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PubMed2003

Psychiatric disability among tortured Bhutanese refugees in Nepal.

OBJECTIVE: Most refugees live in low-income countries. There is a lack of data on psychiatric disability among such refugees. The authors compared psychiatric disability in tortured and nontortured Bhutanese refugees living in Nepal and examined factors associated with psychiatric disability among the tortured refugees. METHOD: A cross-sectional survey was conducted among 418 tortured and 392 nontortured Bhutanese refugees, matched for age and gender. The Composite International Diagnostic Interview, version 2.1, and the World Health Organization Short Disability Assessment Schedule were used to measure ICD-10 psychiatric disorders and disability, respectively. RESULTS: Approximately one in five tortured and nontortured Bhutanese refugees were found to be disabled. Posttraumatic stress disorder, specific phobia, and present physical disease were identified as factors associated with disability among the tortured refugees. On the other hand, present physical disease, greater age, and generalized anxiety disorder were associated with disability among the nontortured group. CONCLUSIONS: These findings show that the tortured and nontortured refugees were equally likely to be disabled. Different sets of predictors were identified among tortured and nontortured refugees, indicating the need for comprehensive psychiatric assessment of both tortured and nontortured refugees in clinical practice.

Adult↗
PubMed2006

The mental health status of Mayan refugees after repatriation to Guatemala.

OBJECTIVE: Only one previous study had examined the epidemiology of mental health in Guatemalan refugees. The objective of this new study was to estimate the prevalence of mental illness and to assess factors associated with poor mental health among Guatemalan Mayan refugees who had been repatriated to Guatemala after spending 12-18 years in refugee camps in Mexico, and to compare the results for the repatriated Guatemalans with those for Guatemalan refugees who were continuing to live in Mexico. METHODS: In 2001 a cross-sectional survey of adults (> or = 16 years) was conducted with random household sampling proportional to the population size in each of the five repatriation villages surveyed. Posttraumatic stress disorder (PTSD), anxiety, and depression were measured by the Harvard Trauma Questionnaire and the Hopkins Symptom Checklist-25. RESULTS: Together, the five repatriation villages had 565 households. Of the 565 households, 203 of them were approached to solicit study participation. A total of 179 households (one adult per household) agreed to participate, representing an overall participation rate of 88%, and one-third of all the households in the five communities. The respondents had personally experienced a mean of 5.5 trauma events and had witnessed a mean of 7.3 other trauma events. Of the respondents, 8.9% met the symptom criteria for PTSD, 17.3% for anxiety, and 47.8% for depression. PTSD was associated with being seriously wounded and with having relatives or friends mutilated. Logistic regression analyses indicated that anxiety was associated with being sexually assaulted, being female, having friends or family mutilated, being seriously wounded, and having 6-12 children (vs. having 1-5 children). Depression was associated with having 6-12 children. Anxiety was significantly more prevalent among the refugees remaining in Mexico (54.4%) than it was among the repatriated refugees (17.3%). The difference in the prevalence rates was not significant for PTSD (11.8% for refugees remaining in Mexico vs. 8.9% for those repatriated) or for depression (38.8% for refugees remaining in Mexico vs. 47.8% for those repatriated). CONCLUSIONS: Psychiatric morbidity was common among the repatriated Mayans. The repatriation of refugees involves moving an already vulnerable, often traumatized population back to a place of distressing memories and still-unsettled conditions. There is a need to consider and plan for adequate mental health services for repatriating refugees.

Adolescent↗
PubMed1999

Oral health among Liberian refugees in Ghana.

