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PubMed2006

Harboring illnesses: on the association between disease and living conditions in a Palestinian refugee camp in Lebanon.

This research examined the association between the domestic built environment in a Palestinian refugee camp in Beirut, Lebanon, and the presence of illness among household members. Data on the domestic built environment, socio-demographics and health were collected in 860 households. The association between the presence of illness among household members and three environmental indices, namely infrastructure and services, housing conditions, and crowding was evaluated. These indices were based on a number of items that reflected the existing problems in the domestic built environment. The main finding was the positive association between poor housing conditions and the presence of illness among household members. Households with 8 - 15 housing problems were twice more likely to report the presence of illness than those with less than four housing problems (OR=2.08, 95% CI=1.40 - 3.11). This research contributes to the understanding of the influence of the built environment on the health of a refugee population.

Arabs↗
PubMed2002

Mineral content of culinary and medicinal plants cultivated by Hmong refugees living in Sacramento, California.

Since the end of the American-Vietnamese War in 1975, more than 1.5 million refugees from Southeast Asia have resettled in the United States. Included among these displaced persons were the Hmong from Laos, a subsistence-based, shifting-cultivation, agricultural society. Hmong who resettled in urban areas have viewed vacant lots adjacent to urban dwellings as potential garden sites for production of familiar herbs and vegetables. In the present study exotic culinary and medicinal herbs grown by Hmong refugees in Sacramento, California were identified and analyzed for mineral composition. The herbs grown in these urban gardens were significant ingredients of Hmong recipes, and herb leaves, or infusions of steamed herb leaves were widely consumed as a component of pregnancy and post-partum diets. Six common species, Acorus gramineus, aff. Angelica, Dendranthema indicum, Eupatorium lindleyana, Sedum aff. sarmentosum, and Sedum aff. spectabile, were used in combination to season chicken. Polygonum odoratum, also widely cultivated, was used to season fish. Exotic culinary-medicinal species with highest mineral profiles included: Basella alba (Ca, Mg, Mn, Zn); Houttuynia cordata (Fe, Mg, Mn); Justica gendarussa (Ca, Mg, Zn); and Polygonum odoratum (Ca, Mg, Mn). While vacant lots sometimes are heavy metal contamination sites, we found no detectable levels of arsenic, cadmium, chromium, or lead in the samples analyzed.

Adult↗
PubMedDate not supplied

Stories of pre-war, war and exile: Bosnian refugee children in Sweden.

While standardized questionnaires produce counts of isolated events, a semi-structured interview derives a story, a complex narrative in time and place. Ninety Bosnian refugee children and adolescents (ages 1-20), resettled in Sweden, were assessed in a semi-structured clinical interview designed to identify and offer support to children at risk. A family-child account of traumatic exposure was analysed quantitatively and qualitatively. Type-stories or clusters of experience were identified for three distinct periods: prior to war, during war, and after war in exile. The extent of trauma-stress exposure during each of these periods proved unrelated. Pre-war experience presented as preponderantly good and safe. Differences in child exposure during war and exile could be understood in relation to identifiable socio-demographic factors; particularly ethnic background, social class, child age and family size. Further, the stories derived cast light on the equity of Swedish refugee reception, exposing both egalitarian and discriminatory tendencies.

Adaptation, Psychological↗
PubMedDate not supplied

Providing health care for refugee children and unaccompanied minors.

The health of refugee children must be considered beyond ensuring access to health care to include issues such as housing and education. Refugees require support in using services, and their culture and religious background must be taken into account. Asylum seeking children have the same rights to health as any other children, yet non-eligibility for welfare foods may have implications for their nutrition. Providing for 15-18 year olds presents particular problems. It is important to arrange access to appropriate care for unfamiliar diseases and to recognize emotional health problems, particularly when they are related to past experiences of violence.

Adolescent↗
PubMedDate not supplied

Children of traumatized and exiled refugee families: resilience and vulnerability. A case study report.

