COVID-19 vaccine acceptance and COVID-19-induced income disruption among migrant workers in Saudi Arabia

Background

Neither COVID-19 vaccine acceptance nor income changes among migrant workers during the pandemic has been assessed in Saudi Arabia.

Aims

To assess the correlates of willingness to take the COVID-19 vaccine and a decrease in income during the pandemic among migrant workers in Saudi Arabia.

Methods

An electronic questionnaire was administered to 2403 migrant workers from the Middle East and South Asia employed in agriculture, auto repair, construction, food service (restaurants), municipality, and poultry farms in Al-Qassim Province, Saudi Arabia. The interviews were conducted in the native languages of the workers in 2021. Chi-square was used to assess the associations, and a multiple logistic regression was used to generate the odds ratio. Data analysis was conducted using SPSS version 27.

Results

South Asian workers were 2.30 [95% confidence interval (CI): 1.60-3.32] times more likely to accept the COVID-19 vaccine than those from the Middle East (reference group). Restaurant, agriculture and poultry workers were respectively 2.36 (95% CI: 1.41-3.95), 2.13 (95% CI: 1.29-3.51) and 14.56 (95% CI: 5.64-37.59) times more likely to accept the vaccine than construction workers (reference group). Older (≥ 56 years, reference group ≤ 25 years) workers were 2.23 (95% CI: 0.99-5.03) times, auto repair 6.75 (95% CI: 4.33-10.53) times, and restaurant workers 4.04 (95% CI: 2.61-6.25) times more likely to experience a reduction in income than construction workers.

Conclusions

Workers from South Asia were more likely to accept the COVID-19 vaccine and less likely to experience an income reduction than those from the Middle East.

Employment relationships of Chinese expatriates: A multi-foci perspective of psychological contract

Introduction

Research into expatriation has made a great contribution to the understanding of issues surrounding international human resource management. However, academic discussion around the subject of expatriate management remains Western-centred, neglecting the use of expatriate staffing in multinational corporations (MNCs) from Eastern countries. By adopting a multi-foci perspective of the psychological contract, the overall objective of this research is to explore the content of Chinese expatriates' psychological contracts.

Methods

This paper draws on the findings of an organisational case study and is based on semi-structured interviews with 14 expatriates.

Results

The findings provide evidence that individuals have multiple simultaneous psychological contracts, each with a different focus. The contracts held by the Chinese expatriates in this sample contain predominately balanced contract beliefs, which contrast sharply to what the other authors find to be salient beliefs (e.g., transactional contract beliefs) for expatriates based on Western samples. Importantly, the most frequently listed exchange partners by the pre-departure expatriates were line managers and department managers in headquarters; individuals appreciate the respective role of each party in shaping their aspects of work conditions whilst acknowledging the simultaneous existence of such influences.

Discussion

This paper has implications for expatriate management in the following ways. First, managers are encouraged to appreciate the role of multiple parties in shaping expatriates' psychological contracts. This helps to enhance management's understanding on the motives and demands of those expatriates. Second, policies of support and contact would aid feelings of integration. Finally, more attention should be paid to planning expatriate career prospects.

Self-reported Competences of Expatriate Practicing Nurses in Kuwait: A Descriptive Study

AIM

The aim of the study was to explore the perceived self-reported competence of nurses who worked in Kuwaiti hospitals and the predictors influencing the level of competence.

BACKGROUND

Competence in nursing is found to affect patient safety and the quality of care provided to patients. The vast majority of nurses working in the health system are non-Kuwaitis. Thus, it is of the utmost importance to assess nurses' competences as the first step toward ensuring the best quality of care.

METHODS

A cross-sectional, descriptive, correlational design was used. A non-random convenience sample of 220 practicing expatriate nurses working in public hospitals completed the NPC-35 scale and a demographic form. Data collection was done over a period of three weeks from January 26^th, 2020 to February 16^th, 2020.

RESULTS

The findings of the study showed that nurses perceived their competence as good. The results also showed that years of experience, enrollment in a traditional program of study, exposure to training programs, working in accredited hospitals and nationality explained 56% of the variation in the level of Nursing Professional Competence (NPC).