OBJECTIVE: To promote community involvement in the provision of oral health services. DESIGN: The project consisted of a four-week training course in oral health for selected refugees, an oral health survey based on WHO guidelines and conducted by the refugees themselves and the provision of oral health care services to the community by the trained refugees. SETTING: Liberian refugee camp, Gomoa Buduburam in Ghana. SUBJECTS: Liberian refugees of all ages. INTERVENTIONS: Twelve refugees were given short term training in oral health. In the oral health survey, 196 refugees were clinically examined for dental caries, periodontal disease and malocclusion. MAIN OUTCOME MEASURES: DMFT (for dental caries), CPITN (for periodontal disease), and malocclusion scores for selected subjects. Also clinical services rendered. RESULTS: Oral health survey revealed a mean age (+/- SD) of 25.7 (+/- 9.5) years. Only thirty nine (19.9%) of the subjects were caries-free, and total DMFT was 2.5 +/- 2.2. Based on the CPITN, 107 (54.6%) required oral hygiene instructions (OHI), and 41 (20.9%) required prophylactic scaling with OHI. Forty four (22.5%) of the subjects had normal occlusion and 152 (77.5%) mild to severe malocclusion. Periodontal (75.5%), prosthetic (52.5%) interventions and extractions (34.2%) constituted the bulk of the treatment needs required. Clinical treatment was rendered by the trained refugees to 846 patients over a twelve month period. CONCLUSION: Relief programmes for refugees should emphasise a primary health care approach, focusing on prevention, based on appropriate technology, and promoting involvement by the refugee community in the provision of services.

Adolescent↗
PubMed2005

Risk of intestinal helminth and protozoan infection in a refugee population.

With continuing emigration from endemic countries, screening for parasitic infections remains a priority in U.S. communities serving refugee and immigrant populations. We report the prevalence of helminths and protozoa as well as demographic risk factors associated with these infections among 533 refugees seen at the Santa Clara County, California, Refugee Clinic between October 2001 and January 2004. Stool parasites were identified from 14% of refugees, including 9% found to have one or more protozoa and 6% found to have at least one helminth. Most common protozoan infections were Giardia lamblia (6%) and Dientamoeba fragilis (3%), and for helminths, hookworm (2%). Protozoa were more frequent in refugees < 18 years of age (OR: 2.2 [1.2-4.2]), whereas helminths were more common in refugees from South Central Asia (OR: 8.0 [2.3-27.7]) and Africa (OR: 5.9 [1.6-21.6]) when compared with refugees from Eastern Europe and the Middle East. Among helminths, Ascaris lumbricoides and hookworm were concentrated among South Central Asians (6 of 7 and 10 of 11 cases, respectively), whereas Strongyloides stercoralis was predominantly found in Africans (5 of 7 cases). Although predeparture empirical treatment programs in Saharan Africa may have helped to reduce prevalence among arriving refugees from this region, parasitic infection is still common among refugees to the United States with helminth infections found in more specific populations. As refugees represent only a fraction of recent immigrants from endemic countries, current studies in nonrefugee groups are also needed.

Adolescent↗
PubMed1995

Health problems of refugees in The Netherlands.

Research was carried out on the medical, i.e. somatic and mental, and social complaints of refugees in The Netherlands. This research consisted of a literature study and a retrospective and prospective, or cross-sectional patient study. The most important assumption which formed the base of the study was: refugees who underwent torture present the same medical and social complaints as refugees who were not tortured but underwent other forms of organized violence. For the cross-sectional study 156 refugees from the Middle East were interviewed. Not only was investigated whether the nature and extent of organized violence influenced the presentation of the refugees' medical and social complaints, but also whether other characteristics such as legal status and length of stay in The Netherlands were related with the refugees' medical and social complaints. The same data were sought for in literature. The results confirm the main assumption, as well as show that factors other than the traumatic experiences in the country of origin are related with the health problems of refugees. Although many studies in literature demonstrated that a relatively high percentage of refugees present a post traumatic stress disorder (DSM-III-R) these findings could not be confirmed. It is concluded that refugees undergo a sequence of traumatic experiences and stress before, during and after their flight into exile. Various pre- and post-migration factors are responsible for the presentation of aspecific physical and mental complaints and social problems of refugees.

Acculturation↗
PubMed1989

Changing health beliefs and behaviors of resettled Laotian refugees: ethnic variation in adaptation.