This paper focuses on the main problems and outcomes of two children of a traumatized refugee family who have been in Britain since 1993. Their parents witnessed near death experiences and physical assaults, and suffered losses and a wide range of physical problems; the father manifests post traumatic stress disorder (PTSD) symptoms. The children have been exposed regularly to episodic rage and violent behaviour by their father, and have developed separation problems and psychosomatic complaints. Their mother has coped better and is very resilient in her care and approach to problems. This report acknowledges the negative experience of trauma, but also the sources of resilience of parents, children's adjustment and cultural differences in coping styles. Refugee experiences devastate individual well-being and coping mechanisms if there is no hope, support and faith in one's own potential. Protective and risk factors that may affect the manifestation of trauma symptoms are highlighted. A variety of treatment approaches are required for both adult and child victims of multiple trauma. A wide range of techniques, such as group therapy, behaviour and cognitive therapy, and desensitization and relaxation training, can help sufferers to enhance their coping skills and deal effectively with devastating life events.

Adaptation, Psychological↗
PubMedDate not supplied

Family environment and emotional and behavioural symptoms in adolescent Cambodian Refugees: influence of time, gender, and acculturation.

For young refugees, the turmoil of adolescence is exacerbated by the acculturation process that sometimes places them at odds with the traditional culture of their ethnic group. The family environment can affect how adolescents cross that pivotal period. This paper focuses on the influence of family environment, gender and acculturation on the mental health of young refugees from early to mid-adolescence. Sixty-seven Cambodian adolescents were followed up from early to mid-adolescence. The effects of the youths' acculturation level, gender, and family environment and structure on internalising and externalising symptoms were analysed through linear regression analyses. Family conflict tends to increase from early to mid-adolescence. The association between family environment and mental health changes over time and, overall, family environment is associated with externalisation whereas gender, acculturation level, and family structure influence internalisation. Cambodian girls and boys cope differently with the challenges of adolescence in the host country, adopting traditional strategies and borrowing new ones from the host culture. Family therapy may help the parents and their adolescents address this process of change, which is both a source of vulnerability and of fulfilment, and enhances the ability of the family to negotiate between the cultural worlds of the home and of the host countries.

Acculturation↗
PubMedDate not supplied

Psychosocial support for war-traumatized child and adolescent refugees: evaluation of a short-term treatment program.

OBJECTIVE: The purpose of this study was to evaluate a newly designed psychosocial treatment program for war traumatized child and adolescent refugees. The program was designed to reduce emotional distress and improve psychosocial functioning. METHOD: Ten young Kosovan refugees (mean age 13.3 years) residing in Germany participated in the manual based intervention program. This multimodal program consists of individual, family and group sessions using a psychoeducational approach beside trauma and grief focusing activities, creative techniques and relaxation. Kind and severity of traumatic experiences were gathered by interviewing the child and their caretakers using the Harvard Trauma Questionnaire (HTQ). Psychiatric diagnoses (Schedule for Affective Disorders and Schizophrenia for School-Age Children, K-SADS) were assessed prior to the intervention. Post-traumatic symptomatology (HTQ), emotional problems (Diagnostic System for Psychological Disorders, DYSIPS) and the overall psychosocial functioning (Child Global Assessment Scale, CGAS) were assessed before and after the 12-week intervention. RESULTS: Following the intervention the degree of overall psychosocial functioning increased substantially in 9 of 10 participants. Furthermore, post-traumatic, anxiety and depressive symptoms were reduced significantly. The rate of post-traumatic stress disorder (PTSD) diagnoses fell from 60% to 30%. The number of patients with PTSD and a high rate of comorbid symptoms (depression and anxiety) as well as a history of severe traumatization remained at 30%. CONCLUSIONS: This study suggests that the psychosocial treatment program specified for war traumatized adolescents may be useful for the relief of psychiatric sequelae and for an improvement in overall psychosocial functions, but not for the subgroup of severely traumatized patients with complex psychiatric disturbances.

Adolescent↗
PubMed2001

Traumatic experience and sleep disturbance in refugee children from the Middle East.

