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PubMed2002

A 3-year follow-up study of psychosocial functioning and general symptoms in settled refugees.

OBJECTIVE: Few community studies have addressed the longitudinal course of post-traumatic stress disorder (PTSD) in traumatized refugees in early resettlement. This longitudinal study investigated changes from the first (T1) to the second interview (T2), 3 years later. The relationship between traumatic exposures and psychosocial factors/psychological symptom load were examined. METHOD: Local health professionals performed the interviews, using rating scales and a structured questionnaire. A total of 240 (52%) refugees attended. RESULTS: Unchanged Hopkins Symptom Checklist-25 and increase in Harvard Trauma Questionnaire and post-traumatic stress symptoms-16 between T1 and T2 were found, indicating the severity and chronicity of problems. Mean post-traumatic stress score was 15% above cut-off. Severe life-threatening trauma and present life in exile with unemployment and unresolved family reunion were risk factors. CONCLUSION: Early diagnostic interview should be followed by targeted approach. Pinpointing those in need of specialist services is essential. An interdisciplinary approach is necessary in this work.

Acculturation↗
PubMed2002

The relationship between post-traumatic symptoms and life in exile in a clinical group of refugees from the former Yugoslavia.

OBJECTIVE: To investigate the association between life situation factors and post-traumatic symptoms among refugees from the former Yugoslavia. METHOD: Twenty-six refugees from the former Yugoslavia were examined by the Harvard Trauma Questionnaire during psychiatric treatment, and 3 years later. At follow-up they also answered a questionnaire regarding their life situations. RESULT: A higher post-traumatic symptom level at follow-up was associated with a pattern of negative living conditions such as open unemployment, social isolation, and a high dependence on social welfare. Gender differences were found regarding the factors most related to symptom severity. CONCLUSION: The results indicate that a main problem in this patient group may be how to break vicious circles of high symptom levels and a poor life situation which suggests a need for integrated rehabilitation efforts.

Female↗
PubMed2003

Suicidal feelings run high among mothers in refugee camps: a cross-sectional survey.

OBJECTIVE: To study levels of mental distress in a sample of Afghan mothers caring for children in two refugee camps in North West Frontier Province (NWFP) of Pakistan. METHOD: Cross-sectional survey of 297 consecutive mothers with young children, attending primary care centres, using a psychiatric screening instrument, the Self-Reporting Questionnaire (SRQ-20). RESULTS: One hundred and six (36%) of women in the sample screened positive for a common mental disorder. Ninety-six (91%) of those screening positive had had suicidal thoughts in the previous month, and nine (8%) rated suicidal feeling as their topmost concern. CONCLUSION: There is a high prevalence and severity of mental distress in Afghan mothers caring for young children in refugee camps. This may have serious long-term effects on the psychological and physical development of their children.

Adult↗
PubMed2006

Barriers to mental health care utilization for U.S. Cambodian refugees.

Asian Americans encounter barriers to mental health care, some of which are structural, whereas others may be cultural. Using data from a probability sample (N = 490) drawn from the largest Cambodian refugee community in the United States, the authors assessed the extent to which structural and cultural barriers were experienced. Surprisingly, a relatively small proportion endorsed commonly cited cultural barriers such as distrust of Western care (4%) and greater confidence in alternative care (5%), whereas most endorsed structural barriers such as high cost (80%) and language (66%). Among those with a probable diagnosis, a similar pattern was found. Findings suggest that structural, not culturally based, barriers are the most critical obstacles to care in this U.S. Cambodian refugee community.

Adult↗
PubMed1993

Mental health status of Cambodian refugees ten years after leaving their homes.

The mental health status of a general population sample of Cambodian refugees living in the United States was assessed ten years after they had left their homes in Cambodia. Subjects were found to be experiencing extremely high levels of post-traumatic stress disorder, dissociation, depression, and anxiety. Ninety percent of these refugees exhibited marked symptomatology in one or more of these categories.

