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PubMed1995

Changes in nutrition among residents and refugees in Sarajevo during the war.

OBJECTIVE: To assess how food shortage has been reflected in changes in nutritional status and dietary intake of resident and refugee populations in wartime Sarajevo. DESIGN: Longitudinal observations were carried out on residents (who stayed in their homes) and refugees (living in collective centres). Three out of four municipal areas of Sarajevo were covered in the sample and households and collective centres in close proximity to the homes of fieldworkers were selected. The same households were visited in October 1992-March 1993 and November 1993-January 1994. SETTING: The study took place in besieged Sarajevo. SUBJECTS: In the first round 362 households (170 resident and 192 refugee) were visited and in the second round 324 households (146 resident and 178 refugee) were visited. INTERVENTIONS: Nutritional information was gathered through anthropometric measurements, medical examination and questionnaires which included a seven day dietary recall. RESULTS: Nutritional status was assessed by calculating body mass index (BMI) (weight/height2) in adults and weight for age percentiles in children (2-18 years of age). Undernutrition in adults was defined as BMI < 18.5 and in children as weight for age < 25th percentile. Results from the first round of data collection showed a higher level of undernutrition among refugees (15.0%) compared to residents (5.3%). The second round revealed higher levels of undernutrition among residents (8.1%) than refugees (7.0%). Daily energy intake in the first round met only half recommended dietary allowances for the former Yugoslavia which is 2700 kcals per day. Refugees were found to consume slightly higher quantities of energy (1500 kcals) compared to residents (1272 kcals). In the second round, energy intake had increased both among refugees (1832 kcals) and residents (1630 kcals). CONCLUSIONS: The population of Sarajevo have been forced to eat a monotonous diet during the war which is deficient both in quantity and quality. Nevertheless the nutritional status of the resident and refugee populations has been maintained. Dietary intake was found to be low but this may have been partly due to under-reporting. The accuracy of data obtained through dietary intake surveys in emergency conditions may be questionable.

Adolescent↗
PubMedDate not supplied

Development of an inventory for measuring war-related events in refugees.

Knowledge about the range of war-related events experienced by refugees is lacking. This initial report of the New Mexico Refugee Project (NMRP) details the development of the Comprehensive Trauma Inventory (CTI), the first empirically developed instrument that measures war-related events in community-dwelling refugees. Both expert and participant methods using quantitative and qualitative approaches were used to broaden knowledge about the range of war-related experiences in refugees. The CTI-164, developed by expert rational methods, was administered to 36 Kurdish and 31 Vietnamese refugees along with an in-depth interview (IDI) and five other quantitative instruments measuring symptoms, impairment, and social support. Focus groups (FGs) were also conducted. Text and descriptive analyses, t tests, and correlations were used to analyze data. Refugees reported an average of 150 war-related events on the CTI-164, more than in other studies. IDIs and FGs revealed 123 war-related events and event types that were not on the CTI-164 or other measures currently used. Refugees reported multiple chronic symptoms and significant impairment in daily functioning. The CTI-164 was modestly correlated with symptoms and impairment. The definable number and type of war-related events endured by refugees is greater than in previously published research. Expert rational methods are not adequate to develop an instrument to define war-related events and measure their association with health outcomes. Participatory and qualitative methods reveal events and event types that have not been previously defined. The CTI warrants further testing after revision to incorporate items and event types determined by qualitative methods.

Adult↗
PubMed2004

Refugee participation in health relief services during the post-emergency phase in Tanzania.

INTRODUCTION: While community participation in health activities has been examined extensively after Alma-Ata, few studies have focused on beneficiary participation in health services in a humanitarian disaster relief programme. This research scrutinized refugee participation in encamped health services, explored its achievement, and identified the further needs of refugees in pursuit of enhanced health services in the camp. METHODS: The study was performed at Lugufu Camp, Tanzania, where a health information team (HIT) of Congolese refugees actively participated in health services. Structured questionnaires were used for this cross-sectional observational study, covering three types of respondents: i.e. (1) systematically selected refugee community members (n=576); (2) all HIT members (n=48); and all Tanzanian health staff in charge of preventive health (n=17). Additional information was also collected through focus group discussions. RESULTS: HIT refugees used their own health initiatives, which resulted in a growth of self-confidence. There was an evidence of benefits, especially in promoting health education, affirmed by an almost established consensus among the refugee community, Tanzanian health staff and HIT members themselves. However, refugee community members who did not know any HIT members had less positive health-seeking behaviours than those who knew one or more HIT members, thus showing a need for further dissemination of HIT services. CONCLUSIONS: Participation in the health services led the HIT refugees to regain the sense that they could contribute to solving peers' health problems with their own knowledge and services, and by working together as a team. Beneficiary participation is a dynamic process that heightened responsibility and health consciousness, along with a concomitant gain in power over their destiny.