BACKGROUND: Sleep disturbance is frequently reported in children after traumatic experiences associated with organised violence. The aim of this study was to identify specific traumatic risk indicators and modifying factors for sleep disturbance among recently arrived refugee children from the Middle East. METHODS: The study group comprises 311, 3-15 year old refugee children from the Middle East. On arrival in Denmark, their parents participated in a structured interview about their childrens' health and history of exile and eventual exposure to war, organised violence and human rights violation. RESULTS: A family history of violence (grandparent's violent death before the birth of the child or parental exposure to torture) as well as a stressful present family situation (father scolds the child more than previously) were the strongest predictors of prevalent sleep disturbance in the children. Arriving in Denmark with both parents rather than one was a modifying factor, so the effect of traumatic experience on sleep patterns later in childhood was mediated through parental presence and behaviour. CONCLUSION: This study indicates that the family environment is of primary importance for childhood sleep disturbance following traumatic experiences connected with war and other organised violence.

Adolescent↗
PubMed1983

An evaluation of supplementary feeding in Somali refugee camps.

Supplementary feeding programmes (SFP) that were functioning in Somali refugee camps were evaluated in March 1981 in order to describe their process of operation and to measure their effect on the refugees' nutritional status. While those children enrolled in SFPs gained weight, many malnourished children in camp had not been identified so that the programme's overall effectiveness was reduced. Even among children who attended SFPs regularly, the rate of weight gain diminished rapidly each succeeding month of attendance. This underlines that supplementary feeding is a short-term, remedial measure in disaster relief and should be quickly incorporated into a broader plan for relief assistance so that resources can be used most efficiently.

Body Height↗
PubMed1990

Measles outbreaks in the Mozambican refugee camps in Malawi: the continued need for an effective vaccine.

Between November 1988 and January 1989, measles outbreaks occurred in 11 Mozambican refugee camps in Malawi with five camps principally affected. A total of 1214 cases were reported. Despite the reduction of the age of measles vaccination to six months in 1987, attack rates were highest in children aged 6-9 months (10-26%); rates were also high in the 0-5 month age group (3-21%). The case-fatality rate was high among children less than five years old (15-21%). Children were being inappropriately vaccinated, either being vaccinated at less than six months of age (2-29%) or failing to receive a second dose if vaccinated at six months (0-25%). With vaccine coverage between 66-87%, vaccine efficacy in children less than five years old was estimated to be more than 90% in the camps principally affected. Reduction of the age of vaccination leads to logistical problems in vaccine delivery in refugee situations. These outbreaks again indicate the need to improve vaccine coverage with the existing Schwarz vaccine, and also highlight the urgent need for an effective single dose measles vaccine for children less than nine months of age.

Age Factors↗
PubMed1980

Practical evaluation of a pilot immunization campaign against typhoid fever in a Cambodian refugee camp.

An outbreak of typhoid fever in the largest refugee camp of the besieged capital of Phnom-Penh, Cambodia, and availability of a locally manufactured Anti-Tetanus-Typhoid-Paratyphoid vaccine prompted us to test the practicability of a mass immunization campaign by carrying out a trial in the smaller, well delineated refugee camp of Pochentong. Initial acceptance was good, due to a comprehensive service (information, health education and individual care of patients). Attendances by adults and children showed a steady decline with only 20% completing the course. It is concluded that multiinjection immunization campaigns against typhoid-paratyphoid are a waste of money in a war-torn situation with an unstable population.

Adolescent↗
PubMed2004

Agreement between husband and wife reports of domestic violence: evidence from poor refugee communities in Lebanon.

