Eight included both reproductive and sexual health. Most grey literature (n = 29) examined GBV vulnerabilities. Themes across studies revealed social-ecological barriers to realizing optimal SRH and accessing SRH services, including factors spanning structural (e.g., livelihood loss), health institution (e.g., lack of health insurance), community (e.g., reduced social support), interpersonal (e.g., gender inequitable relationships), and intrapersonal (e.g., low literacy) levels. CONCLUSIONS This review identified displacement processes, resource insecurities, and multiple forms of stigma as factors contributing to poor SRH outcomes, as well as producing SRH access barriers for forcibly displaced individuals in urban LMIC. Findings have implications for mobilizing innovative approaches such as self-care strategies for SRH (e.g., HIV self-testing) to address these gaps. Regions such as Africa, Latin America, and the Caribbean are underrepresented in research in this review. Our findings can guide SRH providers, policymakers, and researchers to develop programming to address the diverse SRH needs of urban forcibly displaced persons in LMIC. Most forcibly displaced individuals live in low- and middle-income countries (LMICs), with a significant number residing in urban areas. This scoping review examines the sexual and reproductive health (SRH) outcomes of forcibly displaced individuals in urban LMICs. We searched eight databases for relevant literature published between 1998 and 2023. Inclusion criteria encompassed peer-reviewed articles and grey literature. SRH was defined to include various dimensions of sexual health (comprehensive sexuality education; sexual and gender-based violence; HIV/ STI prevention; sexual function, and psychosexual counseling) and reproductive health (antenatal, intrapartum, and postnatal care; contraception; fertility care; and safe abortion care). We included 90 documents (53 peer-reviewed articles, 37 grey literature reports) spanning 100 countries. Most peer-reviewed articles addressed sexual health and approximately one-third centered reproductive health. The grey literature primarily explored sexual and gender-based violence vulnerabilities. Identified SRH barriers encompassed challenges across structural (livelihood loss), health institution (lack of insurance), community (reduced social support), interpersonal (gender inequities), and individual (low literacy) levels. Findings underscore gaps in addressing SRH needs among urban refugees in LMICs specifically regarding sexual function, fertility care, and safe abortion, as well as regional knowledge gaps regarding urban refugees in Africa, Latin America, and the Caribbean. Self-care strategies for SRH (e.g., HIV self-testing, long-acting self-injectable contraception, abortion self-management) hold significant promise to address SRH barriers experienced by urban refugees and warrant further exploration with this population. Urgent research efforts are necessary to bridge these knowledge gaps and develop tailored interventions aimed at supporting urban refugees in LMICs.
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Affiliation(s)
- Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, M5S 1V4, Canada.
- Centre for Gender and Sexual Health Equity, Vancouver, Canada.
- Women's College Research Institute, Women's College Hospital, Toronto, Canada.
- United Nations University Institute for Water, Environment, and Health, Hamilton, Canada.
| | - Frannie MacKenzie
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, M5S 1V4, Canada
| | - Kalonde Malama
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, M5S 1V4, Canada
| | - Nicole Lorimer
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, M5S 1V4, Canada
| | - Anoushka Lad
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, M5S 1V4, Canada
| | - Michelle Zhao
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, M5S 1V4, Canada
| | - Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research, including the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Sasha Fahme
- Center for Global Health, Weill Cornell Medicine, New York, NY, USA
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Bülent Turan
- Department of Psychology, Koc University, Istanbul, Turkey
| | - Julia Kagunda
- Elim Trust, Nairobi, Kenya
- Daystar University, Nairobi, Kenya
| | - Kelika Konda
- Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, University of Southern California, Los Angeles, USA
| | - Aryssa Hasham
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, M5S 1V4, Canada
| | - Amaya Perez-Brumer
- Universidad Peruana Cayetano Heredia, Lima, Peru
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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McKeon G, Curtis J, Rostami R, Sroba M, Farello A, Morell R, Steel Z, Harris M, Silove D, Parmenter B, Matthews E, Jamaluddin J, Rosenbaum S. Co-designing a Physical Activity Service for Refugees and Asylum Seekers Using an Experience-Based Co-design Framework. J Immigr Minor Health 2024:10.1007/s10903-024-01587-5. [PMID: 38605213 DOI: 10.1007/s10903-024-01587-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2024] [Indexed: 04/13/2024]
Abstract
People from refugee and asylum seeker backgrounds resettling in Australia often experience intersecting risks for poor mental and physical health. Physical activity can promote better health outcomes, however there are limited programs tailored for this population. Therefore, understanding how to support refugees and asylum seekers to engage in physical activity is crucial. This paper aims to describe how the experience-based co-design (EBCD) process was used to identify priorities for a new physical activity service for refugees and asylum seekers. Using an EBCD framework we conducted qualitative interviews and co-design workshops with service users (refugees and asylum seekers living in the community) and service providers at a community Centre in Sydney, Australia. Sixteen participants, including eight service users and eight service providers engaged in the EBCD process over 12-months. The interviews revealed common themes or 'touchpoints' including barriers and enablers to physical activity participation such as access, safety and competing stressors. Subsequent co-design focus groups resulted in the establishment of five fundamental priorities and actionable strategies; ensuring cultural and psychological safety, promoting accessibility, facilitating support to access basic needs, enhancing physical activity literacy and fostering social connection. Using EBCD methodology, this study used the insights and lived experiences of both service users and providers to co-design a physical activity service for refugees and asylum seekers which is safe, supportive, social and accessible. The results of the implementation and evaluation of the program are ongoing.
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Affiliation(s)
- Grace McKeon
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia.
- School of Population Health, University of New South Wales, Sydney, Australia.
| | - Jackie Curtis
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
- Mindgardens Neuroscience Network, Sydney, NSW, Australia
| | - Reza Rostami
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Monika Sroba
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | | | - Rachel Morell
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
- Mindgardens Neuroscience Network, Sydney, NSW, Australia
| | - Zachary Steel
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
- St. John of God Health Care North Richmond Hospital, North Richmond, NSW, Australia
| | - Mark Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Derrick Silove
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Belinda Parmenter
- School of Health Sciences, University of New South Wales, Sydney, Australia
| | - Evan Matthews
- Centre for Health Behaviour Research South East Technological University, Waterford, Ireland
| | | | - Simon Rosenbaum
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
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Baauw A, Brouwers CFS, Afshar SF, van Goudoever JB, Chinapaw MJM, Hoogsteder MHH. Perspectives of refugee parents and unaccompanied minors on initial health assessment and access to care. Eur J Pediatr 2024:10.1007/s00431-024-05523-5. [PMID: 38589580 DOI: 10.1007/s00431-024-05523-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/11/2024] [Accepted: 03/12/2024] [Indexed: 04/10/2024]
Abstract
To explore the needs, expectations, and experiences of asylum-seeking parents and unaccompanied minors under the age of 18 years on the initial health assessment for children and adolescents and access to care upon entry in the Netherlands, We conducted five semi-structured focus group discussions with asylum-seeking parents and unaccompanied minors, from Syria, Eritrea, Afghanistan, and other Middle-East and African countries, supported by professional interpreters. To triangulate findings, semi-structured interviews with health care professionals involved in care for refugee children were conducted. Transcripts of focus group discussions were inductively and deductively coded and content analyzed; transcripts of interviews were deductively coded and content analyzed. In total, 31 asylum-seeking participants: 23 parents of 101 children (between 0 and 18 years old), 8 unaccompanied minors (between 15 and 17 years), and 6 healthcare professionals participated. Parents and minors expressed that upon entry, their needs were met for vaccinations, but not for screening or care for physical and mental health problems. Parents, minors, and health professionals emphasized the necessity of appropriate information and education about health, diseases, and the health system. Cultural change was mentioned as stressful for the parent-child interaction and parental well-being. Conclusion: The perspectives of refugee parents and unaccompanied minors revealed opportunities to improve the experience of and access to health care of refugees entering the Netherlands, especially risk-specific screening and more adequate education about health, diseases, and the Dutch health care system. What is Known: • Refugees have specific health needs due to pre-flight, flight, and resettlement conditions. Health assessment upon entry was non-obligatory in the Netherlands, except for the tuberculosis screening. Health needs were not always met, and refugees experienced barriers in access to care. What is New: • The initial health assessment met the needs concerning vaccinations but mismatched the needs regarding physical and mental health assessment. Screening for specific risk-related diseases and mental health could enable refugee parents and minors to engage better with the health system.
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Affiliation(s)
- Albertine Baauw
- Amsterdam UMC, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands.
- Amsterdam UMC, Amsterdam Reproduction and Development Institute, University of Amsterdam, Emma Children's Hospital, Meibergdreef 9, Amsterdam, The Netherlands.
- Training Institute Global Health and Tropical Medicine, Dutch Society of Global Health and Tropical Medicine, Utrecht, The Netherlands.
| | - Chanine F S Brouwers
- Department Health and Society, Wageningen University and Research, Wageningen, The Netherlands
| | - Sogol Fathi Afshar
- Amsterdam UMC, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
| | - Johannes B van Goudoever
- Amsterdam UMC, Amsterdam Reproduction and Development Institute, University of Amsterdam, Emma Children's Hospital, Meibergdreef 9, Amsterdam, The Netherlands
| | - Mai J M Chinapaw
- Training Institute Global Health and Tropical Medicine, Dutch Society of Global Health and Tropical Medicine, Utrecht, The Netherlands
| | - Mariëtte H H Hoogsteder
- Amsterdam UMC, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
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10
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Bala A, Pierce J, Pierce K, Song S. Advocacy and Policy: A Focus on Migrant Youth. Child Adolesc Psychiatr Clin N Am 2024; 33:163-180. [PMID: 38395503 DOI: 10.1016/j.chc.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
Mental health challenges experienced by migrant children are shaped by multiple factors within the health care system and society at large. It is essential for health care providers to recognize the profound impact of these influences on child well-being. By actively engaging in advocacy and policy initiatives, health care providers can address structural barriers, social inequalities, and stigma that perpetuate mental health disparities. Through their advocacy efforts, providers can contribute to creating an inclusive society that upholds children's rights and ensures equitable access to mental health support and services.
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Affiliation(s)
- Abishek Bala
- Central Michigan University, 1000 Houghton Avenue, Saginaw, MI 48602, USA.
| | - Jessica Pierce
- University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5277, USA
| | - Karen Pierce
- Northwestern University Department of Psychiatry, 2634 N Dayton ST, Chicago, Il 60614, USA
| | - Suzan Song
- Boston Children's Hospital, 1 Brookline Place, Suite 552, Boston, MA 02445, USA
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11
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Fortuna LR, Porche MV. Upholding the Human Rights and Well-Being of Refugee Children Through Effective Clinical Care. Child Adolesc Psychiatr Clin N Am 2024; 33:111-124. [PMID: 38395499 PMCID: PMC10894321 DOI: 10.1016/j.chc.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
Refugee children are often exposed to adversities and traumatic experiences that can harm the mental health and well-being of refugee children. These include human trafficking and exploitation and dangers in detention centers and refugee camps. All these adverse events can be traumatic and contribute to poor mental health, including posttraumatic stress, anxiety, depression, and substance use disorders. Therefore, the assessment of refugee children and adolescents should include screening and identification for these experiences, provision of evidence-based trauma treatment, and social supports to promote their well-being and thriving.
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Affiliation(s)
- Lisa R Fortuna
- University of California Riverside, School of Medicine Education Building 2, 5th Floor, Psychiatry and Neurosciences, 900 University Avenue, Riverside, CA 92521, USA.
| | - Michelle V Porche
- University of California, Psychiatry and Behavioral Sciences, 1001 Potrero Avenue, Building 5, 7M10, San Francisco, CA 94110, USA
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12
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Hochstetler E, Taweh O, Mistry AJ, Metz P. Worcester Refugee Assistance Project: An Example of Strengths-Based, Community-Based, Culturally Sensitive Care. Child Adolesc Psychiatr Clin N Am 2024; 33:263-276. [PMID: 38395510 DOI: 10.1016/j.chc.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
Refugee populations are diverse and can present with a variety of unique and complex circumstances. The purpose of this article is to examine an organization that provides care to refugee youth, the ways in which this is accomplished, and a few of the challenges that have been faced. Specifically, the work of this organization will be examined using a Systems of Care philosophy to demonstrate how using these concepts can assist in providing sensitive, high-quality care.
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Affiliation(s)
- Emily Hochstetler
- University of Massachusetts, T.H. Chan School of Medicine, 55 Lake Avenue North, Worcester, MA 01655, USA.
| | - Omar Taweh
- University of Massachusetts, T.H. Chan School of Medicine, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - Anushay J Mistry
- Children's Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA 90027, USA
| | - Peter Metz
- University of Massachusetts, T.H. Chan School of Medicine, 55 Lake Avenue North, Worcester, MA 01655, USA
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13
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Sammouri J, Khachfe HH, Fares MY, Salhab HA, Nassar AH, Chamsy D. Deliveries in Lebanon, the Country with the Highest Refugee Density in the World: A Descriptive Review. Matern Child Health J 2024; 28:601-608. [PMID: 37980311 DOI: 10.1007/s10995-023-03826-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2023] [Indexed: 11/20/2023]
Abstract
PURPOSE The aim of this study is to analyze obstetrical and reproductive health parameters in Lebanon from 2015 until 2018 in the setting of the Syrian refugee influx in order to evaluate potential risks and provide a management plan to improve outcomes. DESCRIPTION Data from the Lebanese Ministry of Public Health (LMPH) on all obstetrical deliveries that occurred in Lebanon between 2015 and 2018 was screened and analyzed. Number and mode of delivery as well as maternal and neonatal outcomes were included. Joinpoint regression analysis was used for trends of selected parameters. Independent two-sample t-tests were used for comparisons. ASSESSMENT Women of non-Lebanese nationality residing in Lebanon had a significantly greater number of total deliveries (p-value < 0.001), vaginal deliveries (p-value = 0.002), cesarean sections (p-value = 0.02). When looking at delivery trends from 2015 to 2018, Lebanese women had a significant decrease in total number of deliveries (p-value < 0.001) and vaginal deliveries (p-value < 0.001). CONCLUSION Total number of deliveries and cesarean sections is on the rise in Lebanon. Cesarean section practice should be audited by the LMPH and the Lebanese Order of Physicians (LOP). Local and international agencies should prioritize the implementation and management of family planning facilities in refugee hosting countries.