Adult↗
PubMed1998

Effects of a refugee-assistance programme on host population in Guinea as measured by obstetric interventions.

BACKGROUND: Since 1990, 500000 people have fled from Liberia and Sierra Leone to Guinea, west Africa, where the government allowed them to settle freely, and provided medical assistance. We assessed whether the host population gained better access to hospital care during 1988-96. METHODS: In Guéckédou prefecture, we used data on major obstetric interventions performed in the district hospital between January, 1988, and August, 1996, and estimated the expected number of births to calculate the rate of major obstetric interventions for the host population. We calculated rates for 1988-90, 1991-93, and 1994-96 for three rural areas with different numbers of refugees. FINDINGS: Rates of major obstetric interventions for the host population increased from 0.03% (95% CI 0-0.09) to 1.06% (0.74-1.38) in the area with high numbers of refugees, from 0.34% (0.22-0.45) to 0.92% (0.74-1.11) in the area with medium numbers, and from 0.07% (0-0.17) to 0.27% (0.08-0.46) in the area with low numbers. The rate ratio over time was 4.35 (2.64-7.15), 1.70 (1.40-2.07), and 1.94 (0.97-3.87) for these areas, respectively. The rates of major obstetric interventions increased significantly more in the area with high numbers of refugees than in the other two areas. INTERPRETATION: In areas with high numbers of refugees, the refugee-assistance programme improved the health system and transport infrastructure. The presence of refugees also led to economic changes and a "refugee-induced demand". The non-directive refugee policy in Guinea made such changes possible and may be a cost-effective alternative to camps.

Adult↗
PubMed2001

Disease and dislocation: the impact of refugee movements on the geography of malaria in NWFP, Pakistan.

Studies of the health implications of refugee movements have generally focused on the effects of dislocation on the health of refugees and the impacts on health care provision at the destination. A somewhat more neglected aspect of the refugee-health research has been the impact of refugee flows on the geography of disease, i.e., how the spatial patterns of disease prevalence are modified through the influx and settlement of refugee populations. We examine this issue by examining the changing geography of malaria in Pakistan's North West Frontier Province (NWFP) between 1972 and 1997. Until the late 1970s, the highest incidence of malaria in the region was seen in the southern and eastern parts. During the 1980s, however, two and a half million Afghan refugees entered the NWFP and were housed in tented villages along the border and in some interior areas. As the decade progressed, there was a significant shift in the spatial pattern of malaria, with the regions of highest incidence shifting to the west and north, coinciding strongly with refugee concentrations. Our study draws attention to the manner in which refugee influx and settlement can alter the ecology of the disease system, leading to long-term changes in the geography of malaria.

Afghanistan↗
PubMed2004

Childhood mortality among former Mozambican refugees and their hosts in rural South Africa.

BACKGROUND: It is important to monitor health differentials between population groups to understand how they are generated. Internationally displaced people represent one potentially disadvantaged group. We investigated differentials in mortality between children from former Mozambican refugee and host South African households in a rural sub-district in the north-east of South Africa. METHODS: Open prospective cohort of 30 276 children (80 462 person years of follow-up) followed from 1 January 1992 to 31 October 2000 in Limpopo Province, South Africa. Exposure and outcomes data came from the Agincourt Health and Demographic Surveillance System (DSS). RESULTS: There was no difference in infant mortality between children from former Mozambican refugee households and those from South African homes (adjusted rate ratio [RR] = 1.02, 95% CI: 0.79, 1.32), but mortality levels were higher among former Mozambican refugee children during the next 4 years (adjusted RR = 1.91, 95% CI: 1.50, 2.42). Increased mortality levels were also seen among children from larger households and whose mother died, while children born to mothers aged >40 years or with higher education were at lower risk. Measured maternal, household, and health service utilization characteristics could not explain the difference in mortality between children from former Mozambican refugee and South African households. Former Mozambican refugee children residing in refugee settlements had higher mortality rates than those residing in more established villages. CONCLUSIONS: This study demonstrates higher childhood, but not infant, mortality rates among children from former Mozambican refugee households compared with those from host South African households in rural South Africa. The lack of legal status and lower wealth of many former Mozambican refugees may partly explain this disparity.

