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PubMed2002

Reproductive health indicators and outcomes among refugee and internally displaced persons in postemergency phase camps.

CONTEXT: Despite increasing awareness of the importance of reproductive health programs and services for refugee and internally displaced populations, there is a paucity of basic epidemiological data on reproductive health outcomes. OBJECTIVES: To collect data on reproductive health outcomes among refugees and internally displaced persons in postemergency phase camps and compare these outcomes with those of host country and country-of-origin populations. To determine programmatic factors that may affect reproductive health outcomes. DESIGN, SETTING, AND PARTICIPANTS: Retrospective study of data collected from August 1998 through March 2000 of 688,766 persons living in 52 postemergency phase camps in 7 countries. Reproductive health outcomes of refugee and internally displaced populations were compared with available data of reference populations within their respective host country and country of origin. MAIN OUTCOME MEASURES: Crude birth rate (CBR), neonatal mortality rate (NNMR), maternal mortality ratio (MMR), percentage of newborns with low birth weight (LBW), and incidence of complications of unsafe or spontaneous abortions. RESULTS: Six of 11 groups had lower CBRs than their country of origin and 5 of 9 groups had lower CBRs than their host country. Four of 5 had lower NNMRs than their country of origin and 6 of 9 had lower NNMRs than the host country. Four of 6 had lower MMRs than their country of origin, and 5 of 6 had lower MMRs than their host country. Seven of 9 had lower percentages of LBWs than in the country of origin and 5 of 9 had lower percentages of LBWs than the host country. Higher CBRs were associated with more recently established camps and higher numbers of local health staff per 1000 persons; and higher percentages of LBW newborns were associated with rainy season, more recently established camps, lower numbers of community health workers per 1000 persons, and camps without supplementary feeding programs. CONCLUSIONS: Refugees and internally displaced persons in most postemergency phase camps had better reproductive health outcomes than their respective host country and country-of-origin populations.

Abortion, Illegal↗
PubMed1987

Changing time perspective and mental health among Southeast Asian refugees.

Little is known about the psychological mechanisms people employ in adapting to extreme circumstances such as becoming refugees. Case studies of refugees making up part of a sample of 1348 persons relocated from Southeast Asia to Vancouver, British Columbia, suggest that altering one's perception of time may be an adaptive strategy. During periods of acute stress, refugees seem to focus on the present to the relative exclusion of past and future. The reemergence of past and future into consciousness brings about a risk for developing depression. Epidemiological data corroborate inferences from case material, demonstrating that refugees are more present-oriented than the indigenous population. A "Nostalgic" time orientation, preoccupation with the past, is associated with elevated depression scores. Contrasts are drawn between nostalgia, a maladaptive pattern, and memory, which is an inevitable part of the process of personality integration.

Acculturation↗
PubMed1997

Establishing social contact in exile: a prospective community cohort study of Vietnamese refugees in Norway.

The social networks of Vietnamese refugees and predictors of their intra- and inter-ethnic social contact after 3 years in Norway were studied. An unselected community cohort of Vietnamese boat refugees was personally interviewed, first on arrival in Norway (n = 145) and again after 3 years (n = 130). By the time of the second interview, the refugees had to a large degree reconstructed social networks and 54% had good contact with other Vietnamese. Only 17% had equally good contact with Norwegians. Female gender, further education after resettlement and having a close confidant on arrival were related to good inter-ethnic social contact. The latter was the only predictor of good intra-ethnic social contact. Competency in the Norwegian language, surprisingly, did not predict good social contact with Norwegians. The refugees were largely successful in re-establishing a social platform in relation to their own ethnic group in their new environment. It was much more difficult to establish good social contact with Norwegians. Educational institutions appear to be important social arenas in this respect. The personal capacity for close attachments during a period of psychosocial transition is also important.

Acculturation↗
PubMed2006

Promoting Hmong refugees' well-being through mutual learning: valuing knowledge, culture, and experience.