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Affiliation(s)
- Julie Sammouri
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hussein H Khachfe
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mohamad Y Fares
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hamza A Salhab
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Anwar H Nassar
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Riad El Solh, PO Box: 11-0236, Beirut, 1107 2020, Lebanon
| | - Dina Chamsy
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Riad El Solh, PO Box: 11-0236, Beirut, 1107 2020, Lebanon.
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14
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Lee K, Kronick R, Miconi D, Rousseau C. Moving Forward in Mental Health Care for Refugee, Asylum-Seeking, and Undocumented Children: Social Determinants, Phased Approach to Care, and Advocacy. Child Adolesc Psychiatr Clin N Am 2024; 33:237-250. [PMID: 38395508 DOI: 10.1016/j.chc.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
Given the current political and climate crisis, the number of forcedly displaced individuals continues to rise, posing new challenges to host societies aiming to support and respond to the needs of those fleeing war or persecution. In this article, we turn our attention to current and historical sociopolitical contexts influencing the mental health of forcedly displaced children (ie, refugee, asylum-seeking, and undocumented) during their resettlement in high-income countries, proposing timely ways to respond to evolving needs and recommendations to redress ubiquitous structural inequities that act as barriers to education and care for the children, youth, and families seeking sanctuary.
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Affiliation(s)
- Keven Lee
- Division of Social and Transcultural Psychiatry, McGill University, 1033 Pine Avenue, Montreal, Quebec, Canada; Lady Davis Institute, 3755 Côte Ste-Catherine Road, Montreal, Quebec.
| | - Rachel Kronick
- Division of Social and Transcultural Psychiatry, McGill University, 1033 Pine Avenue, Montreal, Quebec, Canada; Lady Davis Institute, 3755 Côte Ste-Catherine Road, Montreal, Quebec
| | - Diana Miconi
- Department of Educational Psychology and Adult Education, Université de Montréal, 90 Vincent D'Indy Avenue, Outremont, Montréal, QC, Canada
| | - Cécile Rousseau
- Division of Social and Transcultural Psychiatry, McGill University, 1033 Pine Avenue, Montreal, Quebec, Canada
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15
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Yılmaz Aİ, Pekcan S, Eyüboğlu TŞ, Hangül M, Arslan H, Kılınç AA, Çokuğraş H, Arık E, Keskin Ö, Özdemir A, Ersoy M, Ersoy A, Köse M, Özsezen B, Ünal G, Ercan Ö, Girit S, Oksay SC, Gökdemir Y, Karadağ B, Şen V, Çakır E, Yüksel H, Tekin MN, Aslan AT. Comparison of refugee patients with cystic fibrosis and their counterpart children from Turkey during the war. Eur J Pediatr 2024; 183:1831-1838. [PMID: 38265526 PMCID: PMC11001702 DOI: 10.1007/s00431-024-05431-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 01/25/2024]
Abstract
Since the outbreak of the Syrian civil war in 2011, the population of Arab refugees in Turkey has rapidly increased. While cystic fibrosis (CF) is believed to be rare among Arabs, recent studies suggest it is underdiagnosed. This study aims to present the demographic, clinical, and genetic characteristics of CF patients among Arab refugees in Turkey. Additionally, a comparison is made between the findings in the National CF Registry 2021 in Turkey (NCFRT) and the refugee CF patient group. The study included refugee patients between the ages of 0 and 18 years who were diagnosed with CF and received ongoing care at pediatric pulmonology centers from March 2011 to March 2021. The study examined demographic information, age at diagnosis, age of diagnosis of patients through CF newborn screening (NBS), presenting symptoms, CF transmembrane conductance regulator (CFTR) mutation test results, sputum culture results, weight, height, and body mass index (BMI) z score. Their results were compared with the NCFRT results. The study included 14 pediatric pulmonology centers and 87 patients, consisting of 46 (52.9%) boys and 41 (47.1%) girls. All of the patients were Arab refugees, with 80 (92%) being Syrian. All the patients were diagnosed in Turkey. The median age at diagnosis of patients was 22.33 (interquartile range, 1-258) months. The median age of diagnosis of patients through NBS was 4.2 (interquartile range, 1-12) months. The median age of older patients, who were unable to be included in the NBS program, was 32.3 (interquartile range, 3-258) months. Parental consanguinity was observed in 52 (59.7%) patients. The mutation that was most frequently found was F508del, which accounted for 22.2% of the cases. It was present in 20 patients, constituting 32 out of the total 144 alleles. There was a large number of genetic variations. CFTR genotyping could not be conducted for 12 patients. These patients had high sweat tests, and their genetic mutations could not be determined due to a lack of data. Compared to NCFRT, refugee patients were diagnosed later, and long-term follow-up of refugee CF patients had significantly worse nutritional status and pseudomonas colonization. Conclusion: Although refugee CF patients have equal access to NBS programs and CF medications as well as Turkish patients, the median age at diagnosis of patients, the median age of diagnosis of patients through NBS, their nutritional status, and Pseudomonas colonization were significantly worse than Turkish patients, which may be related to the difficulties of living in another country and poor living conditions. The high genetic heterogeneity and rare mutations detected in the refugee patient group compared to Turkish patients. Well-programmed NBS programs, thorough genetic studies, and the enhancement of living conditions for refugee patients in the countries they relocate to can have several advantages such as early detection and improved prognosis. What is Known: • Children who have chronic diseases are the group that is most affected by wars. • The outcome gets better with early diagnosis and treatment in patients with Cystic Fibrosis (CF). What is New: • Through the implementation of a newborn screening program, which has never been done in Syria previously, refugee patients, the majority of whom are Syrians were diagnosed with cystic fibrosis within a duration of 4 months. • Despite equal access to the newborn screening program and CF medications for both Turkish patients and refugee patients, the challenges of living in a foreign country have an impact on refugees.
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Affiliation(s)
- Aslı İmran Yılmaz
- Department of Pediatric Pulmonology, Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Sevgi Pekcan
- Department of Pediatric Pulmonology, Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey.
| | | | - Melih Hangül
- Pediatric Pulmonology, Adana City Training and Research Hospital, Adana, Turkey
| | - Hüseyin Arslan
- Department of Pediatric Pulmonology, Cerrahpaşa Faculty of Medicine, Istanbul University - Cerrahpasa, Istanbul, Turkey
| | - Ayşe Ayzıt Kılınç
- Department of Pediatric Pulmonology, Cerrahpaşa Faculty of Medicine, Istanbul University - Cerrahpasa, Istanbul, Turkey
| | - Haluk Çokuğraş
- Department of Pediatric Pulmonology, Cerrahpaşa Faculty of Medicine, Istanbul University - Cerrahpasa, Istanbul, Turkey
| | - Elif Arık
- Department of Pediatric Allergy and Immunology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Özlem Keskin
- Department of Pediatric Allergy and Immunology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Ali Özdemir
- Department of Pediatric Pulmonology, Mersin City Training and Research Hospital, Mersin, Turkey
| | - Murat Ersoy
- Department of Pediatric Pulmonology, Mersin City Training and Research Hospital, Mersin, Turkey
| | - Ali Ersoy
- Department of Pediatric Pulmonology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Mehmet Köse
- Department of Pediatric Pulmonology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Beste Özsezen
- Department of Pediatric Pulmonology, Şanlıurfa Training and Research Hospital, Şanlıurfa, Turkey
| | - Gökçen Ünal
- Department of Pediatric Pulmonology, Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Ömür Ercan
- Department of Pediatric Pulmonology, Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Saniye Girit
- Department of Pediatric Pulmonology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Sinem Can Oksay
- Department of Pediatric Pulmonology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Yasemin Gökdemir
- Department of Pediatric Pulmonology, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Bülent Karadağ
- Department of Pediatric Pulmonology, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Velat Şen
- Department of Pediatric Pulmonology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
| | - Erkan Çakır
- Department of Pediatric Pulmonology, Liv Hospital, Istinye University, Istanbul, Turkey
| | - Hasan Yüksel
- Department of Pediatric Pulmonology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Merve Nur Tekin
- Department of Pediatric Pulmonology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Ayşe Tana Aslan
- Department of Pediatric Pulmonology, Faculty of Medicine, Gazi University, Ankara, Turkey
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Klabbers RE, Parrish C, Iraguha P, Ntuyenabo MK, Ajidiru S, Nshimiyimana V, Caroline K, Faustin Z, Sveum EM, Muwonge TR, O’Laughlin KN. Characterizing Mobility and its Association with HIV Outcomes in Refugee Settlements in Uganda. Ann Glob Health 2024; 90:23. [PMID: 38550610 PMCID: PMC10976981 DOI: 10.5334/aogh.4367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/10/2024] [Indexed: 04/02/2024] Open
Abstract
Background A better understanding of refugee mobility is needed to optimize HIV care in refugee settlements. Objectives We aimed to characterize mobility patterns among people living with HIV in refugee settlements in Uganda and evaluate the association between mobility and retention in HIV care. Methods Refugees and Ugandan nationals accessing HIV services at seven health centers in refugee settlements across Uganda, with access to a phone, were recruited and followed for six months. Participants received an intake survey and monthly phone surveys on mobility and HIV. Clinic visit and viral suppression data were extracted from clinic registers. Mobility and HIV data were presented descriptively, and an alluvial plot was generated characterizing mobility for participants' most recent trip. Bivariate Poisson regression models were used to describe the associations between long-term mobility (≥1 continuous month away in the past year) and demographic characteristics, retention (≥1 clinic visit/6 months) and long-term mobility, and retention and general mobility (during any follow-up month: ≥2 trips, travel outside the district or further, or spending >1-2 weeks (8-14 nights) away). Findings Mobility data were provided by 479 participants. At baseline, 67 participants (14%) were considered long-term mobile. Male sex was associated with an increased probability of long-term mobility (RR 2.02; 95%CI: 1.30-3.14, p < 0.01). In follow-up, 185 participants (60% of respondents) were considered generally mobile. Reasons for travel included obtaining food or supporting farming activities (45% of trips) and work or trade (33% of trips). Retention in HIV care was found for 417 (87%) participants. Long-term mobility was associated with a 14% (RR 0.86; 95%CI: 0.75-0.98) lower likelihood of retention (p = 0.03). Conclusions Refugees and Ugandan nationals accessing HIV care in refugee settlements frequently travel to support their survival needs. Mobility is associated with inferior retention and should be considered in interventions to optimize HIV care.
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Affiliation(s)
- Robin E. Klabbers
- Department of Emergency Medicine, University of Washington, Seattle, WA, United States of America
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Canada Parrish
- Department of Emergency Medicine, University of Washington, Seattle, WA, United States of America
| | - Patient Iraguha
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | | | - Scovia Ajidiru
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | | | - Kampire Caroline
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Zikama Faustin
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Elinor M. Sveum
- Department of Emergency Medicine, University of Washington, Seattle, WA, United States of America
| | | | - Kelli N. O’Laughlin
- Department of Emergency Medicine, University of Washington, Seattle, WA, United States of America
- Department of Global Health, University of Washington, Seattle, WA, United States of America
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17
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Talukdar R, Ravel V, Barman D, Kumar V, Dutta S, Kanungo S. Prevalence of undernutrition among migrant, refugee, internally displaced children and children of migrated parents in lower-middle-income countries: A meta-analysis of published studies from last twelve years. Diabetes Metab Syndr 2024; 18:102976. [PMID: 38508036 DOI: 10.1016/j.dsx.2024.102976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 03/03/2024] [Accepted: 03/05/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND AND AIMS This review aims to estimate the prevalence of undernutrition among migrants, refugees, internally displaced children, and children of migrated parents living in lower-middle-income countries. METHODS PubMed, Scopus, Science-Direct, CINAHL-Plus, & Google Scholar were searched for peer-reviewed evidence published between January 2010 to March 2023. Two researchers independently examined the studies and retrieved the data. The internal and external validity of the studies was assessed using the NIH quality assessment tool, and a checklist adapted from Downs & Black, Bracht & Glass, and Del Siegle's guidelines. A random effect model was chosen to pool the estimates. Subgroup analysis, Meta-regression, and sensitivity analysis were done to explore the source of heterogeneity and the robustness of estimates. RESULTS Among the 1978 records initially searched, 21 studies were selected for analysis. The pooled prevalence estimates for stunting, wasting, and underweight were estimated to be 29.39% (Confidence Interval [CI] 21.69-37.73; I2 99%; p < 0.01), 12.76% (CI 7.84-18.68; I2 99%; P < 0.01), and 24.05% (CI 16.17-32.94; I2 100%; p < 0.001) respectively. Among different WHO regions, all three undernutrition estimates were higher in LMICs belonging to the Southeast Asian region (Stunting 37.62%; wasting 14.28% and underweight 31.24%). Undernutrition among migrant Indian children was 43.55%, 18.71%, and 37.45% respectively. High heterogeneity was noted across all estimates with I2-value >90%. Sensitivity analysis across indicators showed the stability of our estimates. CONCLUSIONS The extent of undernutrition, particularly wasting was high among migrant/refugee children living in lower-middle-income countries. Measures should be taken to strengthen the government-subsidized public food distribution system, increase healthcare outreach, and ensure public health insurance coverage among the migrant population.