Acculturation↗
PubMed1994

Refugee patients and the practice of deception.

The example of an Amerasian Vietnamese case study is used to illustrate the complex and interactive effects of refugee status, diverse cultural traditions, and traumatic life events on refugee patients' willingness and ability to share the details of their lives and to enter wholeheartedly into the diagnostic and therapeutic process. Ways in which clinicians working with such patients can increase the accuracy of their database and further the development of a therapeutic alliance are discussed.

Adolescent↗
PubMed1998

Poor quality of life and health in young to middle aged Bosnian female war refugees: a population-based study.

OBJECTIVE: To evaluate whether female Bosnian refugees have a poorer quality of life than Swedish women. DESIGN: A cross-sectional study of quality of life using a slightly modified 'Göteborg Quality of Life' instrument. The women rated their global well-being (19 items) on a 7 degree scale ranging from 'very bad' (1) 'to excellent, could not be better'. The second part of the questionnaire consisted of 29 yes/no items about somatic and psychological symptoms which should take less than 5 min to complete. Factor analysis was performed in order to reduce the number of variables. Differences between mean ranks were tested by the Krusakal-Wallis test. Differences in distributions of the yes/no-questions in the different groups were tested with a likelihood ratio chi 2 test. SETTING: Malmö and Lund, two cities in Southern Sweden. SUBJECTS: A simple random sample of 120 women aged 18-59, born in Bosnia-Hercegovina with accepted refugee status, and registered in Lund and Malmö, was interviewed. The control group for this was 292 Swedish women of the same age, registered in Dalby (Lund). The response rate for Bosnian women was 74% and for Swedish women 75%. MAIN OUTCOME MEASURES: The factor analysis resulted in one factor, 'global health', to which all the well-being variables were related. RESULTS: 38% of the Bosnian and 23% of the Swedes had bad global health. Bosnian women with bad global health had lower mean rankings than Swedish women, namely low quality of life in 'appetite', 'memory', 'leisure time', and aspects of mental well-being such as 'energy', patience', 'sleep', 'mood', and 'health'. They also had larger proportions of symptoms than Swedish women. CONCLUSIONS: Bosnian women irrespective of health status had poorer quality of life in most variables and more symptoms than Swedish women with good global health.

Adult↗
PubMed1999

Body mass index and distribution of body fat in female Bosnian refugees--a study in primary health care.

Between 1992 and 1996 more than one million refugees, mostly women, received asylum in the USA, Canada and Germany and about 47,000 of them sought refuge in Sweden. Little is known about their cardiovascular health. Using data from a cross-sectional study of a simple random sample of non-patients, female Bosnian refugees (n = 98) aged 18-59 and Swedish-born controls (n = 95) we examined six primary diet cardiovascular risk factors: S-triglycerides, S-cholesterol, high-density lipoprotein cholesterol, body mass index (BMI), waist circumference, and sagittal diameter of the abdomen. Bosnian women aged 42-59 y had substantially higher levels of BMI, larger waist and sagittal diameter of the abdomen measurements, higher levels of S-triglycerides, and lower HDL cholesterol indicating a more disadvantaged diet (CVD risk profile) than Swedish women. Younger Bosnian women aged 18-41 y had a higher sagittal diameter of the abdomen and lower high-density lipoprotein cholesterol than Swedish women. In conclusion this is the first study to report large differences in blood lipids, obesity and abdominal obesity after adjustment for socioeconomic status between Bosnian and Swedish women. These findings underscore the critical need to improve early detection obesity-related conditions in Bosnian women in exile.

Adipose Tissue↗
PubMed1997

Resistance of falciparum malaria to chloroquine and sulfadoxine-pyrimethamine in Afghan refugee settlements in western Pakistan: surveys by the general health services using a simplified in vivo test.

