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PubMed2005

Malaria among refugee children at arrival in the United States.

BACKGROUND: Malaria infects >70% of children at any given time in highly disease-endemic areas, such as parts of West Africa. Many infected children are asymptomatic. There are no published data regarding the prevalence of malaria among refugee children arriving in the United States from highly disease-endemic areas. This study was performed to determine the prevalence of malaria among asymptomatic children from West Africa. METHODS: A retrospective chart review for Liberian refugee children arriving in the United States was conducted from 1997 to 2000. RESULTS: Fifty-seven charts were reviewed. There were 28 (64%) positive thick and thin blood smears among the 44 children who had malaria smears performed during refugee medical screening examinations. There were 3 children who had been treated recently for malaria. An additional 3 children had splenomegaly and were treated for presumed malaria. Overall, the prevalence rate was 60% (34 of 57 cases). No sign or symptom, singly or in combination, was sufficient to predict the presence or absence of malaria. However, splenomegaly, fever and thrombocytopenia were highly specific for malaria and should alert clinicians to the likelihood of the diagnosis. Twenty-nine percent of children with malaria were asymptomatic. CONCLUSION: The results of this study suggest that refugee children arriving from West Africa have a significant burden of malaria. It is recommended that children who arrive in the United States as refugees from West Africa be subjected to a thorough physical examination, complete blood count and malaria blood smear.

Age Distribution↗
PubMed2004

Determinants of depression among Ethiopian immigrants and refugees in Toronto.

The purpose of this study was to determine the occurrence of and risk factors for depressive disorder in a random sample of 342 Ethiopian immigrants and refugees in Toronto. The Composite International Diagnostic Interview questionnaire was used to measure depression. The results suggested a lifetime prevalence of depression among Ethiopian immigrants and refugees of 9.8%, which was slightly higher than the lifetime prevalence rate in the Ontario population (7.3%). However, the rate among Ethiopian immigrants and refugees was approximately three times higher than the rate estimated for Southern Ethiopia (3.2%). The data confirmed the significance of known risk factors for depression in immigrants, including younger age, experiences of premigration trauma, refugee camp internment, and postmigration stressful events. The implication of the overall finding is that there is a need to develop mental health intervention programs, particularly for people who have experienced premigration trauma, refugee camp internment, and postmigration stresses.

Adolescent↗
PubMed2006

Simple spectacles for adult refugees on the Thailand-Burma border.

PURPOSE: This article describes the development of, and outputs from, a program in which trained refugee health workers provided spherical lenses to adult refugees along the Thailand-Burma border. METHODS: Between 1998 and 2001, the International Rescue Committee trained 48 refugee health workers in basic refraction courses. Once trained, these health workers conduct weekly eye clinics in several refugee camps and one migrant community covering a total population of 142,000. We supplied spherical lenses in 11 powers from +1.00 to +4.00 in 0.50-D steps and from -1.00 to -2.50 in 0.50-D steps. We collected output data from these clinics for the year 2001. RESULTS: In 2001, these clinics provided a total of 7219 eyeglasses. Approximately 84% of all lenses given were for presbyopia, approximately 10% for myopia, and approximately 6% for hyperopia. Our spectacle provision rates per 100,000 persons were 4284 for presbyopia, 482 for myopia, and 317 for hyperopia. Our target provision rates, which would allow the average wearer to get a new pair every 3 to 4 years, was met for presbyopia, but not met for myopia or hyperopia. Few corrections for high errors were needed and only 92 people were found to need powers higher than we provided. In 2001, the cost per eyeglass recipient was approximately $7.00. CONCLUSIONS: Training refugee health workers has allowed for sustainable, low-cost spectacle provision to a large population over an extensive geographic area in a challenging environment.

Adult↗
PubMed1994

Preterm delivery and low birthweight among refugees in Greece.

