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PubMed1995

Malaria in east African refugees resettling to the United States: development of strategies to reduce the risk of imported malaria.

Resettlement to the United States of malaria-infected refugees can pose problems for both the refugees and their resettlement communities. To formulate malaria management strategies for East African refugees before resettlement to the United States, epidemiologic data were reviewed and malaria prevalence surveys were conducted among refugees awaiting resettlement in Mombasa, Kenya, and Khartoum, Sudan, in 1993. Overall, 279 Somali (Mombasa) and 127 Ethiopian (Khartoum) refugees were surveyed. Malaria contributed significantly to morbidity in Mombasa: 15% (43/279) of Somalis were parasitemic; 39 infections (91%) were due to Plasmodium falciparum. Sulfadoxine-pyrimethamine was effective treatment. In Khartoum, only 0.8% (1/127) were parasitemic; recent fever or antimalarial use were uncommon. Presumptive sulfadoxine-pyrimethamine treatment before departure was recommended for all resettling refugees from Mombasa; in Khartoum, individual assessment of febrile illness was recommended. Prevention of malaria parasitemia by mass drug administration or individual therapy can minimize the burden of malarial illness to refugees and their resettlement communities.

Africa, Eastern↗
PubMed2001

Traumatic experiences and the mental health of Senegalese refugees.

The purpose of our study was to conduct a preliminary investigation into the experiences and mental health of Senegalese refugees. Although research has established that refugees are more prone to psychiatric illnesses than the general population, little has been written about West African refugees. Our focus was on adult refugees (18 years of age and older) from the Casamance region of Senegal. A total of 80 participants (39 women, 41 men) were randomly selected from refugee camps in The Gambia. The Harvard Trauma Questionnaire and the Hopkins Symptom Checklist-25 were used to assess levels of traumatization and mental health status. Typical of refugees of war, participants reported suffering a large number of various traumas. High prevalence rates of anxiety, depression, and posttraumatic stress disorder were also found in this group. A substantial mental health problem exists within the Senegalese refugee population that may signify a potential human crisis.

Adolescent↗
PubMed2002

Science-based policy for psychosocial interventions in refugee camps: a Cambodian example.

No longer are the high rates of psychiatric morbidity associated with mass violence in refugee populations invisible to the humanitarian assistance community. However, identification of mental health risk and protective factors that can be utilized by policy planners is still lacking. The objective of this report is to provide an analytic approach to determining these factors. A description is provided from the first large-scale epidemiological study of Cambodian refugees confined to the Thailand-Cambodian border in the 1980s and 1990s. The original data from this study are reanalyzed to evaluate the mental health impact of psychosocial factors subject to the influence of camp authorities, such as opportunities in the refugee camp environment and personal behaviors, in addition to trauma. The results suggest the extraordinary capacity of refugees to protect themselves against mental illness despite horrific life experiences. The recommendation emerges for refugee policy makers to create programs that support work, indigenous religious practices, and culture-based altruistic behavior among refugees. As refugee mental health policy receives increasing attention from the international community, it must consist of recommendations and practices based on scientific analysis and empirical evidence.

Adaptation, Psychological↗
PubMed1996

Refugee density and dependence: practical implications of camp size.

Different refugee camps may have widely differing morbidity and mortality rates. Some of these differences are ascribed to environmental factors. This paper reviews the key issues relating to one environmental factor: the size of the refugee camp, and provides a tentative theoretical framework for examining the effect of camp size on refugees. This effect may not be considered because aid workers chronically underestimate the value of the refugees' contribution to their own survival. Large camps settle great numbers of refugees to the hinterland of the camp and limit their access to resources available there. This may increase refugee dependency and vulnerability. There is some slight evidence from the analysis of data provided by Mercer (1992) that child mortality rates (aged 0-4 years) are positively correlated with camp size (as inferred from child populations). If other factors allow, it might be wise for camp planners to try to limit camps to a size which allows refugees reasonable access to local resources.

Adult↗
PubMed2000

Aspects of tooth decay in recently arrived refugees.