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Affiliation(s)
- Rounik Talukdar
- ICMR - National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India.
| | - Vanessa Ravel
- ICMR - National Institute of Epidemiology, Chennai, Tamil Nadu, India.
| | - Diplina Barman
- ICMR - National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India.
| | - Vivek Kumar
- Deepak Foundation, Katni, Madhya Pradesh, India.
| | - Shanta Dutta
- ICMR - National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India.
| | - Suman Kanungo
- ICMR - National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India.
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18
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Mattelin E, Paidar K, Söderlind N, Fröberg F, Korhonen L. A systematic review of studies on resilience and risk and protective factors for health among refugee children in Nordic countries. Eur Child Adolesc Psychiatry 2024; 33:667-700. [PMID: 35445318 PMCID: PMC10894096 DOI: 10.1007/s00787-022-01975-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/09/2022] [Indexed: 11/03/2022]
Abstract
The Nordic welfare model is often used as an example for the promotion of health and wellbeing, even in vulnerable groups of children, such as refugees. Nonetheless, there are no published reviews on resilience and/or risk and protective factors for physical and mental health among refugee children living in Nordic countries. In this systematic review, we identified 5181 studies on the topic, screened titles, and abstracts, viewed 632, and finally included 26 studies. These studies described 18 samples with a total of 34,080 individuals ranging in ages 0-18 years. Overall, the studies were of good quality. Nearly all studies assessed adversity. Six studies reported physical health outcomes and all studies mental health outcomes, most often post-traumatic stress disorder and anxiety. None explicitly studied resilience. While we found that age and sex are the most frequently studied risk- and protective factors, findings are inconclusive, since the direction of the associations was different in the different studies. This systematic review indicates that there is still a need for well-designed and -powered studies using clear definitions of key study concepts to examine health outcomes and resilience among refugee children in Nordic countries.
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Affiliation(s)
- Erica Mattelin
- Barnafrid and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Center for Social and Affective Neuroscience and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Kristina Paidar
- Department of Child and Adolescent Psychiatry, Region Halland, Kungsbacka, Sweden
| | - Natalie Söderlind
- Barnafrid and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Frida Fröberg
- Barnafrid and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Laura Korhonen
- Barnafrid and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
- Center for Social and Affective Neuroscience and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
- Department of Child and Adolescent Psychiatry and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
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Hellerslia V, Caldas LM. From refugee to pharmacist: Insights for better care. Curr Pharm Teach Learn 2024; 16:202-206. [PMID: 38177018 DOI: 10.1016/j.cptl.2023.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 11/30/2023] [Accepted: 12/22/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE This reflection utilizing Gibb's model offers insight into the lived experience of a Vietnamese child refugee who, many years later, found herself working as a pharmacist with Afghan refugees. DESCRIPTION Through this piece, the author describes her childhood experience with the United States (US) healthcare system as a refugee, her experience as a pharmacist caring for refugees, and explores her thoughts and feelings about the experience. ANALYSIS/INTERPRETATION The author evaluates the positive and negative aspects of the situation and analyzes the experience to make sense of the situation. CONCLUSIONS After reflecting on what she learned through her experience combined with findings in the literature, the author offers recommendations to pharmacists as they care for refugees, emphasizing the need for trauma-informed care for refugees with limited English language skills who are trying to navigate the complex US healthcare system. IMPLICATIONS This piece offers insights for pharmacists caring for refugees on how to offer better care.
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Affiliation(s)
- Van Hellerslia
- Temple University School of Pharmacy, 3307 North Broad Street, Philadelphia, PA 19001, United States.
| | - Lauren M Caldas
- Virginia Commonwealth University School of Pharmacy, 410 North 12th Street, PO Box 980533, Richmond, VA 23298-0533, United States.
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Osman M, Daaboul D, Tajani AG, El Omari K, Bisha B, Hassan J, Cazer CL, Fiorella KJ, Karah N, Abbara A, Hamze M, Cummings KJ, Naas T, Kassem II. Multidrug-resistant pathogens contaminate river water used in irrigation in disenfranchised communities. J Glob Antimicrob Resist 2024; 36:175-180. [PMID: 38154747 DOI: 10.1016/j.jgar.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 11/15/2023] [Accepted: 12/20/2023] [Indexed: 12/30/2023] Open
Abstract
OBJECTIVES The contamination of fresh surface waters poses a significant burden on human health and prosperity, especially in marginalized communities with limited resources and inadequate infrastructure. Here, we performed in-depth genomic analyses of multidrug-resistant bacteria (MDR-B) isolated from Al-Oueik river water that is used for irrigation of agricultural fields in a disenfranchised area that also hosts a makeshift Syrian refugee camp. METHODS A composite freshwater sample was filtered. Faecal coliforms were counted and extended spectrum cephalosporins and/or ertapenem resistant bacteria were screened. Isolates were identified using MALDI-TOF-MS and analysed using whole-genome sequencing (WGS) to identify the resistome, sequence types, plasmid types, and virulence genes. RESULTS Approximately 106 CFU/100 mL of faecal coliforms were detected in the water. Four drug-resistant Gram-negative bacteria were identified, namely Escherichia coli, Klebsiella pneumoniae, Enterobacter hormaechei, and Pseudomonas otitidis. Notably, the E. coli isolate harboured blaNDM-5 and a YRIN-inserted PBP3, representing an emerging public health challenge. The K. pneumoniae isolate carried blaSHV-187 as well as mutations in the gene encoding the OmpK37 porin. Enterobacter hormaechei and P. otitidis harboured blaACT-16 and blaPOM-1, respectively. CONCLUSION This report provides comprehensive genomic analyses of MDR-B in irrigation water in Lebanon. Our results further support that irrigation water contaminated with faecal material can be a reservoir of important MDR-B, which can spread to adjacent agricultural fields and other water bodies, posing both public health and food safety issues. Therefore, there is an urgent need to implement effective water quality monitoring and management programs to control the proliferation of antibiotic-resistant pathogens in irrigation water in Lebanon.
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Affiliation(s)
- Marwan Osman
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut; Cornell Atkinson Center for Sustainability, Cornell University, Ithaca, New York; Department of Public and Ecosystem Health, College of Veterinary Medicine, Cornell University, Ithaca, New York.
| | - Dina Daaboul
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon; Team 'Resist' UMR1184, 'Immunology of Viral, Auto-Immune, Hematological and Bacterial diseases (IMVA-HB', INSERM, Université Paris-Saclay, CEA, LabEx LERMIT, Faculty of Medicine, Le Kremlin-Bicêtre, France
| | | | - Khaled El Omari
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon; Quality Control Center Laboratories at the Chamber of Commerce, Industry & Agriculture of Tripoli & North Lebanon, Tripoli, Lebanon
| | - Bledar Bisha
- Department of Animal Science, University of Wyoming, Laramie, Wyoming
| | - Jouman Hassan
- Center for Food Safety and Department of Food Science and Technology, University of Georgia, Griffin, Georgia
| | - Casey L Cazer
- Department of Public and Ecosystem Health, College of Veterinary Medicine, Cornell University, Ithaca, New York; Department of Population Medicine & Diagnostic Sciences, Cornell University College of Veterinary Medicine, Ithaca, New York
| | - Kathryn J Fiorella
- Department of Public and Ecosystem Health, College of Veterinary Medicine, Cornell University, Ithaca, New York
| | - Nabil Karah
- Department of Molecular Biology and Umeå Centre for Microbial Research, Umeå University, Umeå, Sweden
| | - Aula Abbara
- Department of Infection, Imperial College, St Marys Hospital, London, Syria Public Health Network, London, United Kingdom
| | - Monzer Hamze
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Kevin J Cummings
- Department of Public and Ecosystem Health, College of Veterinary Medicine, Cornell University, Ithaca, New York
| | - Thierry Naas
- Team 'Resist' UMR1184, 'Immunology of Viral, Auto-Immune, Hematological and Bacterial diseases (IMVA-HB', INSERM, Université Paris-Saclay, CEA, LabEx LERMIT, Faculty of Medicine, Le Kremlin-Bicêtre, France; Bacteriology-Hygiene Unit, Assistance Publique-Hôpitaux de Paris, AP-HP Paris-Saclay, Bicêtre Hospital Le Kremlin-Bicêtre, France; Associated French National Reference Center for Antibiotic Resistance: Carbapenemase-Producing Enterobacteriaceae, Le Kremlin-Bicêtre, France
| | - Issmat I Kassem
- Center for Food Safety and Department of Food Science and Technology, University of Georgia, Griffin, Georgia
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Chen J, Mittendorfer-Rutz E, Taipale H, Rahman S, Niederkrotenthaler T, Klimek P. Association of medication clusters and subsequent labor market marginalization in refugee and Swedish-born young adults with common mental disorders in Sweden. Eur Child Adolesc Psychiatry 2024; 33:897-907. [PMID: 37115278 PMCID: PMC10894142 DOI: 10.1007/s00787-023-02214-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 04/11/2023] [Indexed: 04/29/2023]
Abstract
Little is known about the association between common mental disorders (CMD) and labor market integration among refugee and Swedish-born young adults. Socially disadvantaged patients such as refugees are more likely to discontinue their medication use prematurely. This study aimed to identify clusters of individuals with similar psychotropic medication patterns; and examine the relationship between cluster membership with labor market marginalization (LMM) in refugee and Swedish-born young adults with CMD. The study uses a longitudinal matched cohort aged 18-24 years with CMD diagnoses from Swedish registers covering 2006-2016. Dispensed psychotropic medications (antidepressants, antipsychotics, anxiolytics, sedative-hypnotics, mood stabilizers) were collected one year before and after CMD diagnosis. Clusters of patients with similar time courses of prescribed dosages were algorithmically identified. The association of cluster membership with subsequent LMM, (long-term sickness absence, SA, disability pension, DP, or long-term unemployment, UE) was assessed using Cox regression. Among 12,472 young adults with CMD, there were 13.9% with SA, 11.9% with DP, and 13.0% with UE during a mean follow-up of 4.1 years (SD 2.3 years). Six clusters of individuals were identified. A cluster with a sustained increase in all medication types yielded the highest hazard ratio (HR [95% CI]) 1.69 [1.34, 2.13] for SA and 2.63 [2.05, 3.38] for DP. The highest HRs of UE give a cluster with a concentrated peak in antidepressants at CMD diagnosis (HR 1.61[1.18, 2.18]). Refugees and Swedish-born showed similar associations between clusters and LMM. To prevent LMM, targeted support and early assessment of CMD treatment are needed for individuals with a sustained increase in psychotropic medication after CMD diagnosis and for refugees in high-risk clusters for UE characterized by a rapid lowering of treatment dosages, which could be an indicator for premature medication discontinuation.
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Affiliation(s)
- J Chen
- Section for Science of Complex Systems, CeDAS, Medical University of Vienna, Vienna, Austria
- Complexity Science Hub Vienna, Vienna, Austria
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - E Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - H Taipale
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 171 77, Stockholm, Sweden
- Niuvanniemi Hospital, Kuopio, Finland
- University of Eastern Finland, School of Pharmacy, Kuopio, Finland
| | - S Rahman
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - T Niederkrotenthaler
- Unit Suicide Research and Mental Health Promotion, Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Vienna, Austria
- Wiener Werkstätte for Suicide Research, Vienna, Austria
| | - P Klimek
- Section for Science of Complex Systems, CeDAS, Medical University of Vienna, Vienna, Austria.
- Complexity Science Hub Vienna, Vienna, Austria.
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Smith C, Boylen S, Mutch R, Cherian S. Hear Our Voice: Pediatric Communication Barriers From the Perspectives of Refugee Mothers With Limited English Proficiency. J Pediatr Health Care 2024; 38:114-126. [PMID: 38429024 DOI: 10.1016/j.pedhc.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/27/2023] [Accepted: 12/03/2023] [Indexed: 03/03/2024]
Abstract
BACKGROUND Adverse health outcomes are more common for health consumers with limited English proficiency (LEP). This study examines the consumer experience of refugee mothers with LEP when communicating with paediatric health services. METHOD A community-based participatory qualitative study engaging participants from refugee-like backgrounds. Focus groups and in-depth individual interviews (using professional interpreters) were conducted in community settings and analysed using Grounded Theory principles. RESULTS Fifty ethnolinguistically diverse participants reported universal communication barriers; (i) "Negative health care experiences" (fear, helplessness, lack of safety, trust and dignity), (ii) "Ineffective health service communication and adverse outcomes", (iii) "Logistical access barriers" and (iv) self-sourced solutions". The "importance of professional interpreter utilisation" and subsequent "sense of empowerment" was unanimous. CONCLUSIONS This study highlights gaps in current health interactions which negatively impact care, inclusion, and culturally safe engagement. Recommendations include orgainzational reform enhancing language services, increased cultural competency, long term support, and research with LEP populations.
