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Data from 99 school-aged Bosnian refugee children living in Sweden were analyzed to reveal the patterns of war stress experienced and the relation between these stressors and current psychological problems. A significant pattern of associations emerged. When children had experienced much stress, talking about their experiences seemed to exacerbate their negative effects.
The purpose of this study was to clarify the mental health needs of Iraqi immigrants who arrived in the United States in the 1990s after the Persian Gulf War. The records of 375 clients were examined at a clinic that serves Arab Americans. More posttraumatic stress disorder and health problems were found in Iraqi refugees than in other clients. Results suggest the need for further research on immigrants with traumatic histories to facilitate effective treatments.
The cross-cultural equivalence and validity of the Vietnamese translation of the Minnesota Multiphasic Personality Inventory--2 (MMPI-2) were examined in a sample of 1st-generation Vietnamese refugees in the United States (N = 143). Respondents completed the Vietnamese MMPI-2, the Harvard Trauma Questionnaire, a measure of acculturation, and a demographic questionnaire. An inspection of MMPI-2 mean profiles and items showing extreme endorsement rates suggested that certain symptom tendencies and cultural values may be reflected in responses to some MMPI-2 items. Older age, lower acculturation, greater experienced premigration-postmigration traumas, and military veteran status were all associated with elevated MMPI-2 profiles, suggesting that the MMPI-2 functions in a reasonably equivalent and valid way in this population.
Using play techniques, individual assessments were made of 50 preschool children from 47 Iranian refugee families living in Sweden, while their parents were interviewed about the children's exposure to violence and separation. Reenacting play involving war and persecution was performed by 19 of the children, most of them eyewitnesses to violence. The study demonstrated ways of obtaining information directly from young children to supplement parental reports.
The relationship between school performance and emotional problems was assessed in a general population sample of refugee children from Southeast Asia and Central America. Results suggested that learning difficulties and levels of academic achievement were associated with emotional problems in both groups but that, despite comparable academic records, remedial measures were more often prescribed for Central American children.
OBJECTIVE: To assess whether germinating pulses and beans are a potential source of vitamin C in rations for refugee communities with poor vitamin C status. DESIGN: High pressure liquid chromatographic assessment of vitamin C content of a range of legumes following germination in light and dark and after cooking. RESULTS: Many species of pulses produced significant quantities of vitamin C up to five days following germination in both light and dark although cooking caused a marked loss of ascorbate. CONCLUSION: Germination of approximately half of the seeds of the pulse constituents of many basic rations would be likely to generate, within a 3-5 d germination period, sufficient ascorbate to provide the 10 mg needed to protect adults against the development of scurvy.
An ethnographic study was conducted within a Cambodian refugee community to discover information about Cambodian women's and men's knowledge and use of family planning methods. This 18-month study included participant observation at community and calendrical events, and within families' homes. Open-ended interviews were conducted with 53 informants from a variety of educational and socio-economic backgrounds. Both women and men were interviewed through a female bilingual interpreter when the informant lacked proficiency in speaking English. Major findings include a lack of knowledge among the sample about how the family planning methods work in the woman's body, and concerns about side-effects. Implications include the need to include Cambodian women and men in the planning and implementation of family planning programmes.
Insecticide-treated bedding materials (sheets and blankets) could be protective against vectors of malaria and leishmaniasis--especially in complex emergencies, epidemics and natural disasters where people are more likely to sleep in exposed situations. Comparison of cotton top-sheets impregnated with different pyrethroids (permethrin 500 mg/m2, deltamethrin 25 mg/m2 or alphacypermethrin 25 mg/m2) for effectiveness against mosquitoes (Diptera: Culicidae) was undertaken in a refugee camp in Pakistan. Predominant species encountered were Anopheles stephensi Liston, An. pulcherrimus Theobald, An. nigerrimus Giles, Culex quinquefasciatus Say, Cx. tritaeniorhynchus Giles and other culicine mosquitoes. All three pyrethroid treatments performed significantly better than the untreated sheets in deterrence and killing of mosquitoes. No significant differences were found between the three insecticides tested in terms of entomological effect. Washing of the treated sheets greatly reduced their effectiveness. In a user acceptance study conducted among 88 families (divided into four groups), six families complained of irritation of the skin and mucous membranes. Of these reports, one was from the placebo group (using untreated sheets) and the other five (5/22=23%) from families using deltamethrin-treated sheets. All families allocated to permethrin and alphacypermethrin groups declared an appreciation for the intervention and reported no side-effects. Ten of the placebo group disliked the intervention, citing no prevention of mosquito biting as the reason. Side-effects associated with deltamethrin indicate that alphacypermethrin and permethrin are more appropriate first choice insecticides for treatment of sheets and blankets.