Refugees who resettle in a new country face numerous struggles, including overcoming past traumas and coping with post-migration stressors, such as lack of meaningful social roles, poverty, discrimination, lack of environmental mastery, and social isolation. Thus, in addition to needing to learn concrete language skills and gain access to resources and employment, it is important for refugees to become a part of settings where their experiences, knowledge, and identity are valued and validated. The Refugee Well-Being Project (RWBP) was developed to promote the well-being of Hmong refugees by creating settings for mutual learning to occur between Hmong adults and undergraduate students. The RWBP had two major components: (1) Learning Circles, which involved cultural exchange and one-on-one learning opportunities, and (2) an advocacy component, which involved undergraduates advocating for and transferring advocacy skills to Hmong families to increase their access to resources in their communities. The project was evaluated using a mixed quantitative and qualitative approach. This article discusses data from qualitative interviews with participants, during which the importance of reciprocal helping relationships and mutual learning emerged as significant themes.

Cooperative Behavior↗
PubMed2005

Refugees' perceptions of healthy behaviors.

This descriptive study explored refugees' knowledge and perceptions of nutrition, physical activity and smoking behaviors using the Health Promotion and Transtheoretical Models. A one-time interview used both closed- and open-ended questions. The sample included 31 adults from Bosnia, Iran, and Cuba. Refugees had some knowledge of a healthy diet and physical activity, and were aware of both benefits and barriers for health behaviors. They had a realistic perception of their weight (55% overweight), and none thought obesity was a positive characteristic. Changes in diet, physical activity and smoking since arrival in the US have been positive for some and negative for others. For all categories discussed, refugees were in the pre-contemplation stage of change. There is a need to study refugees' health behaviors over time after arrival. Health behavior interventions must be specific to ethnicity in order to accurately document progress and to be culturally appropriate.

Acculturation↗
PubMed1992

Surgery in a Palestinian refugee camp.

From 1985 to 1987, three Palestinian refugee camps in Lebanon were attacked several times by a Lebanese militia. We present a review of 1276 casualties who were wounded in the refugee camp of Bourj al-Barajneh during two such attacks between December 1985 and April 1987. All were treated in Haifa Hospital (30-40 beds), which had limited equipment, was situated inside the refugee camp and was badly damaged by war. During both attacks, the refugee camp was surrounded and put under siege such that patients could not be evacuated and supplies were not allowed in. The second period lasted almost 6 months resulting in severe shortages of medicines, equipment and food, leading to a rationing of resources and modification of treatment. More than 300 operations were carried out under general anaesthesia, the remainder under local or without anaesthesia. The overall operative mortality was 3.2 per cent. Despite the deprivation, many patients survived severe and complicated wounds because they were quickly brought to the hospital, provided with adequate quantities of fresh blood for transfusion, and sound surgical principles were followed.

Abdominal Injuries↗
PubMed1985

Long-term sensory-specific satiety: evidence from an Ethiopian refugee camp.

The reduction in appetite which occurs during a meal is partly specific to the foods which have been eaten earlier in a meal. This has been called "sensory-specific satiety." In the experiment described here, a long-term form of sensory-specific satiety has been demonstrated. Refugees in an Ethiopian refugee camp reported that the taste of 3 foods which they had been eating for approximately 6 months was less pleasant than that of 3 new foods, whereas refugees who had been eating the regular diet for only two days found its taste as pleasant as that of the different foods. This long-term sensory-specific satiety may have nutritional implications when only a limited variety of food is available, as may occur in refugee camps. It will be useful to determine the extent to which this long-term sensory-specific satiety can be prevented by provision of perhaps even a limited range of spices, flavorings or foods.

Adolescent↗
PubMed1995

Ethnicity, social class and health. A population-based study on the influence of social factors on self-reported illness in 223 Latin American refugees, 333 Finnish and 126 south European labour migrants and 841 Swedish controls.