Recently Greece received a large number of refugees mainly from Eastern European countries, Middle East, Africa and the Pontus region. Refugee status, implying psychosocial adversities and financial problems, has traditionally been associated with unfavourable pregnancy outcome. This study aimed to compare the incidence of preterm delivery and low birthweight among 638 refugees and 1231 indigenous women giving birth at the same hospital in Athens. Conditional logistic regression was used in the analysis to account for parity and delivery date (matching variables) as well as controlling explicitly for maternal age and gender of the neonate. It was demonstrated that refugee status did not overall influence the occurrence of preterm delivery or low birthweight, thus implying that these two variables are not sensitive or early indicators of the adverse effects of psychosocial stress suffered by refugees.

Adolescent↗
PubMed1996

Information and refugee migration: the case of Mozambicans in Malawi.

"Despite increasing prominence in international population movements, refugee migration is a poorly understood social and spatial process. Common assumptions about refugee migration have rarely been empirically tested. This article focuses attention on the migration decision-making process of refugees. Its conceptual basis is that the decision making of refugees can be critically compared with that of other migrants. An analytical framework is suggested which focuses on the receipt and evaluation of information about prospective destinations in the decision-making process. It is tested in the context of Mozambican refugees in Malawi in 1992 and 1993. Analysis shows that this framework achieves a qualified success in explaining the patterns and processes of migration of the study population, and suggests broader applications for the framework."

Africa↗
PubMed1996

Refugees of Turkish origin: "coerced immigrants" to Turkey since 1945.

"While several studies (in both Turkish and English) have been made on migration to the Ottoman Empire from the Caucasus and the Balkans during the nineteenth century...very little systematic and comprehensive research on migration has been undertaken on the period since the establishment of the Turkish Republic. This article, which aims to partially fill the gap, is divided into three parts: the issue of national refugees (refugees of Turkish origin) in relation to Turkey's overall refugee policy; Turkey's policy towards national refugees; and the volume and causes of refugee migration to Turkey since 1945." (SUMMARY IN FRE AND SPA)

Asia↗
PubMed1989

Paranoid symptoms and disorders among 100 Hmong refugees: a longitudinal study.

Paranoid disorder has been recognized as a special problem among migrants in general, and refugees in particular. Controversy exists about whether vulnerability to paranoia is a pre-emigration or postmigration phenomenon, and whether paranoia is caused by genetic or organic factors, victimization, or the stress of acculturation. Information is limited on the distribution of paranoid symptoms among refugees. The course of paranoid symptoms in refugees is unknown. Findings reveal that: most refugees have no or mild paranoid symptoms (suspiciousness or mistrust); a small number have severe symptoms (ideas of reference, paranoid delusions or paranoid hallucinations); paranoid symptoms (unlike depressive symptoms) tend to remain at about the same level over several years; and the prevalence and incidence of paranoid disorders among refugees are high compared with other groups.

Acculturation↗
PubMed2004

Comparison of blood smear, antigen detection, and nested-PCR methods for screening refugees from regions where malaria is endemic after a malaria outbreak in Quebec, Canada.

The importation of malaria into a region where it is not endemic raises many concerns, including the timely delivery of appropriate care, safety of the blood supply, and the risk of autochthonous transmission. There is presently no consensus on the best way to screen mobile populations for malaria. Between August 2000 and March 2001, 535 refugees arrived in Quebec, Canada, from Tanzanian camps. Within 4 weeks of resettlement of the first group of 224, the McGill University Centre for Tropical Diseases noted an outbreak of malaria across the province (15 cases over a 3-week period). This group (group 1) was traced and screened for malaria between 3 and 4 months after arrival in Canada. Subsequent groups of 106 and 205 refugees were screened immediately upon arrival in Canada (group 2) and immediately prior to their departure from refugee camps (group 3), respectively. A single EDTA-blood sample was obtained from 521 refugees for testing by thick and thin blood smears (groups 1 and 2), antigen detection (ICT Malaria Pf and OptiMAL; group 1 only), and nested PCR (all groups). Overall, 98 of 521 refugees were found to be infected (18.8%). The vast majority of infections (81 of 98) were caused by Plasmodium falciparum alone. Using PCR as the "gold standard," both microscopy (sensitivity, 50%; specificity, 100%) and antigen detection (ICT sensitivity, 37.5%; ICT specificity, 100%; OptiMAL sensitivity, 29.1%; OptiMAL specificity, 95.6%) performed poorly. None of the PCR-positive subjects were symptomatic at the time of testing, and only two had recently had symptoms compatible with malaria (with or without diagnosis and treatment). Active surveillance of migrants from regions of intense malaria transmission can reduce the risk of morbidity in the migrant population and mitigate against transmission to the host population. Our data demonstrate that PCR is, by far, the most powerful tool for such surveillance.