Artemisinin-based combination therapy (ACT) is one strategy recommended to increase cure rates in malaria and to contain resistance to Plasmodium falciparum. In the Maheba refugee settlement, children aged 5 years or younger with a confirmed diagnosis of uncomplicated falciparum malaria are treated with the combination of sulphadoxine-pyrimethamine (1 day) and artesunate (3 days). To measure treatment adherence, home visits were carried out the day after the last treatment dose. Patients who had any treatment dose left were considered certainly non-adherent. Other patients' classification was based on the answers to the questionnaire: patients whose caretakers stated the child had received the treatment regimen exactly as prescribed were considered probably adherent; all other patients were considered probably non-adherent. Reasons for non-adherence were assessed. We found 21.2% (95% CI [15.0-28.4]) of the patients to be certainly non-adherent, 39.4% (95% CI [31.6-47.6]) probably non-adherent, and 39.4% (95% CI [31.6-47.6]) probably adherent. Insufficient explanation by the dispenser was identified as an important reason for non-adherence. When considering the use of ACT, the issue of patient adherence remains challenging. However, it should not be used as an argument against the introduction of ACT. For these treatment regimens to remain efficacious on a long-term basis, specific and locally adapted strategies need to be implemented to ensure completion of the treatment.
The present study examines the effect of torture in generating post-traumatic stress disorder (PTSD) symptoms by comparing its impact with that of other traumas suffered by a war-affected sample of Tamils living in Australia. Traumatic predictors of PTSD were examined among a subsample of 107 Tamils (refugees, asylum seekers, and voluntary immigrants) who had endorsed at least one trauma category on the Harvard Trauma Questionnaire. Principal components analysis (PCA) yielded five trauma factors that were applied to predicting PTSD scores. Tamils exposed to torture returned statistically higher PTSD scores than other war trauma survivors after controlling for overall levels of trauma exposure. The torture factor identified by the PCA was found to be the main predictor of PTSD in a multiple regression analysis. Although limited by sampling constraints and retrospective measurement, the present study provides support for the identification of torture as a particularly traumatic event, even when the impact of other war-related trauma is taken into account.
Little is known of difficulties in accessing health care for recently arrived paediatric refugees in Australia. We reviewed routinely collected data for all 199 East African children attending a hospital Immigrant Health Clinic for the first time over a 16 month period. Although 63% of parents reported medical consultations since arrival, 77% of this group reported outstanding, unaddressed health problems. Availability of interpreters and information on health services were the main factors hindering access to care. These data have informed future service planning at the Clinic. Ongoing data collection is key to maintaining a responsive, targeted service for a continually changing population.
OBJECTIVE: To assess the nutritional status of older people in an unstable situation. DESIGN: Anthropometric and socioeconomic data were collected cross-sectionally. Body mass index (BMI), arm muscle area (AMA) and arm fat area (AFA) were calculated to evaluate nutritional status. For 41 subjects with kyphosis, height was estimated from arm span using sex-specific regression equations from the non-kyphotic group. SETTING: The study was carried out in the post-emergency phase in a Rwandan refugee camp in Karagwe district, north-west Tanzania. SUBJECTS: Measurements were obtained from 413 men and 415 women aged 50-92 years. RESULTS: The prevalence of undernutrition (BMI < 18. 5) was 19.5% in men and 13.1% in women and was higher above age 60 years in both sexes: in men the prevalences were 23.2% and 15.0% (P < 0.05) and in women 15.1% and 10.9% for the older and younger age groups respectively. AMA, which is important in relation to the ability to remain active and independent, was also significantly lower in older age groups. No difference was found in AFA. The proportion with low BMI was much higher in the group with kyphosis. CONCLUSIONS: Even in this population of older Rwandans who managed to reach the camp and survive in exile for more than a year, undernutrition does occur and is more prevalent at an advanced age. The higher prevalence of undernutrition in kyphotic people illustrates the importance of including this group in nutritional status assessments.
