Responding to the Health Needs of Newly Arrived Families Within Fractured Policy Environments

The increase in forcibly displaced populations seeking refuge in the United States has been met with fragmented, chaotic, and highly politicized responses to the detriment of migrants and receiving communities alike. Migrants encounter compounding systemic barriers to accessing basic resettlement resources. Expanding on pandemic-era innovations can strengthen social safety net infrastructure as a whole. Pediatricians are a potential early touchpoint for newly arrived families, providing an opportunity to support their specific health needs, refer to critical safety net services, and advocate for improved systems and policies. [Pediatr Ann. 2024;53(5):e161-e166.].

Medical Care for Newly Arrived Displaced Persons

Medical Care for Displaced PersonsThe United Nations High Commissioner for Refugees reports that more than 100 million people have been forcibly displaced from their homes due to persecution, conflict, violence, and human rights violations. Displacement has profound health impacts. Here, Jain and colleagues review medical care for newly displaced persons.

What Counts As 'Safe?': Exposure To Trauma And Violence Among Asylum Seekers From The Northern Triangle

In 2019 the United States signed Asylum Cooperative Agreements with the Northern Triangle countries of El Salvador, Guatemala, and Honduras, in Central America. In November 2019 the Trump administration announced that these agreements would be used to permit the expedited removal of asylum seekers from the US, claiming that these countries provided comprehensive legal procedures for adjudicating asylum claims and protection against further persecution. To assess the presence of dangerous conditions in the three countries, we examined forensic medical evaluations of asylum seekers from the Northern Triangle who are in the US and who presented to an academic medical center asylum clinic in Boston, Massachusetts, from 2017 to 2020. Northern Triangle asylum seekers reported high rates of exposure to trauma and violence, including gender-based violence and violence perpetrated by gangs, and they also exhibited a high prevalence of trauma-related psychiatric disorders. Asylum seekers also reported state actors in Northern Triangle countries as perpetrators of violence and described denial of protection from the state when it was solicited. These findings cast doubt on key tenets underpinning the legal basis for the Asylum Cooperative Agreements. The agreements should be formally terminated and investigations undertaken to determine the impact on people who were subject to removal from the US during preliminary implementation.

Forensic Medical Evaluation of Children Seeking Asylum: A Guide for Pediatricians

Applications for asylum in the United States have increased significantly in the past decade, including those by children fleeing persecution. Pediatricians may serve as a resource for children seeking asylum by participating in specialized training and performing forensic medical evaluations for use in the legal process. A forensic medical evaluation comprises an interview to elicit a narrative of reported abuse, a psychological assessment, and/or a medical assessment. Evaluators document an impression of the consistency of medical and psychological findings with the trauma, which forms the legal basis for a child's asylum claim. This article provides guidance to pediatrician evaluators with an emphasis on an age- and development-specific approach to a forensic medical evaluation of children seeking asylum. Collaboration with primary care pediatricians and community partners about asylum evaluations is important to building support for immigrant children who have experienced trauma. [Pediatr Ann. 2020;49(5):e215-e221.].

Global health research in narrative: a qualitative look at the FICRS-F experience

For American professional and graduate health sciences trainees, a mentored fellowship in a low- or middle-income country (LMIC) can be a transformative experience of personal growth and scientific discovery. We invited 86 American trainees in the Fogarty International Clinical Research Scholars and Fellows Program and Fulbright-Fogarty Fellowship 2011-2012 cohorts to contribute personal essays about formative experiences from their fellowships. Nine trainees contributed essays that were analyzed using an inductive approach. The most frequently addressed themes were the strong continuity of research and infrastructure at Fogarty fellowship sites, the time-limited nature of this international fellowship experience, and the ways in which this fellowship period was important for shaping future career planning. Trainees also addressed interaction with host communities vis-à-vis engagement in project implementation. These qualitative essays have contributed insights on how a 1-year mentored LMIC-based research training experience can influence professional development, complementing conventional evaluations. Full text of the essays is available at http://fogartyscholars.org/.

Universal combination antiretroviral regimens to prevent mother-to-child transmission of HIV in rural Zambia: a two-round cross-sectional study

OBJECTIVE

To evaluate if a pilot programme to prevent mother-to-child transmission (PMTCT) of the human immunodeficiency virus (HIV) was associated with changes in early childhood survival at the population level in rural Zambia.

METHODS

Combination antiretroviral regimens were offered to pregnant and breastfeeding, HIV-infected women, irrespective of immunological status, at four rural health facilities. Twenty-four-month HIV-free survival among children born to HIV-infected mothers was determined before and after PMTCT programme implementation using community surveys. Households were randomly selected and women who had given birth in the previous 24 months were asked to participate. Mothers were tested for HIV antibodies and children born to HIV-infected mothers were tested for viral deoxyribonucleic acid. Multivariable models were used to determine factors associated with child HIV infection or death.

FINDINGS

In the first survey (2008-2009), 335 of 1778 women (18.8%) tested positive for HIV. In the second (2011), 390 of 2386 (16.3%) tested positive. The 24-month HIV-free survival in HIV-exposed children was 0.66 (95% confidence interval, CI: 0.63-0.76) in the first survey and 0.89 (95% CI: 0.83-0.94) in the second. Combination antiretroviral regimen use was associated with a lower risk of HIV infection or death in children (adjusted hazard ratio: 0.33, 95% CI: 0.15-0.73). Maternal knowledge of HIV status, use of HIV tests and use of combination regimens during pregnancy increased between the surveys.

CONCLUSION

The PMTCT programme was associated with an increased HIV-free survival in children born to HIV-infected mothers. Maternal utilization of HIV testing and treatment in the community also increased.

Access to facility delivery and caesarean section in north-central Liberia: a cross-sectional community-based study

OBJECTIVE

Rural north-central Liberia has one of the world's highest maternal mortality ratios. We studied health facility birthing service utilisation and the motives of women seeking or not seeking facility-based care in north-central Liberia.

DESIGN

Cross-sectional community-based structured interviews and health facility medical record review.

SETTING

A regional hospital and the surrounding communities in rural north-central Liberia.

PARTICIPANTS

A convenience sample of 307 women between 15 and 49 years participated in structured interviews. 1031 deliveries performed in the regional hospital were included in the record review.

PRIMARY OUTCOMES

Delivery within a health facility and caesarean delivery rates were used as indicators of direct utilisation of care and as markers of availability of maternal health services.

RESULTS

Of 280 interview respondents with a prior childbirth, only 47 (16.8%) delivered their last child in a health facility. Women who did not use formal services cited cost, sudden labour and family tradition or religion as their principal reasons for home delivery. At the regional hospital, the caesarean delivery rate was 35.5%.

CONCLUSIONS

There is an enormous unmet need for maternal health services in north-central Liberia. Greater outreach and referral services as well as community-based education among women, family members and traditional midwives are vital to improve the timely utilisation of care.