This article shows the influence of ethnicity and social class on self-rated illness compared with social factors and lifestyle. We were particularly interested in health differences between refugees and labour migrants. The study population consisted of 223 Latin American refugees domiciled in Lund, 333 Finnish and 126 South European labour migrants and 841 Swedish controls. The data were analysed unmatched with logistic regression (multivariate analyses) in main effect models. The strongest independent risk indicator for long-term illness was being a Latin American refugee, with an estimated odds ratio of 2.78 (1.95-3.81), or a South European 1.80 (1.17-2.71). Low social class, low material standard, age 45-64 years and overweight were significantly associated with long-term illness. There was a strong association between being a Latin American refugee and ill-health, followed by a weaker association for South European labour migrants and no association for Finlanders and Swedes when controlled for other social factors in logistic regression. Low social class, age 45-64 years, poor social network, not feeling secure in daily life and not taking regular exercise were associated with ill-health. South Europeans were the only ethnic group who showed an association to working impairment and disability. Latin Americans were significantly associated with acute illness with an estimated odds ratio of 2.00 (1.32-2.94). In conclusion, ethnicity was shown to be an independent powerful social dimension compared with social class in relation to self-rated illness.

Adolescent↗
PubMed2026

Interest holder-driven research priorities in sexual and reproductive health for migrant and refugee adolescents and young adults in Australia.

OBJECTIVE: To identify and prioritise sexual and reproductive health research priorities for migrant and refugee adolescents and young adults in Australia using a priority setting partnership approach. METHODS: A James Lind Alliance priority setting partnership was conducted with 92 interest holders: 31 youth from migrant and refugee backgrounds and 61 professionals (healthcare providers, researchers, policymakers and community leaders), recruited online and in-person. The priority setting partnership process included a rapid evidence scan, an online uncertainty survey, evidence verification, interim prioritisation and a final consensus workshop. RESULTS: Eighty-three research uncertainties yielded 11 final priorities across four sexual and reproductive health domains: sexual and reproductive health literacy, sexual violence prevention, accessible services and maternal health. A striking divergence emerged between youth and professional priorities only 3 achieved combined high-priority consensus. Youth prioritised a broader range of topics, including abortion access (rated high by youth but low by professionals), while professionals prioritised fewer areas. Two priorities achieved consensus: community-based maternal health support and barriers to reporting gender-based violence. CONCLUSION: This is the first priority setting partnership to identify sexual and reproductive health research priorities for migrant and refugee youth in Australia and to uniquely highlight substantial misalignment between youth and professional priorities. IMPLICATIONS FOR PUBLIC HEALTH: These identified priorities provide a foundation for targeted research, culturally responsive policy and more equitable sexual and reproductive health service provision for migrant and refugee adolescents and young adults.

Australia↗
PubMed2004

Understanding mental health needs of Southeast Asian refugees: historical, cultural, and contextual challenges.

Research and clinical information pertaining to mental health needs of Asians residing in the United States is limited but growing. There is a tendency to group all persons of Asian descent together and, therefore, the empirical literature does not sufficiently address the mental health needs in specific subgroups. The focus of this article is to understand the mental health needs of one subgroup of Asians--Southeast Asian refugees (SEAR). The main purpose is to review the relevant literature pertaining to Southeast Asian refugees' experiences and to understand the manifestation of psychiatric disorders by examining historical, cultural, and contextual challenges. Despite the well-documented mental health needs for SEAR, most do not present for mental health services. Therefore, resilience and protective factors are discussed. Research and clinical implications are described and suggestions are offered on how to apply information obtained from Southeast Asian refugees' experiences to future refugees.

Asia, Southeastern↗
PubMed2006

Prevalence of hepatitis B among Afghan refugees living in Balochistan, Pakistan.