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Affiliation(s)
- Cassie Smith
- Cassie Smith, Paediatric Advanced Trainee (General Paediatrics and Gastroenterology) Refugee Health Service, Department of General Paediatrics, Perth Children's Hospital, Child and Adolescent Health Service, Perth, Western Australia, Australia.
| | - Susan Boylen
- Susan Boylen, Senior Lecturer & 1(st) Year Academic Advisor, School of Nursing and Midwifery, University of Notre Dame Australia, Perth, Western Australia, Australia
| | - Raewyn Mutch
- Raewyn Mutch, General Paediatrician (Refugee Health Service and General Paediatrics), Department of General Paediatrics, Perth Children's Hospital, Child and Adolescent Health Service, and Clinical Associate Professor Division of Paedaitrics, University of Western Australia, Perth, Western Australia, Australia
| | - Sarah Cherian
- Sarah Cherian, Clinical Associate Professor, Division of Paediatrics, University of Western Australia, and General Paediatrician and Clinical Lead Refugee Health Service, Department of General Paediatrics, Perth Children's Hospital, Child and Adolescent Health Service, and Honorary Research Associate, Wesfarmers Centre for Vaccines and Immunity, Telethon Kids Institute, Perth, Western Australia, Australia
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Barongo V, Kiwale Z, Shayo E, Fabbri C, Turner E, Bakari M, Mubyazi G, Rodrigues K, Devries K. Conceptualisation of violence and discipline among students, teachers, and parents in Nyarugusu Refugee Camp, Tanzania. Child Abuse Negl 2024; 149:106555. [PMID: 38271782 DOI: 10.1016/j.chiabu.2023.106555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 10/09/2023] [Accepted: 11/12/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND Little academic research has been conducted on how people conceptualise 'violence' and 'discipline', especially in humanitarian settings. This may limit the transferability of violence prevention interventions. This paper examines the understanding of violence and discipline concepts among students, teachers, and parents in the Nyarugusu Refugee Camp in Tanzania. METHODS A qualitative study was undertaken as part of the larger trial testing the effectiveness of the EmpaTeach intervention to prevent physical violence from teachers to students implemented in 27 schools in Nyarugusu Refugee Camp. Data from baseline and midline surveys in control schools that did not receive the intervention informed this paper where a total of 14 in-depth interviews (eight with students and six teachers) and six focus group discussions (two with teachers and four with parents from the Parent Teacher Association) were analyzed. Both audio recordings from in-depth interviews and focus group discussions were transcribed verbatim, and translated from Kiswahili to English (Congolese) and Kirundi to English (Burundian). Translated data were verified and coded using thematic analysis based on the views of students, teachers, and parents. RESULTS Participants revealed that the same behavioural acts could be differentially classified as violence or discipline. Violence was understood in relation to the consequences of acts, which could include physical or psychological harm, or other harms which were seen as detrimental to children's futures and life chances, particularly adolescent pregnancy. Sexual acts without consent were also seen as violence. In contrast, discipline was understood according to intent, and perceived acts done towards students to correct bad behaviour. CONCLUSION Results imply that education about the harmful consequences of behavioural acts intended as discipline, may be important for violence prevention interventions and that framing interventions in terms of positive child development could help change discipline strategies in schools.
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Affiliation(s)
- Vivien Barongo
- National Institute for Medical Research(NIMR), 3 Barack Obama Dr, P. O. Box 9653, 11101 Dar es Salaam, Tanzania.
| | - Zenais Kiwale
- National Institute for Medical Research(NIMR), 3 Barack Obama Dr, P. O. Box 9653, 11101 Dar es Salaam, Tanzania.
| | - Elizabeth Shayo
- National Institute for Medical Research(NIMR), 3 Barack Obama Dr, P. O. Box 9653, 11101 Dar es Salaam, Tanzania.
| | - Camilla Fabbri
- London School of Hygiene and Tropical Medicine (LSHTM), 15-17 Tavistock Pl, London WC1H 9SH, United Kingdom.
| | - Ellen Turner
- London School of Hygiene and Tropical Medicine (LSHTM), 15-17 Tavistock Pl, London WC1H 9SH, United Kingdom.
| | - Mtumwa Bakari
- National Institute for Medical Research(NIMR), 3 Barack Obama Dr, P. O. Box 9653, 11101 Dar es Salaam, Tanzania.
| | - Godfrey Mubyazi
- National Institute for Medical Research(NIMR), 3 Barack Obama Dr, P. O. Box 9653, 11101 Dar es Salaam, Tanzania.
| | | | - Karen Devries
- London School of Hygiene and Tropical Medicine (LSHTM), 15-17 Tavistock Pl, London WC1H 9SH, United Kingdom.
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Kuroda M, Shaw AV, Campagna CD. The experiences of community health workers when communicating with refugees about COVID-19 vaccines in Syracuse, NY: A qualitative study. Heliyon 2024; 10:e26136. [PMID: 38434037 PMCID: PMC10906162 DOI: 10.1016/j.heliyon.2024.e26136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 02/06/2024] [Accepted: 02/08/2024] [Indexed: 03/05/2024] Open
Abstract
Background Refugees are among the most health-vulnerable members of society. Despite the importance of vaccination to mitigate the risks associated with COVID-19 infection, ensuring adequate access and uptake of the COVID-19 vaccine remains a pressing concern for refugee populations. Research has suggested that community-oriented approaches and open communication with trusted individuals are essential to address this challenge. Vaccine outreach efforts were performed in Syracuse, NY, by Community Health Workers (CHWs) as trusted refugee community members. This study explored CHWs' experiences during vaccine outreach and perceptions about COVID-19 vaccine hesitancy and acceptance among refugees, including barriers and facilitators to vaccination. Methods A qualitative study was performed using thematic analysis following six semi-structured interviews with CHWs. Results Four main themes supported by 16 sub-themes were extracted. CHWs described the (1) diverse beliefs and attitudes of refugees by ethnic group, with most having low vaccine acceptance at first. (2) Barriers included contextual barriers, lack of awareness, misinformation, and withdrawal when forced from vaccine mandates. However, CHWs also identified numerous (3) facilitators to vaccination, including the internal processing and eventual vaccine acceptance, supported by external messaging by CHWs and time. Culturally sensitive intervention strategies occurred through (4) CHW team efforts and their provision of reliable information to refugee clients, with openness and over time. The team efforts of CHWs significantly contributed to refugee acceptance and uptake of the COVID-19 vaccine. Conclusions This study revealed how the refugee population changed their belief towards the COVID-19 vaccine through trust, time, and reliable information provided by CHWs and describes culturally sensitive strategies for vaccine uptake by refugees. CHWs' reflection on COVID-19 vaccine hesitancy and acceptance among refugees during outreach efforts is an essential perspective when implementing future public health interventions.
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Affiliation(s)
- Moe Kuroda
- Norton College of Medicine, MPH Program, SUNY Upstate Medical University, Syracuse, NY, USA
- Institute for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, NY, USA
- Department of General Medicine, Toyama University Hospital, Toyama, Japan
| | - Andrea V. Shaw
- Institute for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, NY, USA
- Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY, USA
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Christina D. Campagna
- Institute for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, NY, USA
- Department of Public Health & Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
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Mattelin E, Söderlind N, Korhonen L. "You cannot just stop life for just that": a qualitative study on children's experiences on refugee journey to Sweden. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02387-w. [PMID: 38360923 DOI: 10.1007/s00787-024-02387-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 01/22/2024] [Indexed: 02/17/2024]
Abstract
Children with refugee backgrounds are often exposed to violence and other adverse experiences with well-known detrimental consequences on mental health. However, the current group of approximately 40 million child refugees is heterogeneous, stressing the importance of first-person perspectives in understanding children's unique experiences and needs related to the migration process. Identifying contextual factors promoting health and resilience is also essential. For instance, the roles children play as active agents in constructing their own lives and adapting to different environments are poorly described in contemporary research on child refugees and their mental health. To address these knowledge gaps, we conducted qualitative interviews with a reflexive thematic analysis with eighteen children with refugee backgrounds in Sweden. This resulted in two main themes: Longing for a good life that cannot be taken for granted and Challenged agency and changing rights. The narratives indicate that children, although exposed to different challenges in different migration phases and based on gender and asylum status, have experiences of ordinary childhood with a desire for a good life with prospects. The results also show that children execute active and adaptable agency that is impacted by various factors. Reaching the full age appears to be a confusing and ambivalent transition due to changes in rights. The results pinpoint several possibilities to address factors that pose a risk to health and restrictions of rights among child refugees.
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Affiliation(s)
- Erica Mattelin
- Barnafrid, Swedish National Center On Violence Against Children, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Center for Social and Affective Neuroscience and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Save the Children, Stockholm, Sweden
| | - Natalie Söderlind
- Barnafrid, Swedish National Center On Violence Against Children, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Laura Korhonen
- Barnafrid, Swedish National Center On Violence Against Children, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
- Center for Social and Affective Neuroscience and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
- Department of Child and Adolescent Psychiatry and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
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Presser E, Farhat M, Michael M, El Asmar K, Jaber L, Moustafa M, Mowafi H, Al-Hajj S. Epidemiology of burns in a humanitarian setting: A national study among refugees in Lebanon. Burns 2024:S0305-4179(24)00034-2. [PMID: 38402117 DOI: 10.1016/j.burns.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 01/16/2024] [Accepted: 02/08/2024] [Indexed: 02/26/2024]
Abstract
INTRODUCTION Burns represent one of the leading causes of morbidity worldwide and disproportionately impact women, children, and socioeconomically disadvantaged individuals. Syrian refugees who fled conflict to land in overcrowded informal settlements across Lebanon are a particularly vulnerable population. This study aims to assess the etiology and risk factors for burns in this population. METHODS This cross-sectional, cluster-based population study adopted the Surgeons Overseas Assessment of Surgical Need (SOSAS) version 3.0 to capture data from refugees residing in informal settlements in multiple regions across Lebanon. The tool was contextualized and used to collect detailed information on burn cases sustained by refugees during the last 12 months prior to data collection. Univariate logistic regression models were performed to assess the relationship between burns and associated risk factors. RESULTS From the 1468 households surveyed, a total of 223 households experienced a burn in the last 12 months. Over 63% of burns occurred in children under the age of ten years and almost 57% of burns occurred in females. More than 70% of burns resulted from hot liquid, while 17% were caused by direct heat contact. Over 3/4ths of burns occurred while preparing food (77.4%). Approximately 32% of those burned did not seek healthcare, of which almost 85% noted the cause was mainly due to financial limitations. CONCLUSION Burns are a common injury in the Syrian refugee population living in Lebanon. Children and women are particularly impacted, often during cooking. Multi-level interventions are necessary to reduce burn injuries and improve care for those affected by burns. Community kitchens can be used to separate cooking and living environments and get stoves and hot liquids off the floor. Importantly, policies should allow for refugees to receive medical care when necessary without a major financial burden.
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Affiliation(s)
- Elise Presser
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - May Farhat
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Marc Michael
- Department of Sociology, American University of Beirut, Beirut, Lebanon
| | - Khalil El Asmar
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Lubna Jaber
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Moustafa Moustafa
- Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Hani Mowafi
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Samar Al-Hajj
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
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Abdelmassih Y, Makhoul M, Issa M, Sukkarieh G, Cherfan D, El-Khoury S. The Ayounkon project: visual impairment, eye diseases and unmet eye care needs in the Syrian refugee population and the hosting community in Lebanon. Int Ophthalmol 2024; 44:42. [PMID: 38334899 DOI: 10.1007/s10792-024-02930-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 12/17/2023] [Indexed: 02/10/2024]
Abstract
AIM To report on the distribution of eye diseases, aetiologies of severe visual impairment/blindness (SVI/BL) and unmet eye care needs of the Syrian refugee population and the Lebanese host community. METHODS This retrospective study analysed the data of patients that were examined during the Ayounkon project -an eye health care project offering medical and surgical treatment for Syrian refugees and Lebanese host community in the Bekaa Valley in Lebanon. The project took place in three different primary health care centres and involved cooperation between several NGOs and ophthalmologists working on a voluntary basis. Data was analysed for distribution of eye diseases and aetiologies responsible for monocular and binocular SVI/BL. RESULTS A total of 2067 patients were included, 677 were children < 18 years. The most frequent pathologies were ocular allergy (10%), and cataract (7.4%). 158 patients (7.6%) were referred for surgery. Glasses were prescribed for 1103 patients (53.4%), of whom 242 (21.9%) were children of school age. SVI/BL was found in 276 patients (13%). The condition was bilateral in 116 patients (42%). SVI/BL was significantly more frequent in the Syrian population than in the Lebanese (186 patients, 14.8% versus 86 patients, 11.3%; p = 0.04). The main causes for SVI/BL were cataract, keratoconus/corneal decompensation and amblyopia. CONCLUSION The Syrian refugee population and the Lebanese host community have a high prevalence of ophthalmic pathologies and SVI/BL. Visual impairment is more prevalent in the refugee population. Our findings underscore the importance of targeted interventions and access to eye care services for these populations.
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Affiliation(s)
- Youssef Abdelmassih
- Ophthalmology Department, Rothschild Foundation Hospital, 29 Rue Manin, 75019, Paris, France.