OBJECTIVE: To measure and compare the prevalence and distribution of tooth decay among two refugee groups recently arrived in Australia. METHOD: The study included refugees aged 15-44 years from Iraq and the former Yugoslavia and random, age-matched social security recipients attending for emergency dental care in 1996. RESULTS: In younger persons, former Yugoslavian refugees had significantly greater decay experience than Iraqis and emergency care recipients. Refugees had significantly more untreated decay than emergency care recipients and a similar distribution of untreated decayed teeth, with only 15% having none and more than 10% having high decay levels. More than 33% of emergency care recipients had no untreated decay and less than 5% had high levels. CONCLUSION: Significant differences were found between refugees and emergency dental care recipients, with refugees having a higher prevalence and more uniform distribution of untreated decay. IMPLICATIONS: Consistent with public health objectives, the finding that refugees had significantly more untreated decay than other disadvantaged Australians provides support for improved access to dental care during the settlement period.

Adolescent↗
PubMed1995

Utilization of dental services in refugees in Sweden 1975-1985.

Prior to 1940 the population of Sweden was one of the most homogeneous in Europe, with only 0.5% foreign born. Fifty years later, in 1990, the proportion of immigrants was around 15%. In order to describe and analyze consumption of dental care in different refugee groups in Sweden, data registered by the Department of Immigration and the National Social Insurance Board, on a random sample of 2489 refugees arriving in Sweden 1975-85, were merged. Information on nationality, date of arrival in Sweden, date of granting of permanent resident status and statistics on consumption of dental care were retrieved. During the period studied a total of 50,521 refugees arrived in Sweden. The average interval between arrival in Sweden and the first dental visit was 4.5 yr (95% < 1: 4.2-4.7). The total treatment time during the first course of treatment was 165.5 min (95% < 1: 148.7-182.3). Consumption of dental care did not decrease with an increased number of treatments. Only 38% of the refugees had visited a dentist at all in Sweden. With increasing number of years in Sweden the number of courses of dental treatment increased, but 41% of the refugees who had visited the dentist in Sweden had done so only once. This study shows a low utilization of dental services among refugees in Sweden in general. Refugees with dental visits in Sweden, in particular, had a high dental consumption.

Adolescent↗
PubMed2006

Representation of asylum seekers and refugees among psychiatric inpatients in London.

OBJECTIVE: Refugees are at high risk of mental disorders but often complain about a lack of access to appropriate care. The purpose of this study was to assess the representation of refugees among psychiatric inpatients, given that it has been suggested that they use a disproportionate level of care compared with nonrefugees. METHODS: A census of all psychiatric inpatient units in London was used to determine the numbers of inpatients, the numbers of refugees, and measures of need, such as compulsory detention, duration of admission, need for interpreters, and whether inpatient status was appropriate. RESULTS: Of 2,955 psychiatric inpatients, 134 (4.5 percent) were refugees. Refugees' admission rates were similar to or lower than those of nonrefugees. Refugees were more likely to be inappropriately placed, to require interpreters, and to have more complex needs. CONCLUSION: The results of this study suggest that refugees are not overusing London's psychiatric inpatient units but have complex needs that challenge existing service providers.

Adolescent↗
PubMed1999

Use of public mental health services by Russian refugees.

OBJECTIVES: This study identifies the demographic characteristics and patterns of mental health service use among Russian refugees in New York State. METHODS: Data from a 1995 statewide survey of characteristics of patients served by the New York State mental health system were analyzed using chi square statistics and logistic regression. RESULTS: The demographic characteristics and service-use patterns of Russian refugees are different from those of non-Russian refugees and non-refugees. Russian refugees who used mental health services were likely to be older women with major depression who were enrolled in Medicaid and who were using those services for the first time. Relying heavily on themselves, family members, or friends as referral sources, they tended to use exclusively individual, outpatient services at voluntary, nonprofit agencies. CONCLUSIONS: Existing services systems must recognize the presence of Russian refugees. To improve access and service use, outreach efforts to the refugee community should be conducted, and services must be tailored to meet their mental health needs.