Adolescent↗
PubMed1997

Asthma in a Vietnamese refugee population.

Asians and Pacific Islanders comprise a large and growing minority group in the United States, yet data on health status specific to these populations are scant. We conducted an epidemiologic study of asthma in a Vietnamese refugee population to estimate prevalence, evaluate risk factors, and better understand treatments of asthma among Vietnamese individuals. One hundred twenty-four asthma cases were identified from a population of 2,536 new Vietnamese refugees in San Diego (prevalence = 49 per 1,000; 4.9%). Two nonasthmatic control groups of Vietnamese refugees, matched for age and gender with the asthma cases, were recruited for a case-control study, using a questionnaire administered in Vietnamese. Vietnamese asthmatic individuals used both Western and non-Western therapies. Most subjects used traditional health practices, such as coining, cupping, and oil inhalation. As compared with current-refugee controls, the asthmatic subjects used significantly more bleeding (OR: 3.40; 95% CI: 1.06 to 10.80) and herbal ingestion (OR: 1.87; 95% CI: 1.08 to 3.19). As compared with former-refugee controls, the asthmatic subjects used significantly more oil inhalation (OR: 2.58; 95% CI: 1.45 to 4.85), bleeding (OR: 8.64, 95% CI: 1.02 to 73.70), and herbal ingestion (OR: 1.93; 95% CI: 1.02 to 3.67). The presentation and recognition of asthma among the Vietnamese subjects were similar to those in other populations. This information may be helpful in designing culture-specific health-education programs.

Acculturation↗
PubMed1986

Active tuberculosis after isoniazid chemoprophylaxis of Southeast Asian refugees.

The outcome of isoniazid chemoprophylaxis for tuberculosis was assessed in refugees from Southeast Asia. From July 1979 through June 1982, 2,795 tuberculin-positive refugees were prescribed isoniazid chemoprophylaxis at the time of their resettlement in King County, Washington. Through December 1983, 19 cases of active tuberculosis had arisen in those refugees. The annual incidence varied between 2.04 and 2.86 cases per 1,000 receiving treatment during the 4 yr after initiation of chemoprophylaxis (cumulative incidence, 9.66 per 1,000). Seven of the cases of tuberculosis occurring after isoniazid chemoprophylaxis were pulmonary, 1 was pulmonary and extrapulmonary (lymphatic), and 11 were extrapulmonary alone (lymphatic, 6 cases; pleural, 4 cases; soft tissue, 1 case). Fifteen of the 19 cases were culture positive, among which 8 M. tuberculosis isolates were susceptible to isoniazid and 7 were resistant. A case-control analysis showed that poor compliance, defined as taking isoniazid for 3 months or less, was associated with a sixfold increase in risk for subsequent isoniazid-susceptible tuberculosis but with no increased risk for subsequent isoniazid-resistant disease. Thus, active tuberculosis continued to occur with a low but relatively constant incidence after prescription of isoniazid chemoprophylaxis to Southeast Asian refugees. In this setting, poor compliance with chemoprophylaxis predisposed to isoniazid-susceptible, but not to isoniazid-resistant tuberculosis. There is a need to improve the approach to prevention of tuberculosis in Southeast Asian refugees.

Adolescent↗
PubMed1997

Satisfaction of Vietnamese patients and their families with refugee and mainstream mental health services.