Adolescent↗
PubMedDate not supplied

Prevalence of tuberculosis, hepatitis B virus, and intestinal parasitic infections among refugees to Minnesota.

OBJECTIVE: The purpose of this study was to define the prevalence of infection with Mycobacterium tuberculosis, hepatitis B virus, and various intestinal parasites among different groups of primary refugees immigrating to Minnesota. METHODS: 2,545 refugees arriving in Minnesota during 1999 received a domestic health examination that included tuberculin skin testing, hepatitis B virus serologic testing, and stool ova and parasite examinations. The Refugee Health Assessment form asked specifically about screening results for amebiasis, ascariasis, clonorchiasis, giardiasis, hookworm, schistosomiasis, strongyloidiasis, and trichuriasis. RESULTS: Forty-nine percent of refugees had a reactive tuberculin test of >or=10 mm induration, with a higher prevalence in males (54%) and refugees >or=18 years of age (63%) (p<0.001). Seven percent had a positive hepatitis B surface antigen, with the highest prevalence in those people from sub-Saharan Africa (8%) (p=0.002) and those refugees >or=18 years of age (9%) (p=0.006). Twenty-two percent had one or more intestinal parasites asked about, including 30% of those refugees <18 years of age (p<0.001). The most commonly reported parasitic infections were trichuriasis (8%) and giardiasis (7%). CONCLUSIONS: Evidence of infection with M. tuberculosis, hepatitis B virus, or one of eight intestinal parasites was present in a substantial proportion of refugees receiving the domestic health assessment. Screening for such infections gives new immigrants the opportunity to receive important medical evaluation and treatment, provides valuable surveillance data, and allows appropriate public health measures to be taken.

Adolescent↗
PubMed2004

Converting cultural capital among teen refugees and their families from Bosnia-Herzegovina.

OBJECTIVES: The objective of this study was to identify the processes by which teen refugees adapt and apply cultural capital in conditions of refuge in order to develop preventive interventions for refugee youths. METHODS: The study was a multisite ethnographic study in Chicago that involved observation of Bosnian participants in schools, community sites, service organizations, and households as well as in-depth interviews with a subsample of 30 Bosnian adolescents and their families. Field notes and interview data were subjected to thematic analysis. RESULTS: The concept of converting cultural capital emerged as a useful construct for representing the cultural resources that Bosnian teen refugees and their families bring to the refugee trauma experience. Conversion of cultural capital refers to processes of adapting and applying the meanings, knowledge, customs, achievements, and outlooks that teen refugees and their families bring to new environments in order to enhance teens' cultural vitality and social incorporation. Nine mechanisms of converting cultural capital were identified, labeled, and defined in emic terms: using our language, obliging family, sticking together, returning to religion, going ghetto, building a future, taking pride in tradition, critiquing America, and seeking freedom. These mechanisms represent cultural strategies by which teen refugees attempt to manage enormous historical, social, cultural, economic, familial, and psychological changes associated with refugee trauma. CONCLUSIONS: Ethnography is an important methodologic tool in mental health services research, and the concept of converting cultural capital is useful in designing preventive interventions for teen refugees and their families.

Adaptation, Psychological↗
PubMed2004

Health risk and promotion behaviors in refugee populations.

Refugees resettling in the U.S. are generally low-income and underserved by health promotion interventions. To begin to address refugee health promotion issues, this study describes health behaviors of newly arrived (less than 90 days) adult refugees in the U.S. The methods used were retrospective description of clients from one refugee health screening program. The sample consisted of adult refugees (n=591), men and women, from Cuba, Bosnia, Vietnam, Kosovo, Iran, Iraq, and other countries. Rates of overweight were highest among Bosnians and lowest among Vietnamese. Cubans reported the most physical activity and Kosovars the least. Rates of smoking were highest among Bosnians and lowest among Cubans. Older refugees were more overweight and reported less physical activity and more smoking than younger adults. In some cases, different refugee groups have similar health promotion needs, while in others needs differ. This baseline descriptive data supports calls for further health promotion research and interventions in refugee populations.