Surveys of drug resistant falciparum malaria were conducted in several Afghan refugee settlements, distributed over a 700 km range in western Pakistan, during the transmission seasons of 1994 and 1995. Symptomatic malaria patients were recruited by a process of passive case detection at the refugees' basic health units. To facilitate follow-up by local health workers, a modified version of the WHO extended in vivo test was adopted in which blood smears were taken from each subject, and clinical symptoms recorded, at weekly intervals. Resistance to chloroquine and sulfadoxine-pyrimethamine was identified in every settlement. The frequency of chloroquine resistance ranged from 18% to 62%. Resistance occurred mostly as RI, with RII resistance never exceeding 11%. Resistance to sulfadoxine-pyrimethamine occurred at much lower frequencies, ranging from 4% to 25%. There was a resumption of clinical symptoms at the onset of parasite recrudescence in over 90% of cases. The policy of using chloroquine as first-line treatment might be changed in favour of sulfadoxine-pyrimethamine in most camps and areas of western Pakistan. The modified in vivo test was almost as accurate as the normal WHO in vivo test in identifying the grade of resistance, and should prove a useful tool for the monitoring of resistance to common antimalarials by district health services.

Adolescent↗
PubMed2001

The incidence of tuberculosis in a cohort of South-East Asian refugees arriving in Australia 1984-94.

We have used record linkage analysis to describe the incidence of tuberculosis in a cohort of 24 652 predominantly south-east Asian refugees who arrived in Sydney, Australia during the period 1984 to 1994. Cases that had been registered with the State Department of Health were confirmed by examination of case records. After an average follow-up interval of 10.3 years there were 189 cases of tuberculosis, equivalent to an average incidence rate of 74.9 cases per 100 000 person-years. The highest incidence rate was in 40-49 year olds and 47% of cases were in women. One hundred and twenty seven cases (67%) were pulmonary and, of these, 64 (50%) were direct smear positive. The incidence of tuberculosis in this cohort is similar to that observed among Vietnamese migrants to Australia and the USA and substantially higher than the incidence among people born in Australia. It is important to maintain awareness of the diagnosis of tuberculosis, especially in countries such as Australia, where the incidence in the general population is low but where there are large populations of migrants and refugees in whom a higher incidence is expected.

Adolescent↗
PubMed2005

Hurdles to health: immigrant and refugee health care in Australia.

Refugees and asylum seekers face a number of barriers to accessing health care and improved health status. These include language difficulties, financial need and unemployment, cultural differences, legal barriers and a health workforce with generally low awareness of issues specific to refugees. Importantly, current Australian government migration and settlement policy also impacts on access to health and health status. An adequate understanding of these 'hurdles to health' is a prerequisite for health providers and health service managers if they are to tailor health care and services appropriately. We include tables of available resources and entitlements to health care according to visa category to assist providers and managers.

Australia↗
PubMed2006

Excess dietary iodine intake in long-term African refugees.

OBJECTIVE: To assess the iodine status of long-term refugees dependent on international food aid and humanitarian assistance. DESIGN: A series of cross-sectional two-stage cluster or systematic random sample surveys which assessed urinary iodine excretion and the prevalence of visible goitre. Salt samples were also collected and tested for iodine content by titration. SETTING: Six refugee camps in East, North and Southern Africa. SUBJECTS: Male and female adolescents aged 10-19 years. MAIN RESULTS: The median urinary iodine concentration (UIC) ranged from 254 to 1200 microg l(-1) and in five of the camps exceeded the recommended maximum limit of 300 microg l(-1), indicating excessive iodine intake. Visible goitre was assessed in four surveys where it ranged from 0.0 to 7.1%. The camp with the highest UIC also had the highest prevalence of visible goitre. The iodine concentrations in 11 salt samples from three camps were measured by titration and six of these exceeded the production-level concentration of 20 to 40 ppm recommended by the World Health Organization (WHO), but were all less than 100 ppm. CONCLUSIONS: Excessive consumption of iodine is occurring in most of the surveyed populations. Urgent revision of the level of salt iodisation is required to meet current WHO recommendations. However, the full cause of excessive iodine excretion remains unknown and further investigation is required urgently to identify the cause, assess any health impact and identify remedial action.