This paper describes traditional and changing health-related beliefs and behaviors of ethnic Lao refugees now resettled in the United States and how these compare with those of other ethnic groups of resettled refugees from Southeast Asia. New data are presented for Southeast Asian refugees resettled in Franklin County, Ohio, including resettlement agency utilization statistics for refugees of each local ethnic group, which reveal that Laotian refugees have the most persistent use of resettlement agency services. The results of in-depth, open ended interviews with members of the Franklin County Lao community are also presented. The interview data pertain to Lao self-perceived health problems and health care options as well as their health beliefs and practices, both traditionally in Laos and as these have changed with refugee flight and resettlement. These data are compared with the results of the limited relevant health-related research on other ethnic groups of Southeast Asian refugees, revealing that Laotian refugees rely to a relatively great extent on the Western biomedical system. It is suggested that the nature of Lao refugee adaptation is due to the continuation of traditional patron-client relationships in the U.S., with Lao patrons referring their refugee clients to the services of agencies and the biomedical establishment.

Adolescent↗
PubMed2006

Physical and mental health of Afghan, Iranian and Somali asylum seekers and refugees living in the Netherlands.

CONTEXT: Worldwide, the number of refugees and asylum seekers is estimated to be about 11.5 million plus a much larger number of former refugees who have obtained a residence permit in a new country. Although asylum seekers have been coming to the Netherlands since the 1980s, very few epidemiological studies have focused on this group of inhabitants or on the refugees who have resettled in this country. OBJECTIVES: The objectives of this study were to estimate the prevalence rates of physical and mental health problems and to identify the risk factors for these complaints. DESIGN, SETTING, AND PARTICIPANTS: A population-based study was conducted in the Netherlands from June 2003 to April 2004 among adult refugees and asylum seekers from Afghanistan, Iran and Somalia. Asylum seekers were living in 14 randomly selected reception centres, and random samples of refugees were obtained from the population registers of three municipalities (Arnhem, Leiden and Zaanstad). A total of 178 refugees and 232 asylum seekers participated (response rates of 59 and 89%, respectively). MAIN OUTCOME MEASURES: General health and physical health were measured with the Short-Form 36 and a list of 19 chronic conditions, respectively; symptoms of post-traumatic stress disorder (PTSD), depression and anxiety, were measured with the Harvard Trauma Questionnaire and the Hopkins Symptoms Checklist-25. RESULTS: More asylum seekers (59.1%) than refugees (42.0%) considered their health to be poor (P=0.001). In both groups, approximately half of the respondents suffered from more than one chronic condition. More asylum seekers than refugees had symptoms of PTSD (28.1 and 10.6%, respectively; P=0.000) and depression/anxiety (68.1 and 39.4, respectively; P=0.000). Respondents from Afghanistan and, in particular, from Iran had a higher risk for PTSD and depression/anxiety. Female gender was associated with chronic conditions, PTSD and depression/anxiety, and higher age was associated with poor general health and chronic conditions. A greater number of traumatic events was associated with all health outcomes, and more post-migration stress and less social support were associated with PTSD and depression/anxiety symptoms. CONCLUSIONS: Both physical and mental health problems are highly prevalent among refugees and asylum seekers in the Netherlands. Although higher prevalence rates for most health outcomes were found among asylum seekers, both the specific health services for asylum seekers and the general health services in the municipalities should be aware of these problems.

Adolescent↗
PubMed1988

Malaria in Afghan refugees in Pakistan.