CONCLUSION

The results indicate that nurse leaders and policy makers need to improve nursing orientation and training programs so that they are competence based. The results of the study also point to the importance of revisiting the nursing recruitment policy and managing expatriate nurses while making better investment in educating and producing Kuwaiti national nurses.

Dying in a foreign land: A study of completed suicides among foreign workers in Singapore

Suicide is a public health issue that impacts a nation's resident and non-resident populations alike. Singapore has one of the largest non-resident (work permit holder) populations in the world, yet very little attention has been given to examining suicide in this population. The current study examined the case materials of all 303 non-resident completed suicides in Singapore in the period January 2011 to December 2014. Their basic profiles were compared with that of the 1,507 resident cases in the same period. A sample of 30 death notes written by non-residents were randomly selected and thematically analyzed to supplement the descriptive findings and discussion. Results showed that suicides were highest among males, those aged 21-35 years old, and South Asians. Most non-resident suicide cases did not have known physical or mental health issues, prior suicide attempts, or suicide notes. Suicide decedents from South Asia and Europe most frequently used hanging, while jumping was most common among decedents from other regions. Relationship and health problems emerged as the top two suspected triggers for suicide based on our analysis of the suicide notes. The unique situation of working abroad may increase non-residents' vulnerability in general, while adverse life events such as relationship and health issues may be too overwhelming to bear, especially when support services are not readily available and accessible. The results have implications for suicide prevention among this neglected group of people who choose to work in foreign lands.

The Cassandra Experience: A Mixed Methods Study on the Intragroup Cognitive Dissonance of Italian Expatriates During the First Wave of COVID-19

In March 2020, Italy was the first European country to be hit severely by the first wave of coronavirus disease 2019 (COVID-19) and to put in place moderate-high containment measures. 594 Italian expatriates participated in a cross-sectional mixed-methods survey focusing on the period that goes from the beginning of March 2020 to the beginning of April 2020. The survey aimed to describe the experiences of participants when it comes to conflicting beliefs and behavior with the Italian or host country communities in relation to COVID-19, using the Intragroup Cognitive Dissonance (ICD) framework. We explored: (1) COVID-19 risk perception (assessed for themselves, the Italian community, and the host country community); (2) COVID-19 risk meta-perception (participants' perception of the Italian and host country communities' risk perception); (3) intensity of emotions (assessed for themselves); (4) national group identification (assessed for themselves in relation to the Italian and host country communities) before and after the first wave of COVID-19 in Italy. An inductive thematic analysis of three open-ended questions allowed an in-depth understanding of the experiences of Italian expatriates. Results describe the ICD of participants with the Italian or host country communities, expressed as a difference between COVID-19 risk-perception and risk meta-perception. ICD predicts that when a dissonance of beliefs and behavior is experienced within an individual's group, a shift in identification with another more consonant group will happen, if identity enhancing strategies with the dissonant group are unsuccessful. Our findings showed that when the ICD was experienced with the host country community, this was solved through a disidentification strategy and mediated by negative emotions. Identity enhancing strategies with the host country community were unsuccessfully enacted as described by the qualitative answers of participants referring to episodes of racism, ridicule, and to a Cassandra experience: predicting a catastrophic future without being believed. Unexpectedly, participants experiencing the ICD with the Italian community did not enact a disidentification strategy. An increase in virtual contacts, enhanced sense of belonging, a stronger identification baseline, and different features of the two ICDs can be responsible for these results. This study sheds light on the relevance of ICD in natural settings and on international communities, during global crises.

Foreign workers in the Middle East during COVID-19

The COVID-19 pandemic is having an unprecedented and consequential impact on global economies, businesses, and workforces. Foreign nationals account for the majority of the population in the Middle East. Throughout this article, the authors address the negative ramifications the COVID-19 pandemic has had on the migrant workforce in the Middle East. This pandemic has intensified various socio-economic and public health crises such as unemployment, income cuts, depletion of savings, repatriation difficulties, inadequate living conditions, and associated burden on healthcare facilities by the COVID-19 infection.