Adult↗
PubMed1996

Mental disorder among refugees and the impact of persecution and exile: some findings from an out-patient population.

BACKGROUND: Refugees have long been considered at risk for mental disorder. We sought to characterise this risk in an out-patient refugee sample by analysing the relationship between psychiatric symptoms and dysfunction, and between symptoms and the socio-demographic background and stressors specific to this refugee sample. METHOD: A consecutive sample of 231 refugee patients referred to the psychiatric out-patient unit at the Psychosocial Centre for Refugees, University of Oslo, was examined with a semi-structured interview guide, Brief Psychiatric Rating Scale (BPRS), Hopkins Symptom Check-List (HSCL-25) and a check-list for post-traumatic symptoms (PTSS-10). Global Assessment of Function (GAF) scores were obtained; and the data were analysed using nine predictor variables. RESULTS: It was found that 46.6% of the patients had a post-traumatic stress disorder according to the criteria for DSM-III-R as the main diagnosis, while the mean GAF score for the patients was 57.3. Analysis of the GAF and BPRS data did not reveal any predictor of psychotic behaviour. However, torture emerged as an important predictor of emotional withdrawal/retardation. Also, age, gender and no employment or education predicted for anxiety/depression, while refugee status and no employment or school predicted for hostility/aggression. CONCLUSIONS: The results confirm earlier findings that refugees constitute a population at risk for mental disorder. Past traumatic stressors and current existence in exile constitute independent risk factors. However, stressors other than those discussed here appear to be important also, particularly with regard to psychotic symptoms.

Adult↗
PubMed2004

Polymerase chain reaction for Mycobacterium tuberculosis: impact on clinical management of refugees with pulmonary infiltrates.

STUDY OBJECTIVES: Screening for pulmonary tuberculosis (TB) in war refugees entering low-prevalence countries for TB is a common policy, but workup strategies are difficult and expensive. DESIGN: Prospective screening of war refugees for TB by chest radiograph and evaluation of the impact of additional polymerase chain reaction (PCR) testing for Mycobacterium tuberculosis complex (MTB) on clinical management in case of pulmonary infiltrates suspicious for TB. SETTING: Academic university medical center. PATIENTS: A total of 3,119 adult war refugees from the Kosovo war were screened by chest radiograph on arrival. Refugees with pulmonary infiltrates suspicious for TB were hospitalized, and a standardized diagnostic workup was performed. MEASUREMENTS AND RESULTS: Of 3,119 adult war refugees screened for TB, 29 patients (0.9%) were identified with pulmonary infiltrates suspicious for TB; 103 specimens (76 sputa; 27 BAL fluids) were collected for acid-fast smear (AFS), PCR, and culture. The prevalence of culture-proven TB infection in this population was 27.6%. Sensitivity for PCR was higher compared with AFS for all specimens (64% vs 20%; p < 0.01) and also for each refugee with at least one positive specimen finding (100% vs 37.5%; p = 0.025). More important, the negative predictive value for three consecutive PCRs (in two sputa and one BAL) was 100%. CONCLUSIONS: Repeated PCR testing for MTB in a population of asymptomatic war refugees with pulmonary infiltrates highly suggestive of TB is significantly more sensitive than AFS. Three negative PCR results allow discharge from isolation, thus reducing the economic burden of isolation strategies.

Adult↗
PubMed2001

Lead poisoning among refugee children resettled in Massachusetts, 1995 to 1999.