Adolescent↗
PubMedDate not supplied

Research on psychopathological consequences of refugeeism.

The study examined mental and psychopathological consequences of refugeeism and included (109) refugees from refugee camp in Krnjaca. Their reactions were compared with the reactions of (70) somatically injured patients from Orthopedic Hospital of the Clinical Centre in Belgrade and subjects (105) from Belgrade denying any traumatic experience whatsoever. Apart from the questionnaire on socio-demographic features, subjects were asked to provide answers to Post Traumatic Stress Disorder (PTSD-10) scale, Brief Eysenck's Personality Inventory, Family Homogeneity Inventory and Impact of Events Scale. By implementation of appropriate statistical procedures (variance analysis), the significance of differences among certain features within the experimental group of refugees was examined, as well as the difference concerning presence of mental and psychopathological features among all three subgroups. It was determined that within the refugee group, males more significantly and more frequently reacted with PTSD symptoms, as well as with signs of general neuroticism and that married refugees more frequently presented with PTSD symptoms. In comparison to non-refugees, refugees more significantly and more frequently present with PTSD symptoms, which is probably caused by PTSD chronicity in this category of subjects. Subjects denying any significant traumatic experience in their lives presented with symptoms of general neuroticism more than the rest of examinees. This is an interesting finding that can be explained by the fact that the same group achieved the highest values on the extraversion scale (using the same Eysenck instrument), or may be correlated to the increase of neurotic reactions in the whole population of Serbia and Montenegro. The above mentioned and other results were compared to the findings of similar researches performed by other authors.

Adult↗
PubMed1987

A review of refugee medical screening in New South Wales.

Public health concern in relation to refugees arriving in New South Wales is due to the high prevalence of tuberculosis, syphilis and hepatitis B infection in some refugee groups. Other infectious diseases (with the exception of malaria in the Northern Territory and Queensland) do not pose a significant threat to public health owing to their low prevalence (which may result from overseas screening and treatment) and/or low infectivity in Australian conditions. Because of overseas screening by the Commonwealth Government before the departure of the refugees, it was uncommon in 1984 for previously undetected tuberculosis to be detected when refugees were screened on arrival in Sydney (found in only one in 800 refugees who underwent screening). However, of the refugees in Sydney who had positive results of serological tests for syphilis, a substantial proportion (at times in excess of 50%) had had a negative result at the overseas screening; subsequent follow-up of those with positive serological results indicated inactive disease in almost all cases. There is a need to monitor the infectious disease prevalence and the effectiveness of overseas screening of refugees by on-arrival screening; decisions about screening procedures and the selection of particular incoming refugee groups for screening should be based on sound epidemiological and clinical analysis.

Australia↗
PubMed1999

Southeast Asian refugee children: violence experience and depression.

The United Nations High Commission for Refugees (UNHCR) reports that there were approximately 8.2 million refugees world wide in 1980. Estimates today place the number of refugees to be at least 44 million. Although most refugees remain within the boarders of their homelands, others who are granted asylum immigrate to host countries. The largest number of refugees to enter the United States during the past 20 years are from Southeast Asia, following the end of the Viet Nam War in 1975. The majority of immigrating Southeast Asian refugees were children and adolescents. Empirical study of refugee children, who are known to have experienced catastrophic violence during war, escape from homelands and in camps of asylum, is relatively scarce. Some studies that have addressed this issue document association between violence experience, depression and post traumatic stress disorder. Even so, the findings are not always clear. The purpose of this paper is to document the frequency of pre-migration and post-migration violence experiences reported by Southeast Asian refugee children in the U.S. and their relationship to depression. This study also addresses the emotional impact of violence experiences as described by the children. Previous studies have often neglected this important variable in accounting for variations in children' 5 mental health status. Nurses, internationally, will want to consider the multiple facets of violence experience when assessing children who may be at high risk for psycho-social adaptation problems following resettlement.

Adolescent↗
PubMed2002

International Organization for Migration: experience on the need for medical evacuation of refugees during the Kosovo crisis in 1999.