- Beirut Eye Specialist Hospital, Al-Mathaf Square, Beirut, Lebanon.
| | - Maxime Makhoul
- Ophthalmology Department, Rothschild Foundation Hospital, 29 Rue Manin, 75019, Paris, France
- Université Libre de Bruxelles, Brussels, Belgium
| | - Mohammad Issa
- Ophthalmology Department, Rothschild Foundation Hospital, 29 Rue Manin, 75019, Paris, France
- Beirut Eye Specialist Hospital, Al-Mathaf Square, Beirut, Lebanon
| | - George Sukkarieh
- Beirut Eye Specialist Hospital, Al-Mathaf Square, Beirut, Lebanon
| | - Daniel Cherfan
- Beirut Eye Specialist Hospital, Al-Mathaf Square, Beirut, Lebanon
| | - Sylvain El-Khoury
- Beirut Eye Specialist Hospital, Al-Mathaf Square, Beirut, Lebanon
- Centre Hospitalier de Grasse, Chemin de Clavary, Grasse, France
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Gingell T, Adhikari R, Eltahir N, Ntahomvukiye F, Pe E, Murray K, Correa-Velez I, Gallegos D. 'It is human work': qualitatively exploring community roles that facilitate cultural food security for people from refugee backgrounds. Public Health Nutr 2024; 27:e64. [PMID: 38316531 PMCID: PMC10897574 DOI: 10.1017/s1368980024000326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 11/18/2023] [Accepted: 01/15/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVES Cultural food security is crucial for cultural health and, for people from refugee backgrounds, supports the settlement journey. Cultural communities are vital in facilitating access to cultural foods; however, it is not understood how refugee-background communities sustain cultural food security in the Australian context. This study aimed to explore key roles in refugee-background communities to understand why they were important and how they facilitate cultural food security. DESIGN Interviews were conducted by community researchers, and data analysis was undertaken using best-practice framework for collaborative data analysis. SETTING Greater Brisbane, Australia. PARTICIPANTS Six interviews were conducted between August and December 2022 with people from a refugee-background community, lived in Greater Brisbane and who fulfilled a key food role in the community that facilitated access to cultural foods. RESULTS Fostering improved cultural food security supported settlement by creating connections across geographical locations and cultures and generated a sense of belonging that supported the settlement journey. Communities utilised communication methods that prioritised the knowledge, wisdom and experience of community members. It also provided community members with influence over their foodways. Community leaders had an ethos that reflected collectivist values, where community needs were important for their own health and well-being. CONCLUSIONS Communities are inherently structured and communicate in a way that allows collective agency over foodways. This agency promotes cultural food security and is suggestive of increased food sovereignty. Researchers and public health workers should work with communities and recognise community strengths. Food security interventions should target cultural food security and autonomy.
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Affiliation(s)
- Tina Gingell
- School of Nutrition and Exercise Sciences, Queensland University of Technology (QUT), Brisbane, Australia
- Centre for Childhood Nutrition Research (CCNR), Level 6, 62 Graham Street, South Brisbane, Qld4101, Australia
| | - Rishita Adhikari
- School of Nutrition and Exercise Sciences, Queensland University of Technology (QUT), Brisbane, Australia
| | - Nehal Eltahir
- Islamic Women’s Association of Australia, Brisbane, Australia
| | - Fulgence Ntahomvukiye
- School of Nutrition and Exercise Sciences, Queensland University of Technology (QUT), Brisbane, Australia
| | - Evelyn Pe
- Ethnic Communities Council of Queensland, Brisbane, Australia
| | - Kate Murray
- School of Psychology & Counselling, Queensland University of Technology (QUT), Brisbane, Australia
| | - Ignacio Correa-Velez
- School of Public Health & Social Work, Queensland University of Technology (QUT), Brisbane, Australia
| | - Danielle Gallegos
- School of Nutrition and Exercise Sciences, Queensland University of Technology (QUT), Brisbane, Australia
- Centre for Childhood Nutrition Research (CCNR), Level 6, 62 Graham Street, South Brisbane, Qld4101, Australia
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Claudia Lopes A, Lousada M. Breastfeeding knowledge, attitudes, beliefs and practices of refugee, migrant and asylum seeker women in Portugal. BMC Public Health 2024; 24:394. [PMID: 38321425 PMCID: PMC10848452 DOI: 10.1186/s12889-024-17849-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 01/23/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND The World Health Organization recommends exclusive breastfeeding for the first six months after childbirth. However, breastfeeding is influenced by organizational, social, geopolitical, and cultural factors, which are understudied in the migrant population. This study aimed to assess the knowledge, attitudes, beliefs, and practices of refugee, migrant, and asylum-seeking mothers living in Lisbon. METHODS A sociodemographic questionnaire and a Breastfeeding Knowledge, Attitudes, and Beliefs, and Practices questionnaire were used to gather information regarding baseline breastfeeding knowledge, attitudes and beliefs, and practices towards breastfeeding. RESULTS Only 40% of the mothers received antenatal counselling regarding the benefits and management of breastfeeding. Of the 20 responses, 10 (50%) mothers were found to have fair breastfeeding knowledge, 14 (70%) had fair attitudes and beliefs, and 12 (60%) had fair breastfeeding practices. Correlation analysis indicated a positive correlation between mothers' breastfeeding attitudes (r = 0.531, p < 0.05) and their breastfeeding knowledge. There was no statistically significant correlation between the mothers' breastfeeding attitudes, beliefs, and practices. CONCLUSIONS The findings of this study suggest that healthy breastfeeding behaviours can be stimulated by receiving proper counselling from health professionals. Countries must focus on improving breastfeeding practices, as they still fail to do all they can to promote, protect, and support breastfeeding globally. Universal interventions are necessary to improve breastfeeding, regardless of migrant or refugee status.
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Affiliation(s)
- Ana Claudia Lopes
- Center for Health Technology and Services Research (CINTESIS.UA@RISE), University of Aveiro, Aveiro, Portugal
| | - Marisa Lousada
- Center for Health Technology and Services Research (CINTESIS.UA@RISE), University of Aveiro, Aveiro, Portugal
- School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal
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Murt A, Sen EI, Altun E. A case of acute interstitial nephritis superimposed on rhabdomyolysis in a refugee patient. J Nephrol 2024:10.1007/s40620-024-01895-x. [PMID: 38300435 DOI: 10.1007/s40620-024-01895-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/07/2024] [Indexed: 02/02/2024]
Affiliation(s)
- Ahmet Murt
- Nephrology Clinic, Bagcilar Training and Research Hospital, Istanbul, Turkey.
| | - Elif Itir Sen
- Department of Internal Medicine, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Eren Altun
- Department of Pathology, Bagcilar Training and Research Hospital, Istanbul, Turkey
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Bernhardt K, Le Beherec S, Uppendahl JR, Fleischmann M, Klosinski M, Rivera LM, Samaras G, Kenney M, Müller R, Nehring I, Mall V, Hahnefeld A. Young children's development after forced displacement: a systematic review. Child Adolesc Psychiatry Ment Health 2024; 18:20. [PMID: 38303022 PMCID: PMC10835848 DOI: 10.1186/s13034-024-00711-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 01/22/2024] [Indexed: 02/03/2024] Open
Abstract
OBJECTIVES To examine the impact of displacement experiences on 0- to 6-year-old children's social-emotional and cognitive development, as well as influencing factors on reported outcomes. STUDY DESIGN We systematically searched MEDline, Psyndex, Cochrane Library, Web of Science, Elsevier, TandF, Oxford Journal of Refugee Studies, Journal of Immigrant & Refugee Studies, and Canada's Journal on Refugees for existing literature regarding social-emotional and cognitive outcomes in children directly exposed to forced displacement due to political violence. Results were synthesized in the discussion and displayed using harvest plots. RESULTS Our search generated 9,791 articles of which 32 were selected for review and evaluation according to NICE criteria. Included studies provided results for 6,878 forcibly displaced children. Measured outcomes were diverse and included areas such as peer relations, prosocial behavior, family functioning, play, intelligence, learning performance, and language development. Repeated exposure to adverse experiences, separation from parents, parental distress, as well as duration and quality of resettlement in the host country were reported as influencing factors in the reviewed studies. CONCLUSION As protective factors like secure and stable living conditions help to promote children's development, we call for policies that enhance participation in the welcoming society for refugee families. Early integration with low-threshold access to health and educational facilities can help to mitigate the wide-ranging negative consequences of forced displacement on young children's development.
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Affiliation(s)
- Katharina Bernhardt
- Chair of Social Pediatrics, TUM School of Medicine, Technical University of Munich, Munich, Germany.
| | - Saskia Le Beherec
- Chair of Social Pediatrics, TUM School of Medicine, Technical University of Munich, Munich, Germany
- Kbo Kinderzentrum, Heiglhofstrasse 65, 81377, Munich, Germany
| | - Jana R Uppendahl
- Chair of Social Pediatrics, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Melia Fleischmann
- Chair of Social Pediatrics, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Matthias Klosinski
- Chair of Social Pediatrics, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Luisa M Rivera
- Department of Anthropology, Emory University, Atlanta, GA, USA
| | - Georgia Samaras
- Department of Science, Technology and Society, Technical University of Munich, Munich, Germany
| | - Martha Kenney
- Department of Women and Gender Studies, San Francisco State University, San Francisco, CA, USA
| | - Ruth Müller
- Department of Science, Technology and Society, Technical University of Munich, Munich, Germany
- School of Management, Technical University of Munich, Munich, Germany
- School of Life Sciences, Technical University of Munich, Munich, Germany
| | - Ina Nehring
- Chair of Social Pediatrics, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Volker Mall
- Chair of Social Pediatrics, TUM School of Medicine, Technical University of Munich, Munich, Germany
- Kbo Kinderzentrum, Heiglhofstrasse 65, 81377, Munich, Germany
| | - Andrea Hahnefeld
- Chair of Social Pediatrics, TUM School of Medicine, Technical University of Munich, Munich, Germany
- Kbo Kinderzentrum, Heiglhofstrasse 65, 81377, Munich, Germany
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Stevenson M, Guillén J, Ortíz J, Ramírez Correa JF, Page KR, Barriga Talero MÁ, López JJ, Fernández-Niño JA, Núñez RL, Spiegel P, Wirtz AL. Syphilis prevalence and correlates of infection among Venezuelan refugees and migrants in Colombia: findings of a cross-sectional biobehavioral survey. Lancet Reg Health Am 2024; 30:100669. [PMID: 38298201 PMCID: PMC10827575 DOI: 10.1016/j.lana.2023.100669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 12/22/2023] [Accepted: 12/26/2023] [Indexed: 02/02/2024]
Abstract
Background Population-based estimates of syphilis prevalence are critical to informing public health response. We aimed to measure syphilis prevalence among Venezuelan refugees and migrants in Colombia to inform public health programming. Methods Between July 2021 and February 2022, we surveyed 6221 adult Venezuelan refugees and migrants in four cities in Colombia using respondent-driven sampling (RDS). Participants completed a survey and dual-rapid HIV/treponemal syphilis screening. Confirmatory laboratory-based rapid plasma reagin testing was conducted on whole blood samples. Active syphilis infection was defined as RPR titer ≥ 1:8 and no self-reported syphilis treatment. We used multivariable regression models to identify associations with active syphilis infection among subgroups by gender and history of pregnancy (cisgender men n = 2123, cisgender women n = 4044, transgender/nonbinary people n = 47, pregnant women n = 150). Findings Population (RDS-weighted) prevalence of laboratory-confirmed syphilis was 5.1% (95% CI: 4.6-5.6). Syphilis prevalence was 5.8% (weighted) among men; lifetime sexually transmitted infections (STI) diagnosis, same-sex relationships, HIV infection, and partner number were independently associated with syphilis infection. Syphilis prevalence was 4.6% (weighted) in women; correlates of infection included: lifetime STI diagnosis, food insecurity, current engagement in sex work, current pregnancy, any unsafe night in Colombia, irregular migration status, and no healthcare utilization in Colombia. 14.9% (unweighted) of transgender participants had syphilis infection; correlates of infection included partner number and HIV infection. The prevalence of syphilis was 9.0% (weighted) among pregnant women, which was associated with lifetime STI diagnosis. Interpretation Syphilis among Venezuelans in Colombia is high. Correlates of infection are distinct among demographic groups, spanning sexual and social vulnerabilities, suggesting tailored public health strategies. Funding US President's Emergency Plan for AIDS Relief through the U.S. Centers for Disease Control and Prevention.
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Affiliation(s)
- Megan Stevenson
- Bloomberg School of Public Health, Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA
| | | | | | | | - Kathleen R. Page
- Bloomberg School of Public Health, Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA
- Bloomberg School of Public Health, Department of International Health, Center for Humanitarian Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Infectious Disease, Johns Hopkins School of Medicine, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | | | - Paul Spiegel
- Bloomberg School of Public Health, Department of International Health, Center for Humanitarian Health, Johns Hopkins University, Baltimore, MD, USA
| | - Andrea L. Wirtz
- Bloomberg School of Public Health, Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA
- Bloomberg School of Public Health, Department of International Health, Center for Humanitarian Health, Johns Hopkins University, Baltimore, MD, USA
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Dehnel R, Dalky H, Sudarsan S, Al-Delaimy WK. Suicidality Among Syrian Refugee Children in Jordan. Community Ment Health J 2024; 60:224-232. [PMID: 37481688 PMCID: PMC10821978 DOI: 10.1007/s10597-023-01160-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/18/2023] [Indexed: 07/24/2023]
Abstract
History of adverse events in childhood is one of the strongest predictors of developing negative mental health outcomes with suicidality being the most devastating consequence. Syrian refugee children are at very high risk of developing mental illness, however, the prevalence and significance of suicidal thoughts among this population remains undocumented. A total of 339 Syrian refugee children and adolescents aged 10 to 17 years and their parents living in Jordan were surveyed to assess resilience, depression and suicidality. Demographics and parental depression were correlated with child suicidality. Multivariate logistic regression analyses were used to determine the predictors of suicidality within this population. A total of 94 (27.7%) children reported suicidal statements. In the multivariate analyses we found that younger children were more likely to state suicidal ideation than older children. Of the children who stated suicidal ideation, 49 were in primary school, 19 in pre-secondary and 26 in upper-secondary school. In the multivariate analyses, mild (OR 2.633 (95% CI 1.283, 5.709)) and high (OR 6.987 (95% CI 3.532, 14.614)) depression levels among the surveyed children were predictive of suicidality. Experiencing bullying was also predictive of suicidality (OR 2.181 (95% CI 1.179, 4.035)) when compared to those who did not report any bullying. We report high rates of suicidal ideation among Syrian refugee children, especially in children with exposure to pre-existing depression or bullying. Prevention through raising awareness, education and early detection of depression are needed to address suicidality in this and other vulnerable populations of children.