OBJECTIVE: Lead poisoning has been reported among immigrant and refugee populations in the United States; however, prevalences of elevated blood lead (BPb) and risk factors have not been described fully among newly arrived refugee children. This study was conducted to address this lack of data. METHODS: We performed analysis of BPb levels among a cohort of refugee children, aged <7 years, who arrived in Massachusetts between July 1, 1995, and December 31, 1999. Gender, age, birthplace, time of year of lead testing, intestinal parasitoses, anemia, and growth retardation were examined as predictors of elevated BPb. RESULTS: BPb levels >/=10 microgram/dL were found in 11.3% of 693 children shortly after their arrival in the United States. Children from developing countries had the highest prevalences, including 27% of Somalis and Vietnamese. Country of birth was the strongest predictor of elevated BPb. No association between elevated lead and age was found. Among 213 children with BPb tests >/=6 months after the initial test, 7% had newly elevated levels of >/=10 microgram/dL. CONCLUSIONS: The prevalence of elevated BPb levels in recently arrived refugee children is more than twice that of US-born children. Children who are at particular risk are those from developing countries where environmental exposures are more ubiquitous. In addition, a significant percentage of refugees acquired elevated levels after arrival, thus suggesting the importance of follow-up testing of refugee children. Refugee status should be considered a risk factor for lead poisoning.

Child↗
PubMed2001

Major obstetric interventions among encamped refugees and the local population in Turkana District, Kenya.

BACKGROUND: Maternal mortality in developing countries remains high due to lack of appropriate emergency obstetric care. Major obstetric intervention (MOI) rate can be used as an indicator of unmet obstetric needs and quality of care. OBJECTIVES: Identify indications for major obstetric interventions, determine MOI rates and assess extent of unmet obstetric need for women in Turkana district, Kenya. DESIGN: Descriptive bi-directional study. SETTING: Turkana district: Kakuma Refugee Camp, Kakuma Catholic Mission and Lodwar District Hospitals. SUBJECTS: Four thousand two hundred and eighty encamped refugee women and 7,630 women from the host population delivering in Turkana district between January 1995 and September 1999. DATA SOURCES: Maternity registers, inpatient case notes and theatre registers. MAIN OUTCOME MEASURES: Maternal mortality, perinatal mortality, major obstetric interventions, unmet obstetric need and length of stay. RESULTS: The subjects from the two study populations were similar with respect to age, parity and indications for surgical intervention. Caesarean section was the only major obstetric intervention. Overall, caesarean section rate was significantly higher among refugees than in the host population (3.1% versus 2.1%, p<0.01; CI 1.4-2.1). Maternal indications were the main reasons for c/s in both populations, with the c/s rate being higher for refugees than for local women (2.5% versus 1.7%). At least 0.8% of parturient women from the host population had unmet obstetric needs: this translates to 61 pregnant women who may have died or experienced birth-related complications over the study period. The mean length of hospital stay was much less for refugee women than for the host population (8.1 days versus 11.3 days). CONCLUSION: Encamped refugee women in Kakuma have better obstetric care than those from the host population, and the level of unmet obstetric needs in the district is high. This imbalance could be reduced through resource sharing and integration of refugee health care services with that for the host population.

Adolescent↗
PubMedDate not supplied

Changing faces: A review of infectious disease screening of refugees by the Migrant Health Unit, Western Australia in 2003 and 2004.

OBJECTIVE: To document demographic characteristics and prevalence of infectious diseases in refugees and humanitarian entrants attending the Migrant Health Unit (MHU) in Perth for health assessment from 1 January 2003 to 31 December 2004. DESIGN: Retrospective case series. PARTICIPANTS: All refugees and humanitarian entrants arriving in Western Australia on subclass 200 and subclass 202 visas who were invited to attend the MHU. MAIN OUTCOME MEASURES: Demographic details, results of Mantoux tests, and blood and faecal tests for infectious diseases and parasites. RESULTS: WA accepted 2781 refugee and humanitarian entrants in 2003 and 2004; 2617 were invited to attend the MHU, and 2111 (81%) actually attended for screening. Over three-quarters arrived from Africa. Overall, 25% had a positive Mantoux test result, 5% were carriers of hepatitis B, and 5% had positive serological test results for syphilis. People arriving from sub-Saharan Africa had the highest prevalence of most diseases, with 8% having malaria, 7% schistosomiasis, 5% hookworm, and 2% strongyloidiasis. CONCLUSION: Disease prevalence varied greatly between refugees from different countries and was particularly high in those arriving from sub-Saharan Africa, the origin of most of Australia's refugee and humanitarian entrants. These data support the need for refugees and humanitarian entrants from countries with high rates of disease to have access to a comprehensive postarrival medical assessment and appropriate follow-up health care. Health services must provide beneficial and cost-effective services that protect the health of both individual refugees and the wider community.