Prevalence of malaria in Afghan refugees in Pakistan is higher than in the local population. Malaria control officials in Pakistan hypothesized that Afghan refugees have brought a heavy load of malaria infections with them from Afghanistan, causing a serious setback to the malaria control programme in Pakistan. The purpose of this study was to test this hypothesis, because it is important regarding the selection of appropriate strategy for malaria control. The proposed hypothesis is rejected because of the following evidence against it: (i) a comparison of age-specific parasite rates of malaria in Afghan refugees and a nearby local population at Karachi indicated that Afghan refugees were susceptible to malaria even in later age-groups, while infections in the local population were limited to younger age-groups; (ii) a comparison of epidemiological trends of malaria in Afghan refugees and the local population in the North-West Frontier Province from 1979 to 1986 demonstrated that the rate of increase in the prevalence of malaria over the years was much higher in Afghan refugees than in the local population, a manifestation of low herd immunity in Afghan refugees. The most plausible alternate hypothesis is that Afghan refugees, being more susceptible, were at high risk of malaria infection in Pakistan rather than that they brought a high infection load with them from Afghanistan. Therefore, malaria control in Afghan refugee camps in Pakistan should be primarily based on preventive, rather than curative, measures.

Adolescent↗
PubMed2006

Worries are the mother of many diseases: general practitioners and refugees in the Netherlands on stress, being ill and prejudice.

OBJECTIVE: To confront the views of refugee patients and general practitioners in the Netherlands, focusing on medically unexplained physical symptoms (MUPS). METHODS: The study is based on in depth interviews with refugees from Afghanistan (n = 36) and Somalia (n = 30). Additionally, semi-structured interviews were conducted with 24 general practitioners. Text fragments concerning the relationship between mental worries and health or physical ailments were subject of a secondary analysis, the results of which are presented. RESULTS: Medically unexplained physical symptoms were a key issue for both refugees and GPs. The GPs saw MUPS as a significant part of the illness presentation by refugee patients. Refugees felt GPs were often prejudiced, too readily using their difficult background as an explanation for physical symptoms. A 'general narrative' circulating in the refugee communities undermines trust. The GPs applied different strategies in dealing with MUPS presented by their refugee patients. A 'human interest strategy' is distinguished from a 'technical strategy'. The results are discussed in the wider context of the literature on MUPS and patient satisfaction. CONCLUSION: No fundamental difference in paradigms was found between refugees and GPs as to the negative influence worries and bad experiences can have on health. For a fruitful cooperation to develop, based on trust, GPs need to invest in the relationship with individual refugees, and avoid actions based on prejudice. PRACTICE IMPLICATIONS: The importance of (a lack of) trust is underestimated in medical practice. Phenomena undermining trust are often out of sight for practitioners. Critical reflection is needed on the strategies practitioners employ to deal with MUPS.

Adaptation, Psychological↗
PubMedDate not supplied

Postemergency health services for refugee and host populations in Uganda, 1999-2002.

Since 1990, Uganda has hosted an estimated 200?000 refugees in postemergency settlements interspersed within host communities. We investigated the extent to which obstetric needs were met in the refugee and host populations during 1999-2002. Between September and December, 2000, we retrospectively collected data from 1999 and 2000 on major obstetric interventions for absolute maternal indications from all five hospitals in Arua, Adjumani, and Moyo districts, Uganda. The same data were collected prospectively for 2001. We did community-based maternal mortality surveys on refugee and host populations in Adjumani district in 2002. Rates of major obstetric interventions were significantly higher for refugees than for the host population who live in the same rural areas as refugees (1.01% [95% CI 0.77-1.25] vs 0.45% [0.38-0.52]; p<0.0001). Rates of major obstetric interventions were also significantly higher for refugees than for the host population who live in rural areas without refugees (1.01% [0.77-1.25] vs 0.40% [0.36-0.44]; p<0.0001). Maternal mortality was 2.5 times higher in the host population than in refugees in the Adjumani district (322 per 100000 births [247-396] vs 130 [81-179]. Refugees had better access to health services than did the rural host population in the northern Ugandan communities that we surveyed.

Female↗
PubMedDate not supplied

Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review.