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Affiliation(s)
| | - Heyam Dalky
- Jordan University of Science and Technology, Irbid, Jordan
| | | | - Wael K Al-Delaimy
- UC San Diego Division of Global Health, Department of Family and Preventative Medicine, San Diego, USA
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Boettcher J, Heinrich M, Boettche M, Burchert S, Glaesmer H, Gouzoulis-Mayfrank E, Heeke C, Hernek M, Knaevelsrud C, Konnopka A, Muntendorf L, Nilles H, Nohr L, Pohl S, Paskuy S, Reinhardt I, Sierau S, Stammel N, Wirz C, Renneberg B, Wagner B. Internet-based transdiagnostic treatment for emotional disorders in Arabic- and Farsi-speaking refugees: study protocol of a randomized controlled trial. Trials 2024; 25:13. [PMID: 38167060 PMCID: PMC10759366 DOI: 10.1186/s13063-023-07845-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 11/30/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Refugee populations have an increased risk for mental disorders, such as depression, anxiety, and posttraumatic stress disorders. Comorbidity is common. At the same time, refugees face multiple barriers to accessing mental health treatment. Only a minority of them receive adequate help. The planned trial evaluates a low-threshold, transdiagnostic Internet-based treatment. The trial aims at establishing its efficacy and cost-effectiveness compared with no treatment. METHODS N = 131 treatment-seeking Arabic- or Farsi-speaking patients, meeting diagnostic criteria for a depressive, anxiety, and/or posttraumatic stress disorder will be randomized to either the intervention or the waitlist control group. The intervention group receives an Internet-based treatment with weekly written guidance provided by Arabic- or Farsi-speaking professionals. The treatment is based on the Common Elements Treatment Approach (CETA), is tailored to the individual patient, and takes 6-16 weeks. The control group will wait for 3 months and then receive the Internet-based treatment. DISCUSSION The planned trial will result in an estimate of the efficacy of a low-threshold and scalable treatment option for the most common mental disorders in refugees. TRIAL REGISTRATION German Registry for Clinical Trials DRKS00024154. Registered on February 1, 2021.
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Affiliation(s)
- Johanna Boettcher
- Clinical Psychology and Psychotherapy, Freie Universitaet Berlin, Berlin, Germany.
- Clinical Psychology and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany.
| | - Manuel Heinrich
- Clinical Psychological Intervention, Freie Universitaet Berlin, Berlin, Germany
| | - Maria Boettche
- Clinical Psychological Intervention, Freie Universitaet Berlin, Berlin, Germany
| | - Sebastian Burchert
- Clinical Psychological Intervention, Freie Universitaet Berlin, Berlin, Germany
| | - Heide Glaesmer
- Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | | | - Carina Heeke
- Clinical Psychological Intervention, Freie Universitaet Berlin, Berlin, Germany
| | - Martina Hernek
- Clinical Psychology and Psychotherapie, Freie Universitaet Berlin, Berlin, Germany
| | | | - Alexander Konnopka
- Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Louisa Muntendorf
- Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hannah Nilles
- Clinical Psychology and Psychotherapy, Medical School Berlin, Berlin, Germany
| | - Laura Nohr
- Clinical Psychological Intervention, Freie Universitaet Berlin, Berlin, Germany
| | - Steffi Pohl
- Methods and Evaluation/Quality Assurance, Freie Universitaet Berlin, Berlin, Germany
| | - Sophia Paskuy
- Clinical Psychology and Psychotherapy, Medical School Berlin, Berlin, Germany
| | - Isabelle Reinhardt
- Section of Healthcare Research, LVR-Institute for Research and Education, Cologne, Germany
| | - Susan Sierau
- Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Nadine Stammel
- Clinical Psychological Intervention, Freie Universitaet Berlin, Berlin, Germany
| | - Christina Wirz
- Clinical Psychology and Psychotherapie, Freie Universitaet Berlin, Berlin, Germany
| | - Babette Renneberg
- Clinical Psychology and Psychotherapie, Freie Universitaet Berlin, Berlin, Germany
| | - Birgit Wagner
- Clinical Psychology and Psychotherapy, Medical School Berlin, Berlin, Germany
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Logie CH, Loutet MG, Okumu M, Coelho M, Lukone SO, Kisubi N, Latif M, McAlpine A, Kyambadde P. Exploring a syndemic of poverty, cumulative violence, and HIV vulnerability among refugee youth: multi-method insights from a humanitarian setting in Uganda. AIDS Care 2024; 36:36-43. [PMID: 37921837 DOI: 10.1080/09540121.2023.2277151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 10/23/2023] [Indexed: 11/04/2023]
Abstract
Synergistic associations between social inequities and HIV vulnerabilities - known as a syndemic - are understudied with youth in humanitarian settings. We explored refugee youths' HIV prevention needs in Bidi Bidi Refugee Settlement, Uganda. This multi-methods study involved 6 focus groups and 12 in-depth individual interviews (IDI) with refugee youth (n = 60) aged 16-24, and IDI with refugee elders (n = 8) and healthcare providers (n = 8). We then conducted cross-sectional surveys with refugee youth (16-24 years) (n = 115) to assess: poverty, recent sexual and gender-based violence (SGBV), and condom engagement motivation (CEM) (wanting to learn about condoms for HIV prevention). Multivariable logistic regression was used to estimate adjusted odds ratios for associations between poverty and SGBV with CEM. Qualitative narratives revealed poverty and trauma elevated substance use, and these converged to exacerbate SGBV. SGBV and transactional sex increased HIV vulnerabilities. Among survey participants, poverty and recent SGBV were associated with reduced odds of CEM. The interaction between poverty and recent SGBV was significant: the predicted probability of CEM among youth who experienced both poverty and SGBV was almost half than among youth who experienced poverty alone, SGBV alone, or neither. Findings signal the confluence of poverty, violence, and substance use elevate refugee youth HIV vulnerabilities.
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Affiliation(s)
- Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
- United Nations University Institute for Water, Environment, and Health, Hamilton, Canada
- Centre for Gender & Sexual Health Equity, Vancouver, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Miranda G Loutet
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Moses Okumu
- School of Social Work, University of Illinois at Urbana Champaign, Urbana, IL, USA
| | | | | | - Nelson Kisubi
- Uganda Refugee and Disaster Management Council, Yumbe, Uganda
| | - Maya Latif
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Alyssa McAlpine
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Peter Kyambadde
- National AIDS Coordinating Program, Ugandan Ministry of Health, Kampala, Uganda
- Most at Risk Population Initiative (MARPI), Kampala, Uganda
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Mehjabeen D, Blignault I, Taha PH, Reavley N, Slewa-Younan S. A mixed methods systematic review of mental health self-care strategies for Arabic-speaking refugees and migrants. BMC Public Health 2023; 23:2544. [PMID: 38124024 PMCID: PMC10731719 DOI: 10.1186/s12889-023-17395-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/02/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Self-care strategies can improve mental health and wellbeing, however, the evidence on preferred strategies among Arabic-speaking refugees and migrants is unclear. This mixed methods systematic review aimed to identify and synthesise the global research on mental health self-care strategies used by these populations. METHODS English and Arabic language studies reporting on positive mental health self-care strategies to address symptoms of posttraumatic stress disorder, generalised anxiety and depression in the target populations were identified by systematically searching eight electronic databases and grey literature. Studies were deemed eligible if they were published from 2000 onwards and included Arabic-speaking migrants, refugees or asylum seekers aged 12 years and above. A narrative synthesis of study characteristics and relevant key findings was undertaken. The review protocol was registered on PROSPERO (registration number CRD42021265456). RESULTS Fifty-nine records reporting 57 studies were identified, the majority appearing after 2019. There were 37 intervention studies that incorporated a self-care component and 20 observational studies that reported on self-generated self-care practices. Across both study types, four broad groups of mental health self-care were identified-social, psychological, religious/spiritual, and other (e.g., expressive arts and exercise). Psychological strategies were the most reported self-care practice overall and featured in all intervention studies. Religious/spiritual and social strategies were more common in the observational studies. Intervention studies in diverse settings reported statistical improvements on a range of outcome measures. Observational studies reported a range of individual and community benefits. Linguistic, cultural and religious considerations, inherent in the observational studies, were variably addressed in the individual and group interventions. CONCLUSION Overall, study participants experienced self-care as helpful although some encountered challenges in practicing their preferred strategies. Further research on mental health self-care strategies among Arabic-speaking refugees and migrants is needed in Western resettlement countries to guide mental health service delivery and primary healthcare initiatives for new arrivals and in transit countries.
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Affiliation(s)
- Deena Mehjabeen
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, Australia.
| | - Ilse Blignault
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, Australia
| | - Perjan Hashim Taha
- College of Medicine, University of Duhok, Duhok, Iraq
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - Nicola Reavley
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Shameran Slewa-Younan
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, Australia
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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Kaur M, Kamalyan L, Abubaker D, Alheresh R, Al-Rousan T. Self-reported Disability Among Recently Resettled Refugees in the United States: Results from the National Annual Survey of Refugees. J Immigr Minor Health 2023:10.1007/s10903-023-01580-4. [PMID: 38108982 DOI: 10.1007/s10903-023-01580-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
The prevalence rates and correlates of mental or physical disability among recently resettled refugees, who undergo strenuous journeys before arriving in the US, remain unknown, masking potential health disparities. Self-reported disability was measured by the 2018 Annual Survey of Refugees (ASR), and defined as having a physical, mental, or other health condition for more than 6 months that precluded one from working. Prevalence rates of self-reported disability and sample correlates were investigated using descriptive and logistic regression analyses. Of N = 4259 participating refugees in ASR (Mean Age = 28.2, SD = 17.2; 52.5% male), 2875 responded to the disability question and 21.4% reported disability. About 33.7% were born in the Middle East region, 29.5% had no formal education, and 35% had an income of less than $15,000. Age (OR = 1.06, 95% Confidence Interval (CI) [1.06,1.07], p < 0.001), region of birth (OR = 1.82, 95% CI [1.31, 2.51], p < 0.001), employment status (OR = 3.31, 95% CI [2.67, 4.11], p < 0.001), and receiving food stamps (OR = 2.09, 95% CI [1.66, 2.62], p < 0.001) were associated with self-reported disability. Disability levels among refugees recently resettled in the United States are comparable to national disability rates in the US. Our results suggest that multiple aspects of the refugee experience (i.e., demographics, socioeconomic status, contextual migration history) need to be considered to understand the risk for health outcomes. Future investigations of disabilities in diverse refugee populations over time and tailored public health interventions to mitigate potential risk factors are warranted to promote health equity.
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Affiliation(s)
- Mehak Kaur
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, CA, USA
| | - Lily Kamalyan
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego, CA, USA
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University, University of California, San Diego, CA, USA
| | - Dania Abubaker
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University, University of California, San Diego, CA, USA
- Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, CA, USA
| | | | - Tala Al-Rousan
- Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, CA, USA.
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Adhena G, Fikre A. Teenage pregnancy matters in refugee setup: early pregnancy among adolescent girls in Kule refugee camp, Gambella, Ethiopia. BMC Pregnancy Childbirth 2023; 23:861. [PMID: 38097996 PMCID: PMC10720232 DOI: 10.1186/s12884-023-06178-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 12/05/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND An estimated 21 million adolescent girls become pregnant with nearly half of these pregnancies being unintended, and more than half end in unsafe abortion in low and middle-income countries every year. Teenage pregnancy causes serious health, social, and economic consequences around the globe. Despite it is a common problem in the whole community it is more devastating when this occurs in a refugee setup. This study assessed the magnitude of teenage pregnancy in the Kule refugee camp, in Ethiopia. METHODS A community-based mixed cross-sectional study was done among 422 adolescent girls. Participants were selected using a systematic sampling technique. A structured, pre-tested, and interviewer-administered questionnaire was used to collect the data. Binary and multivariable logistic regression was used to identify associated factors. Adjusted odds ratio with 95% CI was used to show the strength and direction of the association. For the qualitative part, four focused group discussion sessions were done, and participants were selected purposely. Thematic analysis was used to analyze, and the finding was triangulated with quantitative findings. RESULT A total of 146 adolescents (34.6%, 95% CI: (29.9, 38.9)) have experienced pregnancy at least one time. Age (≤ 16) [AOR = 0.48, 95% CI: (0.27, 0.85)], not attending school [AOR = 3.59, 95% CI: (1.2, 10.8)], having a mother with no history of teenage pregnancy [AOR = 0.45, 95% CI: (0.21, 0.98)], being unmarried [AOR = 0.21, 95% CI: (0.12, 0.36)], and having a sister/s with a history of teenage pregnancy [AOR = 2.22, 95% CI: (1.33, 3.7)] were significantly associated factors. CONCLUSION More than one-third of adolescents experience teenage pregnancy. The magnitude of teenage pregnancy was high which may lead to serious health consequences for both the mother and their fetus. Addressing cultural barriers and strengthening adolescent reproductive health education to decrease intergenerational transmission of teenage pregnancy through community awareness and strengthening reproductive parent-adolescent Sexual and Reproductive Health communication are important measures to tackle the problem.