Cosmopolitan enclaves: An introduction

Cosmopolitan enclaves emerge at the intersection of global dynamics and local contexts as spaces where the cultivation of a cosmopolitan ethos encounters processes of socio-spatial boundary work and segregation. In the introduction to this special issue, we discuss under which circumstances the intention to cultivate open-mindedness goes hand in hand with keeping the local environment at bay. We argue that ethnographic attention to cosmopolitan enclaves may help bridge macro-level observations regarding globalization and its graduated sovereignties with the micro-level understanding of actual day-to-day interactions and boundary work within concrete spaces. We thus address the paradox of the omnipresence of enclaves in a global world and analyse the ambiguous aspirations and expectations derived from cosmopolitan ideals and how they relate to (under)privilege. While cosmopolitan aspirations exist alongside reproductions of postcolonial representations and hierarchies, they may also express the will to resist the politics of exclusion by demarcating an alternative safe haven.

Health Status and Barriers to Healthcare Access among "Son-in-Law Westerners": A Qualitative Case Study in the Northeast of Thailand

The northeast of Thailand is well-known as a popular destination where many male Westerners marry Thai women and settle down there. However, little is known about their health and well-being. This study aims to explore the Western husbands’ health status and identify barriers hindering their healthcare access. A qualitative case study was conducted from November 2020 to May 2021. In-depth interviews and focus group discussions with 42 key informants who were involved with social and health issues among these expatriates were carried out. The social determinants framework was adapted for guiding the interviews. Data were triangulated with field notes, document reviews, and researchers’ observations. Inductive thematic analysis was applied. Results showed that most male expatriates who married Thai women in the northeast were in their retirement years and had non-communicable diseases, health risk behaviors, and mental health problems. Most of them did not purchase health insurance and held negative impressions toward Thai public hospitals’ quality of care, which was denoted as the main barrier to accessing healthcare services. Other significant barriers consisted of high treatment costs commonly charged by private hospitals and language issues. While the improvement of healthcare quality and the provision of friendly health services are important, public communication with foreign residents, especially male expatriates, is recommended to increase understanding and improve perceptions of the Thai healthcare systems. A regular population-based survey on the health and well-being of expatriates in Thailand, a cost study of a health insurance package, a survey study on willingness to pay for health insurance premiums, and a feasibility survey exploring the opportunity to establish either voluntary or compulsory health insurance among this group should be undertaken.

Noncommunicable Disease Service Utilization among Expatriate Patients in Thailand: An Analysis of Hospital Service Data, 2014-2018

Global morbidity associated with noncommunicable diseases (NCDs) has increased over the years. In Thailand, NCDs are among the most prevalent of all health problems, and affect both Thai citizens and non-Thai residents, such as expatriates. Key barriers to NCD health service utilization among expatriates include cultural and language differences. This study aimed to describe the situation and factors associated with NCD service utilizations among expatriate patients in Thailand. We employed a cross-sectional study design and used the service records of public hospitals from the Ministry of Public Health (MOPH) during the fiscal years 2014–2018. The focus of this study was on expatriates or those who had stayed in Thailand for at least three months. The results showed that, after 2014, there was an increasing trend in NCD service utilizations among expatriate patients for both outpatient (OP) and inpatient (IP) care. For OP care, Cambodia, Laos PDR, Myanmar, and Vietnam (CLMV) expatriates had fewer odds of NCD service utilization, relative to non-CLMV expatriates (p-value < 0.001). For IP care, males tended to have greater odds of NCD service utilization compared with females (AdjOR = 1.35, 95% CI = 1.05–1.74, p-value = 0.019). Increasing age showed a significant association with NCD service utilization. In addition, there was a growing trend of the NCD prevalence amongst expatriate patients. This issue points to a need for prompt public health actions if Thailand aims to have all people on its soil protected with universal health coverage for their well-being, as stipulated in the Sustainable Development Goals. Future studies that aim to collect primary evidence of expatriates at the household level should be conducted. Additional research on other societal factors that may help provide a better insight into access to healthcare for NCDs, such as socioeconomic status, beliefs, and attitudes, should be conducted.