OBJECTIVE: Continued civil war and political instability in Afghanistan have lead to a huge influx of refugees into the neighboring provinces in Pakistan. This study was conducted to estimate seroprevalence of hepatitis B and to identify potential risk factors for hepatitis B virus (HBV) transmission among the refugees living in the camps of Balochistan Province, Pakistan. METHODS: A cross-sectional survey of hepatitis B surface antigen (HBsAg) was conducted during October 2003. We obtained the registration list to select families randomly from the refugee camps. A husband, wife and one of their children, selected at random, were enrolled in the study. Study subjects with positive laboratory results for HBsAg were compared with those who were negative for HBsAg. RESULTS: Field workers interviewed 301 families with a total of 903 study subjects. Blood specimens of 75 study subjects (8.3%, 95% CI 6.6-10.3) were positive for HBsAg. There were 37 husbands (12.3%, 95% CI 7.2-14.4) and 21 wives (7.0%, 95% CI 4.5-10.6) positive for HBsAg. Out of 301 children, 17 (5.6%, 95% CI 3.4-9.1) were positive for HBsAg. Receiving more than ten injections during the previous year increased the risk of HBV infection (OR 3.5, 95% CI 1.8-6.7). A child positive for HBsAg was more likely to have a positive parent compared to an HBsAg negative child (OR 5.7, 95% CI 2.0-16.5). CONCLUSION: Hepatitis B is highly endemic among Afghan refugees living in these camps. Unsafe injection practices will continue to cause a steady increase in the magnitude of this health problem until appropriate control measures are taken. The possibility of mother-to-child transmission underscores the need to include vaccination against hepatitis B as part of routine immunization in this population.

Adolescent↗
PubMed2004

Remaking family life: strategies for re-establishing continuity among Congolese refugees during the family reunification process.

The restrictive immigration and refugee policies of many Western countries force most refugee families to remain separated for long periods. Although there is much discussion among professionals in the community and the clinical milieu about the problems families encounter after reunification, the strategies employed by refugees to restore family life have not been paid much attention. This longitudinal study documents the pre- and post-reunification experiences of 12 refugee families from the Democratic Republic of Congo in Montreal. Our results suggest that family separation can be understood as an ambiguous loss, in that the temporary absence of other family members cannot be fully acknowledged because of the perpetual uncertainty and permanent risk to them. Memory work, in the form of shared family memories, attenuates the pain of the absence. Once reunited, family members must re-establish continuity in spite of the many denied rifts between them. The capacity to recall a personal, familial or collective history of previous separation and loss appears to be protective, as if the memory of life's discontinuities provides an opportunity to recreate a partial sense of continuity out of repeating experiences of chaos.

Adult↗
PubMed2006

Course and predictors of mental health of unaccompanied refugee minors in the Netherlands: one year follow-up.

This epidemiological investigation addresses the prevalence, course, and predictors of the psychological distress and behavioral problems of unaccompanied refugee minors living in the Netherlands. The legal guardians, teachers and minors themselves all reported on the mental health of the refugee minors (n=582) at baseline and follow-up approximately 12 months later. The self-reported psychological distress of refugee minors was found to be severe (50%) and of a chronic nature (stable for one year) which was confirmed by reports from the guardians (33%) and teachers (36%). The number of self-reported experienced adverse life events were strongly related to the severity of psychological distress. Baseline psychopathology was the largest predictor of psychological distress at follow-up reported by all informants accounting for 22-51% of the variance. The present study, which used a population-based sample, further enlarges the knowledge of mental health among refugee adolescents. The investigation is unique because of the large sample size, the longitudinal nature of the study, the use of multiple informants, and the culturally diverse sample.

Adolescent↗
PubMed2002

Long-term effect of psychological trauma on the mental health of Vietnamese refugees resettled in Australia: a population-based study.

BACKGROUND: What are the deleterious effects of mass trauma on the psychological wellbeing of refugees and other war-affected populations? Most epidemiological data are for short-to-medium term effects, leaving the possibility that early psychological reactions could reduce naturally over time. We aimed to assess the long-term effects of trauma on mental health and disability in Vietnamese refugees resettled in Australia. METHODS: In a population-based study, we identified a community sample of 1413 adult Vietnamese from census collection areas in Sydney, Australia. Participants were interviewed by trained bilingual workers who administered questionnaires to assess the frequency of international classification of disease, version 10 (ICD-10) mental disorders in the 12 months before interview; psychiatric symptoms, by use of a culturally-sensitive symptom measure; exposure to psychologically traumatic events; disability and use of health services; and social, economic, and cultural factors since migration. We did multivariate analyses with adjustment for stressors since migration to establish the risk factors for mental illness. FINDINGS: 1161 (82%) adults completed the interview. Mean length of residence in Australia was 11.2 years (SD 14.4) and mean time since the most severe traumatic event was 14.8 years (SD 10.8). 95 (8%) and 75 (7%) of participants had mental disorders defined by ICD-10 and the culturally-sensitive measure, respectively. Trauma exposure was the most important predictor of mental health status. Risk of mental illness fell consistently across time. However, people who had been exposed to more than three trauma events (199) had heightened risk of mental illness (23, [12%]) after 10 years compared with people with no trauma exposure (13, [3%]) (odds ratio 4.7, p<0.0001, 95% CI 2.3-9.5). INTERPRETATION: Most Vietnamese refugees were free from overt mental ill health. Trauma-related mental illness seemed to reduce steadily over time, but a subgroup of people with a high degree of exposure to trauma had long-term psychiatric morbidity. Our findings support the need to develop specialised mental health services to reduce disability in refugees whose exposure to extreme trauma puts them at risk of chronic psychiatric disability.