OBJECTIVE: To identify child hunger and examine its association with family factors, receipt of benefits, housing conditions and social support among recently arrived refugee families with young children. DESIGN: Structured and semi-structured questionnaire administered to a service-based, purposive sample of caregivers. SETTING: East London, United Kingdom. SUBJECTS: Thirty households with children <5 years old, resident in the UK for <2 years. RESULTS: All households sampled were food-insecure, and 60% of index children were experiencing hunger as defined on the Radimer/Cornell scale. Child hunger was significantly associated with recent arrival, marginally significantly associated with receipt of fewer benefits and younger parenthood, and not associated with maternal education or self-efficacy score, household size or composition, or measures of social support. CONCLUSIONS: A community-based, participatory approach for rapid assessment of the prevalence, extent and causes of child hunger among newly arrived asylum seekers recently arrived in Britain is feasible, and preliminary results suggest a programmatic need for a broader, population-based assessment of food insecurity in this rapidly growing population group.
Louse-borne relapsing fever (LBRF) is still endemic among Ethiopian populations. In order to assess the clinical presentation of LBRF in an Ethiopian refugee camp in northern Somalia, a referral system was organized for all pyrexias of unknown origin. Among the 134 patients referred, 37 showed Borrelia in fresh and stained blood smears. Common clinical features were: high fever (above 39 degrees C in 73% of the cases), headache and general body pain (88%), liver tenderness (62%), petechia (54%), nausea and vomiting (46%), chills and rigors (30%) and epistaxis (11%). Jaundice was absent. No fatalities were observed. The clinical picture was less severe than in previous studies on LBRF. This difference might be due to the fact that the present study was community-based as opposed to the previous studies which were hospital-based.
A parasitological survey of refugees based in Juba, Sudan, involving 241 faecal samples, revealed that 66% of the population harboured intestinal helminths. The most commonly found infection was hookworm (36%), followed by Schistosoma mansoni (26%), Strongyloides stercoralis (20%), Hymenolepis nana (11%), Ascaris lumbricoides (1.2%), Trichuris trichiura (0.8%) and Taenia sp. (0.4%). Many of the specimens (42%) harboured a single infection, 21% had double, 2% triple and 1% quadruple infections. Parasite prevalences and intensities were analysed in relation to age, sex, religion and occupation: females (70%) were found to be more infected than males (64%); Muslims (50%) were less infected than Christians (68%) and agriculturalists (90%) were the most infected occupational group.
In a sample of 146 adolescents, the authors developed and validated a measure of acculturative hassles for Soviet Jewish refugees. They based the measure on an ecological perspective, which focuses on hassles involving person-environment transactions occurring in life domains of school, family, peers, and language. The authors reviewed conceptual and methodological issues in existing instruments and incorporated efforts to address current limitations into instrument development. The measure was correlated with psychological distress, level of acculturation to Russian and U.S. cultures, and outcomes in life domains; it contributed to outcomes over and above effects of nonacculturative hassles. Implications for measurement of acculturative hassles are discussed.
Several demographic and post-immigration factors related to self-reported symptoms of anxiety and depression of immigrants in New Zealand were examined in a study involving a sample of 129 Southeast Asian refugees, 57 Pacific Island immigrants, and 63 British immigrants to New Zealand. A questionnaire and the Hopkins Symptom Checklist-25 (HSCL-25) in English and in three Southeast Asian translations were administered, followed by an interview in English or with an interpreter. The findings suggest that demographic characteristics are not associated with symptom level. Post-immigration factors, such as experiencing discrimination in New Zealand, not having close friends, being unemployed, and spending most of one's time with one's own ethnic group affected anxiety and depression scores.
This study reports on Cambodian refugee data related to signs symptomatic of depression and anxiety, the tendency to worry or ruminate over past events (a culture-bound syndrome called "Khoucherang"), and differences that might be influenced by social system and cultural practice. A sample consisting of 155 women of Cambodian national origin were interviewed in their homes in the USA and France. Answers to the research questions were collected by a focused interview to elicit demographic information, and the Hopkins Symptom Checklist (HSCL) in the Cambodian language to elicit depression and anxiety scores. Women residing in France (87%) were significantly more likely to show signs symptomatic of depression than women residing in the USA (65%). Women in the study reported about three times as much depression as the average American woman. Large numbers of women residing in both countries were symptomatic of anxiety (82% on average). Both groups experienced extreme symptoms of the culture-bound syndrome, "Khoucherang," and appeared to be strongly influenced by the different social systems of the two countries.