BACKGROUND: This paper compares husband and wife reports of wife beating using household survey data collected from poor Palestinian refugee communities in Lebanon. METHODS: The analyses are based on a matched data file of 417 currently married couples, drawn from a unique multi-purpose living conditions sample survey of about 3600 Palestinian refugee households interviewed in the spring and summer of 1999. Four outcomes (ever beaten, last year beating, beating during pregnancy, and injuries caused by beating) were analysed using Kappa statistics and per cent agreement. Logistic regression was used to analyse discordant reporting of wife beating during the year preceding the survey. RESULTS: Husband and wives' reports of the four different outcomes are in 'good' agreement as judged by Kappa coefficients, ranging from 0.62 for 'beaten during pregnancy' to 0.69 for 'injuries resulting from beating'. Prevalence estimates of domestic violence are also remarkably similar. However, findings from a multivariate logistic regression model on agreement regarding 'last year beating' show that only age of men was a significant predictor of agreement, controlling for education level, marital duration, region of residence, household size, health status, and consanguinity. CONCLUSIONS: Our findings show that men's self-reports of their violent behaviour against their wives are fairly congruent with those of their spouses, implying that the perpetrators, men, can be 'trusted' in providing basic information on 'beating histories' in epidemiological and demographic population-based investigations in contexts similar to ours. However, care should be taken in studies of young men's current beating behaviour using only their self-reports.

Adolescent↗
PubMed1981

Infection with Schistosoma mekongi in Southeast Asian refugees.

Schistosoma mekongi is a newly recognized species of Schistosoma that is closely related to Schistosoma japonicum and is pathogenic to humans. Like the other forms of schistosomiasis in which the parasites reside in the mesenteric vasculature, S. mekongi infection has hepatosplenomegaly and portal venous hypertension as its most common serious sequelae. Schistosomiasis, although endemic in certain areas of Southeast Asia, has not been recognized as a health problem in Asian refugees who are currently entering the United States. In the present study 12 Laotian immigrants with S. mekongi infection were examined. The clinical, laboratory, and parasitologic findings in these patients are discussed. The diagnosis was made by examination of stool specimens in 11 patients and rectal biopsy specimens in one patient. All patients were asymptomatic, although the six youngest children had hepatomegaly. It is suggested that specific serologic tests may be useful in screening Asian refugees for infection with Schistosoma.

Adolescent↗
PubMed1997

Factors associated with anemia in refugee children.

A nutrition survey was performed in 1990 among children 6 through 35 mo of age living in Palestinian refugee camps in Syria, Jordan, the West Bank, Gaza Strip and Lebanon. Overall, 67% [95% confidence interval (CI): 66, 68] were anemic (hemoglobin <110 g/L), ranging from 54% in the West Bank to 75% in Syria. The following factors were significantly associated with anemia in one or more of three age groups (6-11.9, 12-23.9 and 24-35.9 mo) by logistic regression: living in Syria, Lebanon, or Gaza [with prevalence odds ratios (POR) in the range of 1.4-2.6 depending on the age group and area, relative to children living in Jordan]; never having been breast-fed (POR = 1.7); male sex (POR = 1.2); maternal illiteracy (POR = 1.4 relative to those with >/=6 y of education); having a recent (within 2 wk) or current episode of fever or diarrhea; and stunting. Recent or current illness and stunting interacted in two age groups with the general trend of stunted children with recent or current illness having high POR. Early childhood anemia is associated with factors reflecting poor socioeconomic status and recent diarrheal and febrile illnesses in Palestinian refugee camps.

Aging↗
PubMed2005

Iron and vitamin A deficiency in long-term African refugees.

Five cross-sectional surveys were conducted in African refugee camps to assess the level of iron deficiency anemia and vitamin A deficiency in populations dependent on long-term international food aid and humanitarian assistance. The prevalence of anemia in children [hemoglobin (Hb) <110 g/L] was high, with >60% affected in 3 of 5 camps. Iron deficiency [serum transferrin receptor (sTfR) >8.5 mg/L] was also high, ranging from 23 to 75%; there was also a strong ecological correlation between the prevalence of iron deficiency and anemia among different camps. Within camps, sTfR predicted the concentration of Hb with adjusted R(2) values ranging from 0.19 to 0.51. Although children were more affected, anemia was also a public health problem in adolescents and women. The effect of recent recommendations on Hb cutoff values for African populations was assessed and found to produce decreases in the prevalence of anemia of between 5 and 21%; this did not affect the public health categorization of the anemia problem within the most affected camps. Mean serum retinol in children, after adjustment for infection status, ranged from 0.72 +/- 0.2 to 0.88 +/- 0.2 micromol/L in the 4 camps assessed and vitamin A deficiency (<0.7 micromol/L) was present at levels ranging from 20.5 to 61.7%. In areas in which vitamin A capsule distribution programs were in effect, coverage ranged from 3.5 up to 66.2%. The high level of micronutrient deficiencies seen in long-term refugees argues in favor of further enhancements in food aid fortification and the strengthening of nutrition and public health programs.