Adult↗
PubMed1980

Rapid assessment of health status and preventive-medicine needs of newly arrived Kampuchean refugees, Sa Kaeo, Thailand.

In the disaster relief programme for Kampuchean refugees in Thailand, epidemiological techniques were incorporated into the health-planning process during the first 2 weeks of the refugee influx. The findings influenced not only health care in the first refugee camp but also the delivery of medical services in subsequent camps. The mortality rate in the first week of refugee settlement was 9.1/10 000/day, and fell to 0.71/10 000/day by the fifth week. Children aged 4 and under had the highest risk of death. Fever/malaria was the main cause of morbidity and mortality. Simple epidemiological techniques, if initiated early in the relief effort, can influence medical decisions and lead to more effective use of health resources.

Adolescent↗
PubMedDate not supplied

Psychological well-being of refugee children.

Two groups of refugee families participated in a program aimed at preventing children's mental health problems. The program attempted to gain insight into the character and scope of problems of refugee families and to develop and implement a spectrum of interventions that would meet their specific psychological needs. Data about the family situation and the psychosocial adaptation of refugee children to displacement was gathered during detailed structured interviews with the mothers, while the study families were accommodated either in a shelter or with host families. A considerable range of stress-related reactions among displaced children were identified (e.g., sleeping and eating disorders, separation fears, and withdrawal or aggression). Refugee children exhibited a significantly higher incidence of stress reactions if their mothers had difficulty coping with the stress of displacement. The findings also indicated that children in the collective shelter were at greater mental health risk than their peers housed with host families.

Adaptation, Psychological↗
PubMed2003

Immunity to diphtheria among refugees in southern Italy.

This study assessed the immune status against diphtheria of a sample of refugees (mainly Kosovars and Kurds) in southern Italy (Puglia). The 54.8% of 1128 subjects showed full protection against diphtheria, 30.1% had basic protection and 15.1% resulted seronegative for antitoxin antibody. Only from 45.9 to 73.9% of 0-10 years old refugees were fully protected while from 12.3 to 24.2% were seronegative to diphtheria with the poorest protection rate among Kurdish children from Turkey. Kosovars showed the highest protection rate to diphtheria whereas data suggest a probable endemic level of diphtheria in Iraq. The screening of refugees revealed a low coverage rate for diphtheria, especially in children, probably due to deterioration of the health service infrastructure or intermittent basic health care in the country of provenience. In terms of public health measures, there is the need of administering booster doses to all refugees coming into Italy and into other host countries to increase the coverage rate against diphtheria. The implementation of the immunization programs against diphtheria in the countries of provenience is also strongly recommended.

Adolescent↗
PubMed2004

The extraordinary decline of infant and childhood mortality among Palestinian refugees.

This article documents the levels and patterns of infant and child mortality among Palestinian refugees in Jordan, Lebanon and the Palestinian areas based on comparable data from household sample surveys conducted since 1995. The findings show that Palestinian refugees have clear advantage in mortality levels as compared to their non-refugee counterparts in every setting, and refugees living in the camps have similar or lower levels of mortality than their non-camp counterparts, other things being equal. The recent decline of infant and child mortality among this vulnerable segment of the Palestinian population demonstrates the importance of political will in halting the truncation of infant lives. An examination of the mortality patterns by sex and education sheds light on the nature of the decline currently underway.

Arabs↗