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Affiliation(s)
- Girmay Adhena
- Department of Reproductive Health, International Medical Corps, Gambella, Ethiopia.
| | - Arega Fikre
- Department of Health, International Medical Corps, Addis Ababa, Ethiopia
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Saseetharran A, Hiebert L, Gupta N, Nyirahabihirwe F, Kamali I, Ward JW. Prevention, testing, and treatment interventions for hepatitis B and C in refugee populations: results of a scoping review. BMC Infect Dis 2023; 23:866. [PMID: 38071291 PMCID: PMC10709891 DOI: 10.1186/s12879-023-08861-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND AND AIMS Refugees are at higher risk for hepatitis B (HBV) and hepatitis C (HCV), but often face unique healthcare barriers to vaccination, testing, and treatment. This scoping review aimed to identify and characterize HBV and HCV prevention and care services serving refugee populations globally. METHODS A literature search was conducted on Embase, Cochrane, and PubMed databases. Research studies published in English between January 2010 to July 2022 describing an HBV or HCV prevention, testing, or treatment intervention for refugees were included. RESULTS There were a total of 69 articles reporting viral hepatitis prevalence, implementation of services, or economic modelling. Of the 38 implementation studies, 14 were stand-alone HBV and/or HCV interventions, while 24 studies included HBV and/or HCV in an intervention targeting multiple infectious diseases and/or parasitic infections. Interventions commonly included a testing (n = 30) or referral (n = 24) component. Frequently reported features to promote program accessibility included bilingual services (n = 25), community partnerships (n = 21), and multidisciplinary staff members (n = 18), such as cultural and/or linguistic mediators, community health workers, community health leaders, lay health workers, local health staff, members of the refugee community, and social workers. The most commonly reported challenge was the transience of refugees (n = 5). Twenty studies noted funding sources, of which twelve reported governmental funding (not including national health insurance) and eight reported that refugees received national health insurance. CONCLUSIONS This is the first scoping review to characterize the types of hepatitis prevention, screening, and treatment interventions serving refugee populations globally. Published experiences of HBV and HCV services for refugee populations remain limited. Additional efforts are needed to disseminate models of hepatitis interventions for refugees to ensure access to care for this key population. To achieve hepatitis elimination globally, best practices must be identified and shared to expand access to hepatitis services for refugee populations.
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Affiliation(s)
- Ankeeta Saseetharran
- Coalition for Global Hepatitis Elimination, 330 W Ponce de Leon Ave, Decatur, GA 30030, USA.
| | - Lindsey Hiebert
- Coalition for Global Hepatitis Elimination, 330 W Ponce de Leon Ave, Decatur, GA 30030, USA
| | - Neil Gupta
- Coalition for Global Hepatitis Elimination, 330 W Ponce de Leon Ave, Decatur, GA 30030, USA
| | | | | | - John W Ward
- Coalition for Global Hepatitis Elimination, 330 W Ponce de Leon Ave, Decatur, GA 30030, USA
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Lokot M, Hartman E, Hashmi I. Participatory approaches and methods in gender equality and gender-based violence research with refugees and internally displaced populations: a scoping review. Confl Health 2023; 17:58. [PMID: 38066619 PMCID: PMC10704759 DOI: 10.1186/s13031-023-00554-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 11/22/2023] [Indexed: 01/05/2024] Open
Abstract
Using participatory approaches or methods are often positioned as a strategy to tackle power hierarchies in research. Despite momentum on decolonising aid, humanitarian actors have struggled to describe what 'participation' of refugees and internally displaced persons (IDPs) means in practice. Efforts to promote refugee and IDP participation can be tokenistic. However, it is not clear if and how these critiques apply to gender-based violence (GBV) and gender equality-topics that often innately include power analysis and seek to tackle inequalities. This scoping review sought to explore how refugee and IDP participation is conceptualised within research on GBV and gender equality. We found that participatory methods and approaches are not always clearly described. We suggest that future research should articulate more clearly what constitutes participation, consider incorporating feminist research methods which have been used outside humanitarian settings, take more intentional steps to engage refugees and IDPs, ensure compensation for their participation, and include more explicit reflection and strategies to address power imbalances.
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Affiliation(s)
- Michelle Lokot
- London School of Hygiene and Tropical Medicine, London, UK.
| | - Erin Hartman
- London School of Hygiene and Tropical Medicine, London, UK
| | - Iram Hashmi
- London School of Hygiene and Tropical Medicine, London, UK
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Ho CH, Denton AH, Blackstone SR, Saif N, MacIntyre K, Ozkaynak M, Valdez RS, Hauck FR. Access to Healthcare Among US Adult Refugees: A Systematic Qualitative Review. J Immigr Minor Health 2023; 25:1426-1462. [PMID: 37009980 DOI: 10.1007/s10903-023-01477-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 04/04/2023]
Abstract
Refugees encounter numerous healthcare access barriers in host countries, leading to lower utilization rates and poorer health outcomes. In the US, social inequities and fragmented health systems may exacerbate these disparities. Understanding these factors is necessary to ensure equitable care of refugee populations. A systematic literature review of qualitative studies on US adult refugee healthcare access from January 2000 to June 2021 was performed in accordance with PRISMA. Studies were analyzed deductively and then inductively to incorporate previous findings in other resettlement countries and emergence of US-specific themes. 64 articles representing 16+ countries of origin emerged from the final analysis, yielding nine interrelated themes related to health literacy, cost of services, cultural beliefs, and social supports, among others. The main challenges to refugees' healthcare access emerge from the interactions of care fragmentation with adverse social determinants. Given diverse barriers, integrated care models are recommended in treating refugee populations.
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Affiliation(s)
- Chi H Ho
- Department of Public Health Sciences, Frank Batten School of Leadership and Public Policy, University of Virginia, Charlottesville, VA, USA
| | - Andrea H Denton
- Claude Moore Health Sciences Library, University of Virginia, Charlottesville, VA, USA
| | - Sarah R Blackstone
- Office of Institutional Research, James Madison University, Harrisonburg, VA, USA
| | - Nadia Saif
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, Baltimore, MD, USA
| | - Kara MacIntyre
- Office of Institutional Research, James Madison University, Harrisonburg, VA, USA
| | - Mustafa Ozkaynak
- College of Nursing, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Rupa S Valdez
- Department of Public Health Sciences, Department of Engineering Systems and Environment, University of Virginia, Charlottesville, VA, USA
| | - Fern R Hauck
- Department of Family Medicine, Department of Public Health Sciences, University of Virginia, PO Box 800729, Charlottesville, VA, 22908-0729, USA.
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Stryker SD, Conway K, Kaeppler C, Porada K, Tam RP, Holmberg PJ, Schubert C. Underprepared: influences of U.S. medical students' self-assessed confidence in immigrant and refugee health care. Med Educ Online 2023; 28:2161117. [PMID: 36594616 PMCID: PMC9815430 DOI: 10.1080/10872981.2022.2161117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 06/19/2022] [Accepted: 12/16/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND United States (U.S.) census data from 2017 indicates that the percentage of persons born outside of the U.S. is increasing. However, no studies describe the amount of class time focused on immigrant and refugee health during medical school in the U.S. nor on incoming residents' confidence in providing culturally sensitive care. The objective of this study is to characterize final-year medical students' exposure to immigrant and refugee health and their confidence in caring for these populations. METHODS A voluntary, cross-sectional survey was sent electronically to fourth-year medical students at twelve U.S. medical schools in 2020, with 707 respondents (46% response rate). Questions addressed respondents' curricular exposure to immigrant and refugee health care during medical school and their confidence in providing culturally sensitive care. Chi-square tests were used to assess relationships between categorical variables, and odds ratios were calculated for dichotomized variables. RESULTS Most students (70.6%) described insufficient class time dedicated to culturally sensitive care, and many (64.5%) reported insufficient clinical exposure in caring for immigrants/refugees. The odds that incoming residents felt 'usually' or 'always' confident in their ability to provide culturally sensitive care to immigrants and refugees were higher in those with more class time on culturally sensitive care (OR 5.2 [3.6-7.4]), those with more clinical opportunities to care for immigrants and refugees (OR 7.2 [5.1-10.2]), and those who participated in a domestic low-resource or international elective (OR 1.4 [1.02-1.9]). More than half (55.3%) of respondents reported feeling 'not at all' or only 'sometimes' confident in their ability to provide culturally sensitive care to immigrants/refugees. CONCLUSIONS Most fourth-year U.S. medical students entering residency feel unprepared to deliver culturally sensitive care to immigrants and refugees. This may be mediated by increased exposure to didactic curricula class time and/or experiential clinical activities, as those factors are associated with improved student confidence.
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Affiliation(s)
- Shanna D. Stryker
- Department of Family and Community Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Katharine Conway
- Department of Family Medicine, Boonshoft School of Medicine, Wright State University, Dayton, Ohio, USA
| | - Caitlin Kaeppler
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin,USA
| | - Kelsey Porada
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin,USA
| | - Reena P. Tam
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | | | - Charles Schubert
- Department of Family and Community Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
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Essex R, Dudley M. Resistance and the delivery of healthcare in Australian immigration detention centres. Monash Bioeth Rev 2023; 41:82-95. [PMID: 37812375 PMCID: PMC10754717 DOI: 10.1007/s40592-023-00182-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 10/10/2023]
Abstract
There are few issues that have been as vexing for the Australian healthcare community as the Australian governments policy of mandatory, indefinite, immigration detention. While many concepts have been used to begin to describe the many dilemmas faced by healthcare professionals and their resolution, they are limited, perhaps most fundamentally by the fact that immigration detention is antithetical to health and wellbeing. Furthermore, and while most advice recognises that the abolition of detention is the only option in overcoming these issues, it provides little guidance on how action within detention could contribute to this. Drawing on the work of political theorists and the broader sociological literature, we will introduce and apply a form of action that has not yet been considered for healthcare workers within detention, resistance. We will draw on several examples from the literature to show how everyday resistance could be enacted in healthcare and immigration detention settings. We argue that the concept of resistance has several conceptual and practical advantages over much existing guidance for healthcare workers in these environments, namely that it politicises care and has synergies with other efforts aimed at the abolition of detention. We also offer some reflections on the justifiability of such action, arguing that it is largely consistent with the existing guidance produced by all major healthcare bodies in Australia.
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Affiliation(s)
- Ryan Essex
- Institute for Lifecourse Development, University of Greenwich, Old Royal Naval College, Park RowLondon, London, SE10 9LS, UK.
| | - Michael Dudley
- School of Psychiatry, University of New South Wales, High St, Kensington, NSW, 2052, Australia
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Khai TS, Asaduzzaman M. Preventive knowledge, attitude, and vaccination challenges for COVID-19 among Myanmar refugees and irregular migrants in Malaysia. Vaccine X 2023; 15:100360. [PMID: 37560758 PMCID: PMC10407728 DOI: 10.1016/j.jvacx.2023.100360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 07/20/2023] [Accepted: 07/26/2023] [Indexed: 08/11/2023] Open
Abstract
Access to vaccinations is crucial for everyone in the fight against the COVID-19 pandemic, regardless of migration or refugee status. This study explored COVID-19 prevention knowledge, attitudes, and vaccination challenges among refugees and irregular migrants from Myanmar in Malaysia. This study employed a descriptive mixed-method approach. Convenience sampling was used to conduct an online survey of 174 participants and two focus groups (N = 14). The majority (51.7 %) were refugees, and 48% were irregular migrant workers. In this study, 90.9% of the participants used social networks and social media chats to obtain information about COVID-19, 84.1% understood and found the vaccination campaign helpful, and 44.2% were aware of it. Although 70% of the participants considered vaccination crucial, 95% said that they would not take it because of fear of arrest and deportation, even though they considered vaccination necessary. Approximately 21.2% of the workers reported that their employers did not provide masks or hand sanitisers. Most of the participants (39.7 %) lived in dormitories provided by their employers. This puts them at a higher risk of infection because of the difficulty in practising social distancing. As part of COVID-19 prevention, the government should grant an amnesty period and work with migrant civil society organisations to administer vaccinations and effective measures for all immigrant populations in Malaysia.
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Affiliation(s)
- Tual Sawn Khai
- School of Graduate Studies, Lingnan University, Hong Kong Special Administrative Region
- Refugee Law Initiative (RLI), School of Advanced Study, University of London, United Kingdom
| | - Muhammad Asaduzzaman
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, 450 Oslo, Norway
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Zhang M, Payton C, Gurung A, Anglewicz P, Subedi P, Ali A, Ibrahim A, Haider M, Hamidi N, Atem J, Thang J, Wang S, Kim C, Kimball SL, Karaki F, Nazhat N, Abouagila M, Yun K. COVID-19 Infection and Contact Tracing Among Refugees in the United States, 2020-2021. J Immigr Minor Health 2023; 25:1239-1245. [PMID: 36586088 PMCID: PMC9803886 DOI: 10.1007/s10903-022-01441-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2022] [Indexed: 01/01/2023]
Abstract
Refugees in the United States are believed to be at high risk of COVID-19. A cross-sectional study design was utilized to collect anonymous, online surveys from refugee communities in the United States during December 2020 to January 2021. We invited bilingual community leaders to share the survey link with other refugees aged ≥18 years. We identified factors associated with COVID-19 infection and measured the distribution of contact tracing among those who tested positive. Of 435 refugees who completed the survey, 26.4% reported testing positive for COVID-19. COVID-19 infection was associated with having an infected family member and knowing people in one's immediate social environment who were infected. Among respondents who tested positive, 84.4% reported that they had been contacted for contact tracing. To prepare for future pandemics, public health authorities should continue partner with refugee community leaders and organizations to ensure efficient programs are inclusive of refugee communities.