Current Epidemiological Characteristics of Imported Malaria, Vector Control Status and Malaria Elimination Prospects in the Gulf Cooperation Council (GCC) Countries

Malaria is the most common vector-borne parasitic infection causing significant human morbidity and mortality in nearly 90 tropical/sub-tropical countries worldwide. Significant differences exist in the incidence of malaria cases, dominant Plasmodium species, drug-resistant strains and mortality rates in different countries. Six Gulf Cooperation Council (GCC) countries (Bahrain, Kuwait, Qatar, Oman, Saudi Arabia and United Arab Emirates, UAE) in the Middle East region with similar climates, population demographics and economic prosperity are aiming to achieve malaria elimination. In this narrative review, all studies indexed in PubMed describing epidemiological characteristics of indigenous and imported malaria cases, vector control status and how malaria infections can be controlled to achieve malaria elimination in GCC countries were reviewed and discussed. These studies have shown that indigenous malaria cases are absent in Bahrain, Kuwait, Qatar and UAE and have progressively declined in Oman and Saudi Arabia. However, imported malaria cases continue to occur as GCC countries have large expatriate populations originating from malaria-endemic countries. Various malaria control and prevention strategies adopted by GCC countries including more stringent measures to reduce the likelihood of importing malaria cases by prior screening of newly arriving expatriates and vector elimination programs are likely to lead to malaria elimination in this region.

Perception of Threat and Psychological Impact of COVID-19 among Expatriates in Makkah Region, Saudi Arabia

In the first few months of the pandemic, Makkah region reported the highest number of COVID-19 cases among all regions in Saudi Arabia. More than 80% of these reported cases were non-Saudi residents. In this study, we evaluated the perceived threat from and psychological impact of COVID-19 among non-Saudi residents of Makkah region. This was a cross-sectional analysis of data collected using a standardized self-report questionnaire. A total of 292 expatriates were included in the study, the majority of whom were non-Arabic speakers. The prevalence of self-reported depression was nearly 40%, anxiety was 32%, and stress was 43%. The findings indicated variability in the prevalence of psychological symptoms among expatriates from different ethnic backgrounds. Additionally, work environment and perceived threat were strong predictors of psychological disorders. This suggested that the perceived threat from and psychological burden of COVID-19 among non-Saudis in Makkah region is substantial. Future research should investigate the reasons behind these variations in the psychological impact of the pandemic among different ethnic groups.

The Role of Extraversion and Openness on Host Country Nationals' Task Performance and Contextual Performance at Work

Purpose

This study answer calls for research on host country nationals (HCNs) by examining factors that may influence HCN task performance and contextual performance during work with their self-initiated expatriate (SIE) colleagues.

Participants and Methods

Data on personality traits (extraversion, openness), socialization self-efficacy, and frequency of interaction, task, and contextual performance were collected by surveying 373 Chinese HCNs. The first author recruited the HCNs through SIEs working and living in China. SIEs who participated in this project provided the email addresses of HCNs with whom they worked.

Results

The frequency of interactions fully mediated the relationship between (a) extraversion with task and contextual performance and (b) openness with task and contextual performance. Only socialization self-efficacy moderated the mediating effects of extraversion on task performance via the frequency of interaction; it also moderated the mediating effects of openness on contextual performance via the frequency of interactions, but not in the hypothesized direction.

Conclusion

This study investigated the neglected stakeholder in the expatriation process, namely, HCNs, and what factors may impact HCNs' performance during work and collaboration with their SIE colleagues.

Differences among Saudi and Expatriate Students: Body Composition Indices, Sitting Time Associated with Media Use and Physical Activity Pattern