OBJECTIVE: The study examined levels of satisfaction with mainstream mental health services and specialized mental health services for refugees among Vietnamese psychiatric patients and their relatives. Demographic, diagnostic, symptomatic, and service-related issues that might influence satisfaction were investigated. METHODS: Eighty-six Vietnamese patients were identified from case notes of mainstream inpatient services (N = 31), mainstream community services (N = 7), and a specialized refugee treatment unit (N = 48). During an interview, a scale measuring satisfaction with treatment as well as measures of anxiety, depression, and posttraumatic stress disorder was administered to them. A modified satisfaction scale was administered to 56 relatives. RESULTS: Patients and relatives were, on average, moderately satisfied with treatment. Patients expressed greater satisfaction with the specialized treatment unit for refugees than with mainstream services, a finding that was not influenced by diagnostic differences or symptom levels at the time patients responded. Further analyses controlling for multiple comparisons revealed that the extent of the information provided and the ease of negotiating changes in treatment were the most salient variables in distinguishing satisfaction levels across the two types of treatment centers. Patients' fluency in English and their relatives' level of education were inversely associated with satisfaction scores, tentatively suggesting that the greater the ability of patients and their families to evaluate services, the less likely they were to express satisfaction with treatment. CONCLUSIONS: Specialized mental health services for refugees may be more acceptable to refugee populations than their mainstream counterparts, perhaps because better communication with patients and their families is possible in the specialized services. Patients and families who are in a position to evaluate services fully are more likely to be critical of treatments offered.

Acculturation↗
PubMed1982

Coping with refugees. A Canadian experience: 1948-1981.

Clinical and field studies of five successive refugee groups to Canada over the past 32 years are summarised. A consistent pattern of behaviour among refugees of different cultural background is described. The concept of Social Displacement Syndrome is reviewed and discussed from the perspective of the refugee recipient society. The early stages of the natural history of resettlement are seen as a series of predictable behaviour patterns of Refugees and Helpers. Some general principles are assigned for the study of refugee situation, of relevance to the development of specific personal and social support systems and to practical social psychiatric research.

Acculturation↗
PubMedDate not supplied

Refugee women's reproductive health in early resettlement.

OBJECTIVE: To describe reproductive health needs and screening rates for breast and cervical cancer for newly arrived (less than 90 days) refugee women in the United States. DESIGN: A retrospective study of existing medical charts from 1996 to 2000. SETTING: Refugee health screening clinic, central Texas. PATIENTS: Refugee women (n = 283) newly arrived in the United States from Cuba (31.1%), Bosnia (26.1%), Vietnam (24.7%), and other countries (18.0%); age range = 18 to 74 years, mean age = 34.4 years. MAIN OUTCOME MEASURES: Frequency of reproductive health problems and breast and cervical cancer screening rates. RESULTS: Twenty-five percent of women in the sample were pregnant or had a reproductive health problem. A significant percentage older than 40 (86%) had never had a mammogram when compared to American women of the same age (33%). Only 24% reported having had a Pap test within the previous 3 years. CONCLUSIONS: The risk of not receiving adequate reproductive health care is higher among newly arrived refugee women compared to nonrefugee women in the United States. For refugee women to enjoy optimum health, their individual needs and health care system issues must be addressed.

Adult↗
PubMed2004

Subsidized sales of insecticide-treated nets in Afghan refugee camps demonstrate the feasibility of a transition from humanitarian aid towards sustainability.

BACKGROUND: Introducing sustainability and self-reliance is essential in chronic humanitarian emergencies before financial assistance is phased out. In Pakistan-based Afghan refugee camps, this was attempted through shifting from indoor residual spraying (IRS) to the subsidized sale of insecticide-treated nets (ITNs) for prevention of malaria and anthroponotic cutaneous leishmaniasis (ACL). Here we outline the strategy and document the progress to provide guidance for replication of similar approaches in other chronic refugee situations. METHODS: The operational monitoring data presented were collected through: (i) two surveys of knowledge, attitude and practice (KAP); (ii) routine sales reporting of health-care providers; (iii) records completed during field visits; and (iv) registers used during annual re-treatment campaigns. RESULTS: From 2000 until 2003, subsidized ITN sales expanded from 17 to 44 camps. Based on 2003 sales records, maximum coverage from subsidized sales exceeded 50% in 13 camps and 20% in an additional 14 camps. Free annual treatment campaigns showed that many refugees were in possession of non-programme nets, which were either locally-made or had leaked from an ITN programme in Afghanistan. Estimated re-treatment coverage of sold and existing nets through annual campaigns exceeded 43% in all camps and was above 70% in the majority. CONCLUSION: Subsidized sales of ITNs have effectively introduced the components of sustainability and self-reliance to the prevention of malaria and ACL in Afghan refugee camps. Similar approaches should be investigated in other chronic refugee situations to discourage expectations of continuing humanitarian donations that cannot be fulfilled.