BACKGROUND: About 13 million people are classified as refugees worldwide, and many more former refugees have been granted citizenship in their new countries. However, the prevalence of post-traumatic stress disorder, major depression, or psychotic illnesses in these individuals is not known. We did a systematic review of surveys about these disorders in general refugee populations in western countries. METHODS: We searched for psychiatric surveys that were based on interviews of unselected refugee populations and that included current diagnoses of post-traumatic stress disorder, major depression, psychotic illnesses, or generalised anxiety disorder. We did computer-assisted searches, scanned reference lists, searched journals, and corresponded with authors to determine prevalence rates of these mental disorders and to explore potential sources of heterogeneity, such as diagnostic criteria, sampling methods, and other characteristics. FINDINGS: 20 eligible surveys provided results for 6743 adult refugees from seven countries, with substantial variation in assessment and sampling methods. In the larger studies, 9% (99% CI 8-10%) were diagnosed with post-traumatic stress disorder and 5% (4-6%) with major depression, with evidence of much psychiatric comorbidity. Five surveys of 260 refugee children from three countries yielded a prevalence of 11% (7-17%) for post-traumatic stress disorder. Larger and more rigorous surveys reported lower prevalence rates than did studies with less optimum designs, but heterogeneity persisted even in findings from the larger studies. INTERPRETATION: Refugees resettled in western countries could be about ten times more likely to have post-traumatic stress disorder than age-matched general populations in those countries. Worldwide, tens of thousands of refugees and former refugees resettled in western countries probably have post-traumatic stress disorder.

Anxiety Disorders↗
PubMed1998

The refugee crisis in Africa and implications for health and disease: a political ecology approach.

Political violence in civil war and ethnic conflicts has generated millions of refugees across the African continent with unbelievable pictures of suffering and unnecessary death. Using a political ecology framework, this paper examines the geographies of exile and refugee movements and the associated implications for re-emerging and newly emerging infectious diseases in great detail. It examines how the political ecologic circumstances underlying the refugee crisis influences health services delivery and the problems of disease and health in refugee camps. It has four main themes, namely, an examination of the geography of the refugee crisis: the disruption of health services due to political ecologic forces that produce refugees; the breeding of disease in refugee camps due to the prevailing desperation and destitution; and the creation of an optimal environment for emergence and spread of disease due to the chaotic nature of war and violence that produces refugees. We argue in this paper that there is great potential of something more virulent than cholera and Ebola emerging and taking a big toll before being identified and controlled. We conclude by noting that once such a disease is out in the public rapid diffusion despite political boundaries is likely, a fact that has a direct bearing on global health. The extensive evidence presented in this paper of the overriding role of political factors in the refugee health problem calls for political reform and peace accords, engagement and empowerment of Pan-African organizations, foreign policy changes by Western governments and greater vigilance of non-governmental organizations (NGOs) in the allocation and distribution of relief aid.

Africa↗
PubMedDate not supplied

Injuries among Afghan refugees: review of evidence.

BACKGROUND: Injuries are a public health problem in developing countries resulting in major financial and productivity losses. Injuries in vulnerable populations, such as refugees, make an even greater impact on loss of life. Afghan refugees in Pakistan continue to form one of the world's largest refugee populations. This study systemically reviews the literature to estimate the magnitude and prevalence of intentional and unintentional injuries in Afghan refugees, and explores the implications of the findings for refugee healthcare policy and development of potential interventions specifically for Afghan refugees. METHODS: Electronic databases of MEDLINE, POPLINE, Refworld, and Winspirs were searched. In addition, a web search was conducted and specific organizational websites were reviewed. The search in developing countries was limited to studies in English or with an English abstract for the years 1966-2001. RESULTS: The literature review identified patients with reported war injuries who presented to hospitals. Injuries to extremities (45%) were more frequent than injuries to the head or neck (36%, p < 0.001), and thorax/abdomen (14%, p < 0.001) regions. A majority of the injuries were caused by explosives, which included landmines (32.5%), fragmentations, such as shrapnel (33%), and firearms (27%). The mean incidence of mortality in these studies was 11%. CONCLUSIONS: Despite such an extensive search, limited information was found pertinent to injuries in Afghan refugees residing in refugee camps. This dearth of literature on the prevalence of injuries, risk factors, and outcomes among this vulnerable group is a research and policy gap for public health. Specific quantitive and qualitative studies in this field are required to shape refugee healthcare policies and develop intervention programs.