Background: Being overweight at a young age is a predictor of developing obesity and related complications later in adulthood, posing a high risk to public health. Various ethnic subgroups have been identified as having a higher prevalence of overweight or obese. Saudi Arabia is one of the fastest-growing economies in the world, where the expatriate population comprises 33% of its total population. The objective of this study was to investigate differences in body composition indices, sitting time associated with media use, and physical activity pattern among a sample of local and expatriate school students in Saudi Arabia. Methods: 500 students (aged 8-18 years) from various schools were invited to participate in this study. Body weight, waist circumference (WC) and height were measured using a portable digital metric scale, standard measuring tape and wall mounted tape respectively. Participants and their parents were jointly asked to report the average time that the participant spent sitting using media (watching TV, playing video games, and using the internet and other screen-based devices etc.) per day. The pattern of physical activity among participants was measured using a short form of the International Physical Activity Questionnaire (IPAQ). Basal metabolic rate (BMR) and total daily energy expenditure (TEE) were estimated from body weight, height, age, sex and physical activity, according to the Harris-Benedict equation. Results: Data from 450 (90%) of the participants were used for analysis. The mean age of the participants was 14.55 ± 1.74 years. Body mass index (BMI), WC, waist to height ratio (WHtR), BMR and TEE differed significantly among the participants. Physical fitness score negatively correlated with BMI and WC, while sitting time associated with media use positively correlated with BMI, WC, WHtR and physical fitness score, among both Saudi and expatriate participants. Conclusions: Body composition indices and sitting time associated with media use were higher among Saudi boys and expatriate girls. Expatriate boys and girls were reported to be physically more active than their Saudi counterparts. BMR and TEE were higher among expatriate boys and Saudi girls. Although this study provides useful information about the association of body composition indices, sitting time associated with media use, and physical activity pattern among local and expatriate school students in SA, similar studies involving a larger study sample, with equal gender representation, are further required to determine various factors associated with this link.

Living Well in Times of Threat: The Importance of Adjustment Processes to Explain Functional Adaptation to Uncertain Security in Expatriates Deployed in the Sudan

The present study investigated expatriate humanitarian aid workers' perceptions and responses to uncertain security while deployed in the Sudan. Interviews conducted in Khartoum (n = 7) and Darfur (n = 17) focused on risk perception, concern for personal security, and strategies used to function well in an insecure environment. Despite a high perceived general risk, as well as broad knowledge and experience with security incidents, participants often expressed low concern. General adjustment processes were drawn on to explain this finding, while different constellations of processes resulted in different patterns of adjustment. Functional adjustment, resulting in adequate risk perception, protective behavior, protection, and low concern, was characterized by a constellation of complementary activation of accommodation and assimilation processes.

The paradox role of extraversion in the cross-cultural adjustment process of Asian expatriates

BACKGROUND

The purpose of this study is to present a broad-brush picture based on empirical evidence on the role of hindrance stressors, motivation, and cultural novelty in expatriate adjustment. Drawing on trait activation theory, this study examines the moderating role of extraversion in enhancing cultural adjustment to achieve positive work engagement and organizational citizenship behavior (OCB) by expatriates.

METHODS

We gathered data using a sample of 458 eastern expatriates with current international assignments in different countries around the world. They completed questionnaires sent to them using online platforms for expatriates.

RESULTS

The results reveal that hindrance stressors and intrapersonal motivation significantly predict adjustment. Adjustment plays a partially mediating role in achieving OCB and expatriate work engagement. However, this work engagement is stronger when adjustment is used as a mediating factor. Surprisingly, our results provided paradox role of extraversion in predicting adjustment which was somewhat in contradiction to our hypothesized direction of moderating effect.

CONCLUSION

Our research puts forward strategies for international business organizations when assigning business expatriates, especially in novel cultures. Our research provides valuable information about expatriates' context for international organizations planning for the accomplishment of their assignments in distant cultures.

Social Support, Adjustment, and Psychological Distress of Help-Seeking Expatriates

The present study aimed to explore the interrelations between support processes, adjustment, and psychological distress within a sample of help-seeking expatriates. Specifically, we examined (1) the association between expatriates’ cross-cultural adjustment (i.e., work, interaction and general adjustment) and levels of psychological distress (i.e., depression, anxiety and stress), (2) the association between expatriates’ perceptions of socioemotional and instrumental support availability and their level of cross-cultural adjustment, and (3) the moderating role of expatriates’ socioemotional and instrumental support needs in the latter association. Findings showed that lower levels of expatriates’ work adjustment were associated with higher levels of psychological distress. Further, perceived availability of socioemotional support was positively linked to expatriates’ interaction and work adjustment. Finally, instrumental support needs moderated the relationship between instrumental support availability and general adjustment such that higher levels of instrumental support availability were associated with better general adjustment, but only for expatriates reporting high needs for instrumental support. Our study represents a novel contribution to the expatriate literature by shedding light on expatriates’ vulnerability for psychological distress and understanding the type of social support that is considered most beneficial for help-seeking expatriates. Suggestions are made for clinical interventions for expatriates in need of support.