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Affiliation(s)
- Mengxi Zhang
- Department of Health Systems and Implementation Science, Virginia Tech Carilion School of Medicine, Roanoke, VA, 24073, USA.
| | - Colleen Payton
- School of Nursing and Public Health, Moravian University, Bethlehem, PA, USA
| | - Ashok Gurung
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Philip Anglewicz
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Parangkush Subedi
- Office of Refugee Resettlement, Administration for Children and Families, US Department of Health and Human Services, Washington DC, USA
| | - Ahmed Ali
- Somali Health Board, Seattle, WA, USA
| | - Anisa Ibrahim
- Pediatric Clinic, Harborview Medical Center, Seattle, WA, USA
| | - Mahri Haider
- Division of General Internal Medicine, University of Washington, Seattle, WA, USA
- International Medicine Clinic, Harborview Medical Center, Seattle, WA, USA
| | | | - Jacob Atem
- Southern Sudan Healthcare Organization, Okemos, MI, USA
| | - Jenni Thang
- Department of Consulting Psychology, Purdue University, West Lafayette, IN, USA
| | - Siqin Wang
- School of Earth and Environmental Sciences, University of Queensland, Brisbane, QLD, Australia
- Graduate School of Interdisciplinary Information Studies, University of Tokyo, Tokyo, Hongo, Japan
| | - Curi Kim
- Office of Refugee Resettlement, Administration for Children and Families, US Department of Health and Human Services, Washington DC, USA
| | - Sarah L Kimball
- Boston University School of Medicine, 72 E Concord St, Boston, MA, USA
- Immigrant and Refugee Health Center, Boston Medical Center, 725 Albany St, Suite 5B, Boston, MA, USA
| | - Fatima Karaki
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | | | - Mouammar Abouagila
- Refugee Resettlement and Placement Services, Lutheran Community Services Northwest, SeaTac, WA, USA
| | - Katherine Yun
- Division of General Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine Philadelphia, 3401 Civic Center Blvd. , Philadelphia, PA, USA.
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Soeiro RE, de Siqueira Guida JP, da-Costa-Santos J, Costa ML. Sexual and reproductive health (SRH) needs for forcibly displaced adolescent girls and young women (10-24 years old) in humanitarian settings: a mixed-methods systematic review. Reprod Health 2023; 20:174. [PMID: 37996929 PMCID: PMC10668438 DOI: 10.1186/s12978-023-01715-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/10/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Globally, there are 42 million women and girls estimated to be forcibly displaced. Adolescent girls and young women in humanitarian settings have their sexual and reproductive health (SRH) neglected. This systematic review aimed to describe SRH obstacles that adolescent girls and young women (10-24 years old) face in humanitarian settings in line with the Sustainable Development Goals. METHODS We conducted a mixed-methods systematic review in six databases, focusing on migrant women ages 10 - 24and their SRH outcomes. The mixed-methods appraisal tool was used to evaluate the quality of the studies. This review follows PRISMA and the Systematic Review Guidelines from the Centre for Reviews and Dissemination recommendations. RESULTS Among the 1290 studies screened by abstracts, 32 met the eligibility criteria: 15 were qualitative, 10 were quantitative and seven were mixed-methods studies. Most studies were performed in the last four years, in African countries. They discussed the increased frequency of adolescent pregnancies (16-23%), lack of contraceptive use and access (8-32%), poor menstrual hygiene management (lack of water, shortage of menstrual hygiene supplies), ignorance and stigma about sexually transmitted infections and HIV, a higher number of child, early and forced marriage or partnership and sexual and gender-based violence, challenging to obtain SRH information/knowledge/access, and unmet SRH needs. CONCLUSION Migration is a current issue. Although there is a growing number of studies on adolescent girls and young women's SRH in humanitarian settings, this population remains overlooked, and face several challenges in SRH. There is a need for targeting interventions on SRH.
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Affiliation(s)
- Rachel E Soeiro
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), 101 Alexander Fleming St, Campinas, SP, Brazil
| | - José Paulo de Siqueira Guida
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), 101 Alexander Fleming St, Campinas, SP, Brazil
| | - Juliana da-Costa-Santos
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), 101 Alexander Fleming St, Campinas, SP, Brazil
| | - Maria Laura Costa
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), 101 Alexander Fleming St, Campinas, SP, Brazil.
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Rogers HJ, Ao CSEH, Henry A. Perspectives of women and partners from migrant and refugee backgrounds accessing the Cross Cultural Worker Service in maternity and early childhood services-a survey study. BMC Health Serv Res 2023; 23:1233. [PMID: 37946230 PMCID: PMC10636916 DOI: 10.1186/s12913-023-10194-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 10/21/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Women from migrant and refugee backgrounds living in high-income countries have increased risk of adverse perinatal outcomes and report lower satisfaction with perinatal healthcare. In Sydney, Australia, a new service known as the Cross Cultural Workers (CCWs) in Maternity and Child and Family Health Service (the CCW Service) was implemented to support such women and families from pregnancy to the early parenting period. This study aimed to ascertain the experiences of women and their partners engaging with the CCW Service. METHODS A survey study was undertaken. Women accessing the CCW Service were recruited during pregnancy and were asked to complete surveys at three time points: in the third trimester of pregnancy, at 6 and 12 months postpartum. Their partners were invited to complete a survey at 6 months postpartum. Survey data were analysed to compare satisfaction, usefulness, number of CCW interactions, cultural sensitivity, and service improvement recommendations across all three survey timepoints. RESULTS A total of 231 surveys were received: 113 during pregnancy, 50 at 6-months postpartum, 44 at 12-months postpartum, and 24 partner surveys. Participants in all surveys reported the CCW Service to be useful (84-94%), stating that it increased their understanding of pregnancy, birth and parenting (95-100%), and that they would recommend the CCW Service (92-98%). Participants experienced a high level of satisfaction (88-95%) irrespective of the number of CCW interactions (p = 0.42). Thoughts on becoming a mother or parent were more positive after meeting the CCW than before for both women (p = 0.01) and partners (p = 0.12). Suggestions for CCW Service improvement were to 1) increase the provision of information, specifically financial entitlements, postnatal depression, and support services, 2) increase involvement of partners in care, 3) increase the CCW workforce/or number of CCWs. CONCLUSION The CCW Service was associated with positive experiences and high rates of satisfaction at all timepoints. This service has the potential to inform the implementation of similar models of care that improve accessibility, the perinatal experience, and respond to the unique needs of women and families from migrant and refugee backgrounds.
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Affiliation(s)
- Helen J Rogers
- Child, Youth & Family Services, South Eastern Sydney Local Health District, Sydney, NSW, 2010, Australia.
- Discipline of Women's Health, School of Clinical Medicine, University of NSW (UNSW), Sydney, NSW, 2000, Australia.
| | - Caroline S E Homer Ao
- Maternal and Child Health, Burnet Institute, Melbourne, Vic, 3004, Australia
- Centre for Midwifery and Child and Family Health, Faculty of Health, University of Technology Sydney), Sydney, NSW, 2007, Australia
| | - Amanda Henry
- Discipline of Women's Health, School of Clinical Medicine, University of NSW (UNSW), Sydney, NSW, 2000, Australia
- Department of Women's and Children's Health, St George Hospital, Sydney, NSW, 2217, Australia
- Australia Global Women's Health Program, The George Institute for Global Health, Sydney, NSW, 2042, Australia
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Cavit L, Charania NA. Exploring factors that influence vaccination uptake for children with refugee backgrounds: An interpretive description study of primary healthcare providers' perspectives. Vaccine 2023; 41:6690-6699. [PMID: 37802749 DOI: 10.1016/j.vaccine.2023.09.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/21/2023] [Accepted: 09/26/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Children with refugee backgrounds are at high risk of acquiring vaccine preventable diseases (VPDs) due to a complex set of factors, one being under-immunisation. In Aotearoa New Zealand (NZ), reported age-appropriate vaccination rates are suboptimal among children with refugee backgrounds. METHODS A qualitative interpretive description study was undertaken to explore factors associated with access and uptake of immunisations and develop strategies to improve age-appropriate vaccinations among refugee children post-resettlement in NZ. Semi-structured interviews were conducted with healthcare providers (nurses and doctors) (N = 14) across seven resettlement locations in NZ. Collected data was transcribed verbatim and thematically analysed. RESULTS Five themes were derived from the data that demonstrate the interrelated factors that influence vaccination uptake across the refugee caregiver, health provider and system levels. Providers discussed how caregivers' competing resettlement priorities and challenges early in the resettlement phase influenced their knowledge and access of vaccines and health services in NZ. Providers' knowledge of refugee caregivers' concerns was seen as a driver for positive change in forming therapeutic relationships with, and delivering health services to, former refugees. They discussed system level factors that influence access to and provision of immunisation services, such as resourcing, resettlement policies, system inefficiencies and missed opportunities. Emphasis was placed on communication between patients and providers to facilitate positive immunisation experiences. Overwhelming, providers displayed high motivation to improve immunisation services. Strategies were suggested to overcome identified barriers and included the provision of culturally and linguistically appropriate resources, education campaigns, reducing access barriers (e.g., after-hours clinics), and improving system efficiencies. CONCLUSIONS These findings highlight root factors that impact immunisation uptake and experiences among children with refugee backgrounds. To reduce the burden of VPDs, broad system level changes are required to address the barriers to vaccine uptake faced by both families of refugee backgrounds and health providers.
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Affiliation(s)
- Larisa Cavit
- Department of Public Health, Auckland University of Technology, 640 Great South Road, Manukau, Auckland 2025, New Zealand
| | - Nadia A Charania
- Department of Public Health, Auckland University of Technology, 640 Great South Road, Manukau, Auckland 2025, New Zealand; Migrant and Refugee Health Research Centre, Auckland University of Technology, Auckland, New Zealand.
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Smyth E, Steel C, Ellett L. The prevalence of non-affective psychosis in refugee populations: A systematic review. Schizophr Res 2023; 260:99-112. [PMID: 37634388 DOI: 10.1016/j.schres.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 06/27/2023] [Accepted: 08/13/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND As we face the largest refugee crisis since World War Two, research is increasingly examining the impact of forced displacement. The risk of non-affective psychosis in refugees is evidenced to be significantly greater than non-refugees, and the role of pre-, peri- and post-migratory trauma and dissociation is increasingly implicated. AIMS To determine the prevalence of non-affective psychosis in refugee populations. METHOD PRISMA guidelines were followed. Three key databases (PubMed, PsychINFO and Web of Science), Google scholar and study references were searched. The full-text of 62 studies were screened and 23 studies were eligible for inclusion. A narrative synthesis was undertaken and the Quality Assessment Tool for Quantitative Studies was used to assess methodological quality. (PROSPERO registration CRD42019152170). RESULTS The results were widely heterogeneous. The combined weighted average prevalence of non-affective psychosis in refugee populations was 0.9 %. Psychosis prevalence for individual psychotic symptoms was 28.4 %; 0.5 % for schizophrenia; 1.0 % for psychosis; 0.6 % for mixed psychotic disorders and 2.9 % for psychotic episodes. CONCLUSIONS Variations in examined populations, diagnostic and prevalence classifications, and study designs and methodologies likely contributed to heterogeneity across the data. The findings highlight a greater need to provide more specialist mental health services and trauma-focused interventions, as well as transculturally sensitive assessment and treatment to address refugee vulnerability to psychosis. Future research should examine psychosis prevalence longitudinally and in refugees-only, address methodological bias and further examine the role of trauma and dissociation in refugee psychosis prevalence.
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Affiliation(s)
- Emily Smyth
- Psychology Department, Royal Holloway, University of London, Egham Hill, Egham TW20 0EX, UK.
| | - Craig Steel
- The Oxford Institute of Clinical Psychology Training and Research, The Oxford Centre for Psychological Health, University of Oxford, Isis Education Centre, Warneford Hospital, Oxford OX3 7JX, UK.
| | - Lyn Ellett
- School of Psychology, University of Southampton, UK.
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Leps C, Monteiro J, Barozzino T, Bowry A, Rashid M, Sgro M, Suleman S. Interim Federal Health Program: Survey of use of supplemental benefits by paediatric health care providers. Paediatr Child Health 2023; 28:344-348. [PMID: 37744757 PMCID: PMC10517246 DOI: 10.1093/pch/pxad011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 02/07/2023] [Indexed: 09/26/2023] Open
Abstract
Objectives The Interim Federal Health Program (IFHP) provides temporary healthcare coverage to refugees and refugee claimants. Previous research demonstrates that paediatric healthcare providers poorly utilize the IFHP, with low registration rates and limited understanding of the program. The objective of this study was to examine paediatric provider use of IFHP-covered supplemental benefits, and their experience with trying to access these benefits. Methods A one-time survey was administered via the Canadian Paediatric Surveillance Program in February 2020. Of those who had provided care to IFHP-eligible patients, descriptive tables and statistics were created looking at provider demographics, and experience using the IFHP supplemental benefits. A multinomial logistic regression was built to look at provider characteristics associated with trying to access supplemental benefits. Results Of the 2,753 physicians surveyed, there were 1,006 respondents (general paediatricians and subspecialists). Of the respondents, 526 had recently provided care to IFHP-eligible patients. Just over 30% of those who had recently provided care did not access supplemental benefits as they did not know they were covered by the IFHP. Of those who had tried to access supplemental benefits, over 80% described their experience as difficult, or very difficult. Conclusions Paediatric providers have a poor understanding of IFHP-covered supplemental benefits, which is cited as a reason for not trying to access supplemental benefits. Of those who do try to access these benefits, they describe the process as difficult. Efforts should be made to improve provider knowledge and streamline the process to improve access to healthcare for refugee children and youth.
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Affiliation(s)
- Caroline Leps
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario
| | - Jessica Monteiro
- McGill University, Montreal Children’s Hospital, Pediatrics, Montreal, Quebec
| | - Tony Barozzino
- Women and Children’s Program, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ashna Bowry
- Department of Family and Community Medicine, St Michael’s Hospital, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Meb Rashid
- Department of Family and Community Medicine, Crossroads Clinic, Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Michael Sgro
- Women and Children’s Program, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shazeen Suleman
- Women and Children’s Program, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
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