The International Organization for Migration (IOM) developed and implemented a three-month project entitled Priority Medical Screening of Kosovar Refugees in Macedonia, within the Humanitarian Evacuation Program (HEP) for Kosovar refugees from FR Yugoslavia, which was adopted in May 1999. The project was based on an agreement with the office of United Nations High Commission for Refugees (UNHCR) and comprised the entry of registration data of refugees with medical condition (Priority Medical Database), and classification (Priority Medical Screening) and medical evacuation of refugees (Priority Medical Evacuation) in Macedonia. To realize the Priority Medical Screening project plan, IOM developed and set up a Medical Database linked to IOM/UNHCR HEP database, recruited and trained a four-member data entry team, worked out and set up a referral system for medical cases from the refugee camps, and established and staffed medical contact office for refugees in Skopje and Tetovo. Furthermore, it organized and staffed a mobile medical screening team, developed and implemented the system and criteria for the classification of referred medical cases, continuously registered and classified the incoming medical reports, contacted regularly the national delegates and referred to them the medically prioritized cases asking for acceptance and evacuation, and co-operated and continuously exchanged the information with UNHCR Medical Co-ordination and HEP team. Within the timeframe of the project, 1,032 medical cases were successfully evacuated for medical treatment to 25 host countries throughout the world. IOM found that those refugees suffering from health problems, who at the time of the termination of the program were still in Macedonia and had not been assisted by the project, were not likely to have been priority one cases, whose health problems could be solved only in a third country. The majority of these vulnerable people needed social rather than medical care and assistance a challenge that international aid agencies needed to address in Macedonia and will need to address elsewhere.

Delivery of Health Care↗
PubMed2001

Surveillance of mortality during a refugee crisis--Guinea, January-May 2001.

Since 1990, the republic of Guinea (2000 population: 7.5 million) has accepted 390,000-450,000 refugees from Sierra Leone and Liberia. During this 10-year period, refugees have lived in small villages scattered throughout rural southeastern Guinea. During September-December 2000, attacks by armed factions in Guinea led to the widespread displacement of refugees living in the southeastern camps; the refugees subsequently were transferred to safer camps in the northwest. Approximately 280,000 refugees initially were estimated to have been displaced. After the attacks, the number of refugees relocated was approximately 58,000. This report demonstrates methods used to calculate mortality rates when large populations are displaced. The findings indicate that the number of refugees in Guinea before the relocation probably was overestimated. The mortality rates calculated using conservative denominator numbers did not meet the definition of an emergency phase of a complex emergency, and mortality rates were lower for refugees compared with baseline rates for the local population. Accurate methods are needed to estimate population size in complex emergencies to provide resources to vulnerable groups.

Guinea↗
PubMedDate not supplied

Alarming increase in refugees.

Over the past decade and half there has been an alarming worldwide increase in refugees. The total rose form 2.8 million in 1976 to 8.2 million in 1980, to 17.3 million in 1990. Africa's refugees rose from 1.2 million in 1976 to 5.6 million in 1990. Asia's increase over this period was much more rapid--from a mere 180,000 to 8 million. In the Americas the numbers more than trebled, from 770,000 to 2.7 million. Europe was the smallest increase, from 570,000 to 894,000. International law defines a refugee as someone outside of their own country, who has a well-founded fear of persecution because of their political or religious beliefs or ethnic origin, and who cannot turn to their own country for protection. Most refugees are genuine by this definition. The increase reflects, in part, fallout from the cold war. Ethiopia, Mozambique and Angola accounted for almost 1/2 of Africa's refugees; Afghanistan alone for 3/4 of Asia's total. They fled, for the most part, from 1 poor country into another, where they added to shortages of land and fuelwood, and intensified environmental pressure. Malawi, 1 of the poorest countries in the world, is sheltering perhaps as many as 750,000 refugees from the war in Mozambique. But among these refugees--especially among those who turned to the rich countries for asylum--were an increasing number of people who were not suffering political persecution. Driven out of their homes by the collapse of their environment or economic despair, and ready to take any means to get across borders, they are a new category: economic and environmental refugees. The most spectacular attempts hit the television screens: the Vietnamese boat people, ships festooned with Albanians. Behind the headlines there was a growing tide of asylum seekers. The numbers rose 10-fold in Germany from 1983 to 1990. In Switzerland they multiplied by 4 times. In Europe, as a whole, they grew from 71,000 in 1983 to an estimated 550,000 in 1990. In 1990 the numbers threatened to swamp reception systems. There was a growing phenomenon of "asylum shopping" -- people turned down by 1 country applying to another and another. The cost of supporting applicants on welfare while their claims were processing was rising. In 1990 there were some 800,000 foreigners in Germany alone whose claims were under consideration.