Expatriate Family Adjustment: An Overview of Empirical Evidence on Challenges and Resources

The current theoretical paper presents a comprehensive overview of findings from research attempting to understand what happens with expatriates and their families while living abroad. Our paper draws on research on adjustment of individual family members (expatriates, their partners, and children) and families as a whole, across different literatures (e.g., cultural psychology, family psychology, stress literature). The key challenges of expatriation are discussed, as well as family members' resources. Our findings lead to the following conclusions: First, there is lack of systematic research as studies are either missing a theoretical background or largely neglect the multi-informant approach. A comprehensive theory of expatriate family adjustment integrating multiple theoretical perspectives, including the culture identity formation and the impact of home country and host country culture, is called upon. Second, the majority of studies paid little attention to define the concept of family or failed to take into account the cultural aspect of relocation. Third, there is a call for more longitudinal studies including all family members as adjustment is a process that unfolds over time and therefore cannot be sufficiently explained by cross-sectional studies. Suggestions for future research and practical implications are provided, with a special focus on how families could be assisted during their adjustment process.

Imported Infections with Mansonella perstans Nematodes, Italy

These infections should be included in differential diagnoses for patients with eosinophilia from disease-endemic countries.

We report 74 patients in Italy infected with Mansonella perstans nematodes, a poorly described filarial parasite. M. perstans nematodes should be included in the differential diagnosis for patients with eosinophilia from disease-endemic countries. Serologic analysis is useful for screening, and testing for microfilaremia in peripheral blood should be performed for parasite-positive patients.

The Roles of Motivation and Coping Behaviours in Managing Stress: Qualitative Interview Study of Hong Kong Expatriate Construction Professionals in Mainland China

Driven by fast-growing economies worldwide, the number of international construction projects is booming, and employing expatriates has inevitably become a strategy used by construction firms. However, stress arising from expatriate assignments can lead to early return, assignment failure, and staff turnover, causing in significant losses to an organisation. Extensive research has focused on the effectiveness of coping behaviours in relation to stress. However, studies investigating the antecedents of coping are rare. The limited studies to date tend to focus on content-based motivations (identifying what), instead of on how coping behaviours can be motivated in the stress management process (identifying how). Focus on expatriate construction professionals (ECPs) is further limited. Hence, this study aims to investigate from a process theory perspective the role of motivation in the stress management process. Using a qualitative interview study approach, involving 22 in-depth interviews, this study first identifies the content of motivation, coping behaviours, performance, and stress in the context of Hong Kong ECPs working on cross-cultural projects in China; it then unveils and explains the associations between the identified variables. Based on the results, stakeholders are recommended to review pre-departure training, so as to ensure that key elements such as personal awareness of stress (cognitive, affective, and physical), expectancies of coping strategies on stress (adaptive or maladaptive), and expectancies of the influence of stress on performance are covered.

Coping with Fear of and Exposure to Terrorism among Expatriates

This paper examines existing research on the impact of terrorism on expatriate coping strategies. We consider pre-assignment fear of terrorism, in-country coping strategies, and anxiety and posttraumatic stress disorder (PTSD) associated with repatriation. The extant research is small but growing. Our model for expatriate coping at the pre-departure, in-country, and repatriation stages includes strategies specific to each stage. Preparation using proactive coping, systematic desensitization, problem and emotion focused coping, social support, and virtual reality explorations are recommended. Selecting expatriate candidates who are well-adjusted, emotionally intelligent, and possessing good coping skills is essential for successful assignments in terror-prone regions.

Medical evacuations in the oil and gas industry: a retrospective review with implications for future evacuation and preventative strategies

BACKGROUND

Businesses increasingly conduct operations in remote areas where medical evacuation [Medevac(s)] carries more risk. Royal Dutch Shell developed a remote healthcare strategy whereby enhanced remote healthcare is made available to the patient through use of telemedicine and telemetry. To evaluate that strategy, a review of Medevacs of Shell International employees [i.e. expatriate employees (EEs) and frequent business travellers (FBTs)] was undertaken.