Africa↗
PubMed1977

Epidemic keratoconjunctivitis at a Vietnamese refugee camp in Florida.

During the summer of 1975 an ongoing outbreak of conjunctivitis occurred among Vietnamese refugees temporarily housed at a U.S. mainland camp. Twenty-two per cent of surveyed refugees gave a history of the disease and 10% were documented as having clinical conjunctivitis at the time of the survey. Fifty-six per cent of documented cases were in children less than 10 years of age. The attack rate among American camp personnel was 4%. Comprehensive microbiologic analysis revealed multiple potential pathogens in most cases, but the recovery of adenovirus 8 (AV8) in 81% of cases cultured within two weeks of onset implicated AV8 as the principal cause of the epidemic.

Adenoviridae Infections↗
PubMed1991

Elevated blood pressure among Southeast Asian refugee children in Minnesota.

The blood pressures and body sizes of children aged 10-15 years in the Minneapolis and St. Paul, Minnesota, public schools were measured during 1986 and 1987. The sample consisted of 1,680 Southeast Asian refugees--including 219 Cambodians, 1,086 Hmong, 149 Lao, and 226 Vietnamese--and 3,424 blacks and 11,336 whites. Mean systolic blood pressure in Hmong boys was higher than that in black boys and white boys. Mean systolic blood pressures of Hmong, Lao, and Vietnamese girls were lower than those of black girls and white girls. The mean diastolic blood pressures of Hmong boys and of Cambodian and Hmong girls were greater than those of blacks and whites of the same sexes. Southeast Asian children were shorter and weighed less than black children and white children. Body size may confound associations between ethnic groups and blood pressures and may obscure the problem of hypertension among the smaller Southeast Asian children. Southeast Asian boys had greater mean systolic blood pressures than did black and white boys across all weight strata; a similar contrast among girls did not reveal this difference. The risk of hypertension, defined by US National Heart, Lung, and Blood Institute guidelines, was assessed in multiple logistic regression analyses that controlled for differences in weight, height, age, and pulse rate. The odds ratios for hypertension, relative to blacks and whites of the same sexes, were 2.69 (95% confidence interval (CI) 1.85-3.65) in Hmong boys, 2.89 (95% CI 1.35-6.21) in Lao boys, 2.10 (95% CI 1.03-4.28) in Cambodian girls, and 1.49 (95% CI 1.00-2.20) in Hmong girls. Hypertension and subsequent cardiovascular disease may emerge as a significant problem among Southeast Asian refugees in the United States.

Adolescent↗
PubMed1992

A trichinosis outbreak among Southeast Asian refugees.

The number of cases of trichinosis reported to Centers for Disease Control has declined steadily, with an average of only 44 cases per year from 1984 through 1988. This decline was almost entirely due to a reduction in cases acquired from ingestion of fresh commercial pork. However, from July 21 through September 3, 1990, 90 (72%) of 125 Southeast Asian refugees from six states and Canada developed trichinosis after attending or eating pork sausage taken from a wedding held in Des Moines, Iowa, on July 14, 1990. Eating uncooked sausage prepared at home from commercially obtained pork was associated with the development of this illness (odds ratio = 34.0, p less than 0.001). Analysis by amount of pork consumed was significant (Mann-Whitney U rank sum test, p less than 0.001). This outbreak of trichinosis in Iowa is the fourth reported within the last 15 years among the 900,000 Southeast Asian refugees resident in the United States and one of the largest reported outbreaks in US history. The continued presence of Trichinella spiralis in commercial pork emphasizes the need for further education and control measures for persons whose dietary habits place them at risk for developing trichinosis.

Animals↗