Afghanistan↗
PubMed1990

Tuberculosis morbidity and infection in Vietnamese in Southeast Asian refugee camps.

During the last decade, the refugee population in less-developed countries has undergone unprecedented growth. High tuberculosis rates have been documented in refugees, particularly among those from Asia and Africa, generating interest in tuberculosis control efforts. To assess the tuberculosis burden among Vietnamese refugees, we screened refugees within 1 or 2 days after arrival in camps in Thailand and in the Philippines. Refugees in camps in Thailand were screened with chest radiographs. Persons with radiographic findings consistent with tuberculosis received microscopic and culture examination of sputum specimens. The prevalence of bacteriologically confirmed pulmonary tuberculosis was 5.8 per 1,000 refugees. Males had a higher risk than females (relative risk RR = 1.7, 95% confidence interval CI = 1.2 to 2.4). Refugees in the Philippines were given a tuberculin skin test. An annual risk of infection of 2.2% was calculated for this group. Males had a higher risk of infection (RR = 1.9, 95% CI = 1.5 to 2.4) than females. The age-specific prevalence of tuberculosis and the tuberculous infection increased with age. A high proportion of refugees (85%) with positive tuberculin skin tests were eligible for preventive therapy. Special efforts may be necessary to target Vietnamese refugees, as well as other persons originating from countries of high tuberculosis prevalence, for enhanced diagnostic and preventive intervention against tuberculosis to achieve the national goal of tuberculosis elimination by the year 2010.

Adult↗
PubMed1982

A survey of malaria in Indochinese refugees arriving in the United States, 1980.

During the months April-June and October-November 1980, a survey was conducted among Indochinese refugees arriving in California to assess the prevalence of malaria. During the two study periods, 3,433 refugees were met and 3,289 (95.8%) of the arriving refugees were screened for malaria by examining thick blood smears and by indirect fluorescent malaria antibody tests of blood absorbed on filter paper. Examination of the blood smears showed that the overall patency rates were 1.7% and 0.6% for the first and second surveys, respectively. The Cambodian Refugees and refugees from camps in Thailand had the highest patency rate in the first survey. In the second survey, the Cambodian refugees and refugees from camps in Indonesia had the highest patency rate. The average malaria seropositivity rate was 15% in the first and 13.6% in the second survey. The Laotian refugees had the highest rate of malaria seropositivity in both surveys. Plasmodium vivax was the most commonly identified species in blood examination, while a higher rate of seropositivity to P. falciparum was found in both surveys. This study indicates that the malaria infection rate was at least 1.7% based on blood smear examination but might be as high as 45% based on serologic examinations. The results of this study when combined with malaria surveillance indicate that the likelihood of introduced malaria in the United States from the Indochinese refugees is low.

Antibodies↗
PubMed2003

The impact of migration on health beliefs and behaviours: the case of Ethiopian refugees in the UK.

The Research Centre for Transcultural Studies in Health, Middlesex University and the Ethiopian Community Centre in the UK conducted a study to explore the migration experiences of Ethiopian refugees in the UK and the impact of this on their health beliefs and behaviours. Data was collected via: i) semi-structured interviews were conducted with Ethiopians refugees and asylum seekers and Ethiopian professionals providing services for Ethiopian refugees; ii) a semi-structured questionnaire; iii) a documentary analysis of newspaper articles concerning refugees; and iv) an ethnohistory of Ethiopia. The findings revealed that Ethiopian refugees place a stronger emphasis on externalised factors influencing health (such as happiness and good social relations) than they did in Ethiopia. The study found that participants fled Ethiopia due to oppression, violence, fear and poverty; and once in the UK experience poor housing, unemployment, racism and isolation, all of which impact on their health status. Whilst it is difficult to ascertain how these factors affect health beliefs it is probable that these negative experiences and the consequent unhappiness they have caused have highlighted to them the relationship between health and subjective well-being, something that people who have not suffered such life traumas may take for granted. In the UK Ethiopian refugees are more likely to seek Western medicine than they did in Ethiopia, which reflects both acculturation and differences in health resources. This study highlights that Ethiopian refugees, require holistic health care that addresses all their needs--physical, mental, spiritual, environmental and social-cultural. Nurses should understand that many refugees have had traumatic experiences and continue to live in desperate circumstances. Thus nurses should be aware of the experiences, needs and beliefs of refugees and address their own cultural competence.