METHOD

A retrospective review of Medevac data (period 2008-12) that were similar in operational constraints and population profile was conducted. Employee records and Human Resource data were used as a denominator for the population. Analogous Medevac data from specific locations were used to compare patterns of diagnoses.

RESULTS

A total of 130 Medevacs were conducted during the study period, resulting in a Medevac rate of 4 per 1000 of population with 16 per 1000 for females and 3 per 1000 for males, respectively. The youngest and oldest age-groups required Medevacs in larger proportions. The evacuation rates were highest for countries classified as 'high' or 'extreme risk'. The most frequent diagnostic categories for Medevac were: trauma, digestive, musculoskeletal, cardiac and neurological. In 9% of the total, a strong to moderate link could be made between the pre-existing medical condition and diagnosis leading to Medevac.

CONCLUSION

This study uniquely provides a benchmark Medevac rate (4 per 1000) for EEs and FBTs and demonstrates that Medevac rates are highest from countries identified as 'high risk'; there is an age and gender bias, and pre-existing medical conditions are of notable relevance. It confirms a change in the trend from injury to illness as a reason for Medevac in the oil and gas industry and demonstrates that diagnoses of a digestive and traumatic nature are the most frequent. A holistic approach to health (as opposed to a predominant focus on fitness to work), more attention to female travellers, and the application of modern technology and communication will reduce the need for Medevacs.

HIV, Other Blood-Borne Viruses and Sexually Transmitted Infections amongst Expatriates and Travellers to Low- and Middle-Income Countries: A Systematic Review

In some high-income countries, a proportion of human immunodeficiency virus (HIV), other blood-borne virus (BBV) or sexually transmitted infection (STI) diagnoses have been reported as acquired overseas in low- and middle-income countries. A review was conducted to explore HIV, other BBV or STI related knowledge, risk behavior and acquisition amongst expatriates and travelers, particularly males, travelling from high to low- and middle-income countries. Seven academic databases were searched for 26 peer reviewed articles that met inclusion criteria. Significant variability in the studies was noted, in age, travel duration and frequency and outcomes/risk factors measured and reported on. Risk factors described included longer duration of stay; being single; travel for romance or sex; alcohol and other drug use; lack of travel advice; being male; higher number of sexual partners; and inconsistent condom use. Vaccination, pre-travel health advice, and having fewer sexual partners were described as protective. Studies are needed focusing on the social context in which risk-taking occurs. Better collaboration is essential to deliver comprehensive health promotion interventions alongside more consistent pre- and post- travel testing and advice. Policy measures are crucial, including consistent evaluation indicators to assess impacts of HIV, other BBVs or STIs in the context of mobility. Risks and responses for these epidemics are shared globally.

Local in Practice: Professional Distinctions in Angolan Development Work

Development workers employed by international nongovernmental organizations (NGOs) are commonly classified as national (local) or international (expatriate) staff members. The distinction is presumed to reflect the varieties of expertise required for the work and the workers' different biographies. I examine the experiences of Angolans working in an international democratization program to demonstrate how some professionals at the lowest tiers of international development NGOs engage in social practices that strategically emphasize or conceal certain skills, kinds of knowledge, or family circumstances to fulfill industry expectations of "local staff." Doing so allows them access to employment with international organizations and pursuit of a variety of personal and professional goals. These practices reinforce hierarchical inequalities within the development industry, however, limiting these workers' influence over programmatic action. I argue that professional distinctions among development workers are social achievements and instruments of strategic manipulation by individuals and NGOs rather than accurate reflections of work or workers. The case study provides insight into the institutional reproduction of hierarchical inequalities and the complexly social reasons why those who suffer their limitations may act in ways that reinforce, rather than resist, unequal social structures.

Effectiveness of twice a week prophylaxis with atovaquone-proguanil (Malarone®) in long-term travellers to West Africa

BACKGROUND

Current guidelines recommend daily dosing of atovaquone-proguanil (AP), beginning a day before travel to endemic areas and continuing for 7 days after departure. Adherence of long-term travellers to daily malaria chemoprophylaxis tends to be poor, even when residing in highly endemic malaria regions. Evidence from a volunteer challenging study suggests that non-daily, longer intervals dosing of AP provides effective protection against Plasmodium falciparum This study examines the effectiveness of twice weekly AP prophylaxis in long-term travellers to highly endemic P. falciparum areas in West Africa.