Demography↗
PubMed2003

TB status among Kosovar refugees.

DESIGN: In the spring of 1999, 864 Kosovars were directly airborne from refugee camps in Macedonia to a refugee camp in Kristiansand, Norway; 800 were examined according to official Norwegian TB screening procedures with X-ray (if more than 15 years of age) and tuberculin test shortly after arrival. RESULTS: The mean (SD) age was 29.2 (18.7) years of age and 29% were aged under 15 years; 79% of the refugees had escaped from urban areas in Kosovo, and 75% had an identifiable BCG scar. Among those with BCG scar, increasing age and male sex were associated with a significant tuberculin reaction: 20% had tuberculin reactions indicating latent TB infection, while 40% had negative tuberculin reactions. Approximately 4% of the refugees aged over 15 had abnormal chest X-rays, predictive of an enhanced tuberculin reaction. Four refugees had X-ray findings compatible with active TB and were treated with standard four-drug chemotherapy. CONCLUSION: The Kosovar refugees had a high incidence of active tuberculosis (50/100,000). A fifth of the BCG-vaccinated refugees needed careful follow-up to monitor possible progress from latent to active TB infection after immigration, while one in seven non-BCG-vaccinated refugees had tuberculin skin reactions compatible with latent TB infection.

Adolescent↗
PubMed2004

Southeast Asian refugee children: self-esteem as a predictor of depression and scholastic achievement in the U.S.

The eruption of conflicts and war in this century has led to new masses of refugees and displaced persons. Globally, host countries will continue to confront issues of how to ensure the successful adaptation of refugees who typically are women and children. The United States received three major waves of Southeast Asian (SEA) refugees during the past twenty-five years. One million SEA refugees arrived in the past decade; the majority were children and adolescents. Today, there is still a lack of understanding surrounding mental health issues and their relationship to children's violence experience. We know that SEA refugee children suffered violence during the war in Southeast Asia, their escape from homelands, in camps of asylum and in the U.S. Although researchers have examined the relationship of violence with depression and post-traumatic stress disorder in refugee children, the findings have been unclear and sometimes conflictual in their relationship to scholastic achievement. In the U.S., healthy self-esteem is recognized as an important component of mental health and academic success, while low self-esteem is associated with depression and academic failure. In general, self-esteem and measures of self-esteem have not been studied cross-culturally. The authors report the findings of a measure of self-esteem, depression and academic achievement in a convenience sample of 237 Southeast Asian refugee children aged 6 to 17 years of age in the U.S. Internationally, nurses who assess the mental health of refugee children and design interventions to assist in their adaptation, will want to have an understanding of mental health issues cross-culturally.

Adolescent↗
PubMed1983

Tuberculosis among Indochinese refugees in the United States.

Surveys of state tuberculosis control programs revealed that of the 262,602 Indochinese refugees who entered the United States in 1979 and 1980, approximately 1.5% either had tuberculosis at the time of entry or developed it by the end of 1980; another 18% were placed on preventive therapy. The refugees comprised 5.3% of the nationally counted cases during the two-year period. Age- and sex-specific incidence rates among Indochinese refugees were 30 to 200 times higher than those for other persons in the United States. For refugees who arrived in 1979, the incidence of tuberculosis during 1980 (231 per 100,000) was only one third the incidence during 1979 (719 per 100,000). For refugees who entered the United States in 1980, the incidence during 1980 was 480 per 100,000. Bacteriologic confirmation of the diagnosis was reported for only 26% of refugees, compared with 79% of other patients with tuberculosis in the United States, suggesting overdiagnosis of tuberculosis among refugees. However, age-specific rates of bacteriologically positive tuberculosis were still 14 to 70 times higher for refugees than for the United States as a whole.

Adolescent↗