Afghanistan↗
PubMed1994

Themes in managing culturally defined illness in the Cambodian refugee family.

The Cambodian (Khmer) refugee population in America is considered to be the Indochinese refugee population at highest risk for stress-related health problems resulting from traumatic physical and emotional experiences during the Khmer Rouge holocaust in this Southeast Asian country. In this study, koucharang, described as "thinking too much," was identified by informants as a culture-bound syndrome in response to the violence experienced in Cambodia. It is characterized by behavioral changes and somatic complaints. This study identified two cultural themes used by Cambodian families in the management of this disabling condition. The research is a follow-up from a prior study that examined cultural themes in health care decision making among Khmer women. This study of themes in family management of culturally defined illness was conducted with 120 Cambodian refugee women in Long Beach, California and Lowell, Massachusetts. These geographical areas were selected because the Khmer refugee population in America has relocated primarily to the low-income inner-city areas of southern California and Massachusetts. Nursing strategies for utilizing the identified cultural themes in intervening with the Cambodian family are identified. The community health nurse can build upon the strength of these themes and the resulting culturally dictated practices as he or she provides supportive counseling and health promotion to this highly traumatized population. The emotional risks to the community health nurse in working with the Cambodian refugee family are discussed in the context of maintaining self-integrity in the face of overwhelming tragedy.

Adaptation, Psychological↗
PubMed1994

"Those with unheard voices": the plight of a Cambodian refugee woman.

Refugee women and children compose 80% of the total refugee population worldwide (Martin, 1991). Such a large group is significant because of the magnitude of their need, which is often unheard or misunderstood. This article discusses the plight of a Cambodian refugee woman who was interviewed as part of a larger ethnographic study (Kulig, 1991). Theary's story reveals the differences in perceptions of events according to cultural understanding and the consequences of community shunning. Theary's case is extreme because of its complexity regarding her mental health needs, but it shares themes noted among other refugee women. Recommendations for community health nurses working with refugee women are discussed.

Adult↗
PubMed1991

Family living arrangement and social adjustment among three ethnic groups of elderly Indochinese refugees.

This study examines family living arrangement and social adjustment in an area probability sample of 258 elderly Indochinese refugees fifty-five years or older in the United States. Data were collected in 1982 from five locations representing the diversity of the Indochinese refugee communities in the United States. Multiple regression analysis was used. The findings reveal that elderly refugees who lived within the nuclear or extended family had a better sense of social adjustment than those living outside the family context. Elderly refugees who lived in overcrowded households and in households that had children under the age of sixteen experienced a poorer sense of adjustment. Ethnicity had no significant relationship with social adjustment. Finally, among six control variables, age had a significant relationship that indicates that older refugees had a poorer sense of adjustment than their younger counterparts.

Acculturation↗
PubMed2002

Mental health among Afghan refugees settled in Shiraz, Iran.

This study was designed to investigate the mental health of Afghan refugees settled in Shiraz, the capital of a southern province of Iran. They were mostly refugees from Afghanistan by reason of internal war during the last two decades. A version of the General Health Questionnaire (GHQ-28) in Persian was administered on a group of randomly selected Afghan refugees (n=81) from a pool of Afghan residents in the Shiraz district. 34.5% of the subjects scored high enough to be considered as having psychiatric problems. There was a significant positive correlation between refugees' years of age and GHQ-28 factor scores, i.e., Physical Health and Social Functioning. The mental health of the subjects was not related to education or marital status. The years of settling in Iran were not significantly correlated with any GHQ-28 indices. The overall findings suggest that the rate of psychiatric problems in the refugees is higher than in the native population.

Acculturation↗