METHODS

An observational surveillance study aimed to detect prophylactic failures associated with twice weekly AP, during the years 2013-2014, among long-term expatriates in two sites in West Africa. The expatriates were divided according to the malaria prophylaxis regimen taken: AP twice weekly; mefloquine once weekly and a group refusing to take prophylaxis. Malaria events were recorded for each group. The incidence-density of malaria was calculated by dividing malaria events per number of person-months at risk.

RESULTS

Among 122 expatriates to West Africa the malaria rates were: 11.7/1000 person-months in the group with no-prophylaxis (n = 63); 2.06/1000 person-months in the 40 expatriates taking mefloquine (P = 0.006) and no cases of malaria (0/391 person-months, P = 0.01) in the twice weekly AP group (n = 33).

CONCLUSIONS

No prophylaxis failures were detected among the group of expatriates taking AP prophylaxis twice weekly compared with 11.7/1000 person-months among the no-prophylaxis group. Twice weekly AP prophylaxis may be an acceptable approach for long-term travellers who are unwilling to adhere to malaria chemoprophylaxis guidelines.

Traffic-related pedestrian injuries amongst expatriate workers in Qatar: a need for cross-cultural injury prevention programme

Qatar is a rapidly developing country in which expatriate workers constitute the majority of population. Also, Qatar is an example of right-sided road driving convention (RDC) country. The aim of our study is to analyse the traffic-related pedestrian injuries (TRPI) amongst expatriates in relation to RDC. A retrospective analysis of prospectively collected data of TRPI patients who were admitted to the only Level I trauma centre in Qatar between 2009 and 2011 was performed. Demographics, country of origin, time of injury, injury severity score (ISS), RDC, morbidity and mortality were analysed. Of the 4997 injured patients, 601 (12%) were pedestrians. Of these, 92% were expatriates. The mean age was 31.8 ± 17 and 64% of them were 18-45 years old. Mean ISS was higher in those who were injured on weekends (15.4 ± 10) in comparison to working days (13.5 ± 10) (p = 0.04). The overall mortality was 15%. Sixty-seven percent of those who died were from left RDC countries. Expatriate workers, originally from left RDC countries are disproportionately affected by TRPI. This group of injured patients requires focused injury prevention programmes that are culture and language appropriate.

Knowledge of hepatitis B and vaccination status of some expatriate ethnic groups of blue collar workers in northern saudi arabia

OBJECTIVE

To find out the level of knowledge and vaccination status of some expatriate ethnic groups of blue color workers.

BACKGROUND

Hepatitis B (HBV) infection is relatively common throughout the world, but more prevalent in low socioeconomic and underprivileged classes. The chronic infection may lead to severe consequences including Hepatocellular carcinoma (HCC).

METHOD

A cross-sectional, community-based survey of some ethnic expatriate groups of blue color workers (n=665) living in four main areas along the Northern Borders of Saudi Arabia was completed in 2005. We examined knowledge of HBV and vaccination status and compared them with some socio-demographic factors.

RESULTS

The mean age of the participants was 45.61 years (±8.44), 53% of whom were Non-Arabs (Non Arabic speaking). Of the total, 41.6% gave seven or more correct answers out of 12 questions addressing knowledge about the transmission and sequelae of HBV. Almost 40% of the respondents had not been vaccinated while the remaining respondents had had three full doses of vaccination. A high level of knowledge (≥ 7 correct answers) was significantly associated (p<0.05) with higher level of education, vaccination status, ethnic groups, occupation, age, marital status, and the time spent in Saudi Arabia. Income and type of accommodation were not associated (p>0.05) with level of knowledge. However, vaccination status was associated (p<0.05) with almost all socio-demographic factors.

CONCLUSION

Hepatitis screening programs for expatriates in the Kingdom of Saudi Arabia started 10 years ago and are expected to have a great impact on the combat against HBV infections and their complications. However, beyond screening, health promotion, vaccination campaigns, and access to vaccine for the underprivileged classes are some necessary measures towards achieving success.