Adolescent↗
PubMed2001

Malaria epidemiology and control in refugee camps and complex emergencies.

Owing to the breakdown of health systems, mass population displacements, and resettlement of vulnerable refugees in camps or locations prone to vector breeding, malaria is often a major health problem during war and the aftermath of war. During the initial acute phase of the emergency, before health services become properly established, mortality rates may rise to alarming levels. Establishing good case management and effective malaria prevention are important priorities for international agencies responsible for emergency health services. The operational strategies and control methods used in peacetime must be adapted to emergency conditions, and should be regularly re-assessed as social, political and epidemiological conditions evolve. During the last decade, research on malaria in refugee camps on the Pakistan-Afghanistan and Thailand-Burma borders has led to new methods and strategies for malaria prevention and case management, and these are now being taken up by international health agencies. This experience has shown that integration of research within control programmes is an efficient and dynamic mode of working that can lead to innovation and hopefully sustainable malaria control. United Nations' humanitarian and non-governmental agencies can play a significant part in resolving the outstanding research issues in malaria control.

Afghanistan↗
PubMed1990

Malaria in refugee camps in eastern Sudan: a sero-epidemiological approach.

A study of the endemicity of malaria was carried out in two refugee camps in Sudan, and the advantages and disadvantages of treating either all febrile cases or only confirmed cases of malaria were considered. Based on the information obtained during the survey, guidelines for the treatment of malaria in such refugee camps are proposed.

Adolescent↗
PubMed1997

Migrants, refugees and foreign policy: prevention and intervention strategies.

The authors discuss policy development options to deal with migrants and refugees to developed countries. "Our principal argument--perhaps to state the obvious--is that international migration and refugee movements are foreign policy, not simply domestic, issues. Nevertheless, citizens and policy makers are all too often unaware that if they want to secure their borders against unwanted population flows, this cannot be done simply by unilateral decisions to regulate entry." The focus is on Germany and the United States.

Americas↗
PubMed1990

A review of the health status of Southeast Asian refugee women.

Six substantive areas that contribute to knowledge of the health status of Southeast Asian (SEA) refugee women were identified in the current literature. The six areas are general information, childbearing issues, health beliefs and practices, health-illness focus, stress and adaptation, and miscellaneous issues. The majority of the articles focused on the women's childbearing role, emphasizing their unique cultural beliefs and the implications of those for health care delivery. The remaining substantive areas provided more limited information about this group's health status, including incidence and prevalence of disease, the women's role in resettlement, and the presence of mental health problems. Future research with this group could be conducted from a feminist perspective by studying the multitude of roles of SEA refugee women and their effects on health status.

Asia, Southeastern↗
PubMedDate not supplied

Mental health of Southeast Asian refugee women: an overview.

Southeast Asian refugee women suffered extremely traumatic experiences at the hands of the Khmer Rouge, during their escapes from Cambodia and Laos, and in refugee camps. I describe these experiences as the background for interventions to promote and re-establish mental health in these women. A reported study of women who were experiencing psychosomatic blindness as a result of the trauma they had undergone is presented as an example. Therapeutic strategies are suggested.

Asia, Southeastern↗
PubMed2005

Housing environment and women's health in a Palestinian refugee camp.

This study was carried out during January and February 2002 in Al-Ein Refugee Camp in Nablus city in Palestine. Interviews were held with 150 women of different age groups and different marital status. The results show a positive relationship between women's physical and mental health and housing conditions. There is a statistically significant relationship between the family size represented by the number of children in the household, the number of children that sleep in one room, and the number of children that sleep in one bed, the house size, and number of rooms and women's feeling of privacy (mental health and well-being). Most of the houses in the camp are unhealthy and overcrowded. The family income is very low and there is a general poor health status of women in the camp. Most of the women do not know the conditions of a healthy house. The study shows the importance of housing reforms on the health of the family in general and women's health in particular, mainly in refugee camps.

Adult↗