Adolescent↗
PubMed1987

Mariel refugees: six years after.

In 1983, the economic situation of Mariel Cubans could be summarized as abysmal. Those without a job represented close to 1/2 of the sample; the unemployment rate amounted to 27%. A study conducted by Johns Hopkins University in collaboration with Miami-Dade Community College and Florida International University has investigated whether Mariels remain a group apart within the broader Cuban community or whether they have melted into the rest of the community. The study followed a large sample of Mariel refugees living in the Miami area over a period of several years. A sample of 514 Mariel men and women were interviewed in 1983 and were reinterviewed during 1985-1986. The authors conclude that, as a group, Mariel refugees have made rapid progress toward integration into the South Florida economy. There has been a rapid decline in unemployment during the past 2 years and a rapid shift into self-employment. There is still a sizable gap in labor force participation and earnings between this group and the pre-Mariel Cuban population. Mariel incorporation into South Florida society has taken place almost completely through their absorption into the pre-existing Cuban community; there is tension, however, as Mariel refugees see themselves as more discriminated against by fellow Cubans than by outside Anglos. This minority-within-a-minority syndrome is likely to underlie the reported willingness of many to leave the US if conditions in Cuba were to change for the better. Despite these problems, the majority of Mariel refugees would come again to the US if they had to make the choice anew and declare themselves satisfied with their present lives. Within Dade County, the more positive indicators of economic advancement and general adaptation are found among refugees in the cities of Miami and Hialeah. The most problematic economic situation and the greatest alienation from their surroundings is detected among refugees living elsewhere, primarily in Miami Beach. Results indicate that official and private programs targeted on this refugee group should give priority to 4 aspects: 1) support of small entrepreneurship through credit and training facilities to buttress the widespread efforts in this direction; 2) provision of English language courses and help to overcome extreme language deficiencies; 3) promotion of the reunification of the Mariel refugee families who were separated against their will; and 4) additional efforts by Cuban-American organizations to combat lingering prejudice against Mariel refugees.

Americas↗
PubMed2005

Elevated blood lead levels in refugee children--New Hampshire, 2003-2004.

As a result of reductions in lead hazards and improved screening practices, blood lead levels (BLLs) in children aged 1-5 years are decreasing in the United States. However, the risk for elevated BLLs (> or =10 microg/dL) remains high for certain populations, including refugees. After the death of a Sudanese refugee child from lead poisoning in New Hampshire in 2000, the New Hampshire Department of Health and Human Services (NHDHHS) developed lead testing guidelines to screen and monitor refugee children. These guidelines recommend 1) capillary blood lead testing for refugee children aged 6 months-15 years within 3 months after arrival in New Hampshire, 2) follow-up venous testing of children aged <6 years within 3-6 months after initial screening, and 3) notation of refugee status on laboratory slips for first tests. In 2004, routine laboratory telephone reports of elevated BLLs to the New Hampshire Childhood Lead Poisoning Prevention Program (NHCLPPP) called attention to a pattern of elevated BLLs among refugee children. To develop prevention strategies, NHDHHS analyzed NHCLPPP and Manchester Health Department (MHD) data, focusing on the 37 African refugee children with elevated BLLs on follow-up for whom complete data were available. This report describes the results of that analysis, which indicated that 1) follow-up blood lead testing is useful to identify lead exposure that occurs after resettlement and 2) refugee children in New Hampshire older than those routinely tested might have elevated BLLs. Refugee children in all states should be tested for lead poisoning on arrival and several months after initial screening to assess exposure after resettlement.

Adolescent↗