Adolescent↗
PubMed1999

Longitudinal incidence of tuberculosis in South-East Asian refugees after re-settlement.

SETTING: A State refugee screening programme in Victoria. OBJECTIVE: To determine the longitudinal incidence of tuberculosis (TB) in South-East Asian refugees in the first five years after re-settlement, and to determine predictors of risk. DESIGN: A retrospective cohort study of 1101 refugees from Laos, Cambodia and Vietnam screened for TB after arrival in Australia, in the 6-month period from July 1989 to January 1990. Incident cases of TB were identified by matching the refugee database with the TB notification database for 1989-1994, giving five years of follow-up data. Preventability was assessed for incident cases by reviewing medical records. MAIN OUTCOME: The development of active tuberculosis in the first five years after re-settlement. RESULTS: The incidence of active TB was 363/100000 during the first year after re-settlement, and 109/100000/year during the first five years. There were no incident cases of TB in refugees with initial skin test reactions <10 mm. Skin test reaction size was the only predictor of risk of TB. CONCLUSIONS: There is a high risk of tuberculosis in South-East Asian refugees, particularly in the first year after re-settlement. This risk decreases with time. Migration stress, concurrent illnesses and poor nutrition may be explanations for this observation. Refugees are at high risk for TB, even after pre- and post-migration screening, emphasising the importance of preventive therapy and follow up in this group.

Adult↗
PubMed1999

[Perspectives in public health care for refugees in Germany].

Germany in fact became an immigration country during the last 25 years. The German public health service for refugees aims at avoiding epidemic diseases and protecting the local population. In spite of the internationally recognised high capability of the German health system it is open to question whether sufficient health care for refugees who are regarded as highly vulnerable is guaranteed. Relevant investigations are missing. The present article illustrates perspectives of the health situation, health perception, health behaviour and finally also the health resources of refugees. Health as well as the health care of refugees appears to be fragmented. Three possible scenarios of the health care of refugees are discussed: Compartmentalisation of general health care, incorporation of health care through the communities of migrants as well as stronger integration in the German health care system. The article bases on a research of present scientific work about health and illness of refugees as well as on empirical data of a feasibility study in an area in south-west Germany on the health and primary health care for refugees.

Delivery of Health Care↗
PubMed1999

Morbidity and mortality amongst southern Sudanese in Koboko refugee camps, Arua District, Uganda.

OBJECTIVE: To determine the causes of morbidity, mortality and assess the nutritional status of children under five years, in Koboko refugee camps, Arua District, Uganda. DESIGN: Review and analysis of refugee treatment records between 1992 and 1994 from Maracha and Koboko hospitals and cross sectional nutritional survey of children under five years in camps. SETTING: Between June 1992 and March 1994, an estimated 70,000 Sudanese refugees were encamped in five transit camps in Koboko county, Arua district. Koboko field hospital was immediately established and Maracha hospital designated the referral hospital for refugees. PARTICIPANTS: Hospitalised refugees between 1992 and 1994 in Koboko and Maracha hospitals and children under five years in the camps formed the study populations. INTERVENTIONS: Health facilities and therapeutic nutrition centres were established in the camps. Fortnightly general food distribution and therapeutic feeding programmes were instituted. Severe medical and surgical conditions were referred to Maracha hospital. MAIN OUTCOME MEASURES: Outcome variables considered were morbidity, mortality, case fatality rates; weight/height, weight/age and height/age. RESULTS: Out of 1476 refugees hospitalised in Koboko and Maracha hospitals, 267 died giving a case fatality rate of 18%. The leading causes of morbidity were diarrhoeal diseases (26.9%), ARI (13.6%), malaria (10.2%), trauma (7.6%) and malnutrition (5.0%). The main causes of mortality were similar, that is, diarrhoeal diseases (35.9%), ARI (23.9%), anaemia (7.2%) and HIV/AIDS (6.8%). Conditions associated with high overall case fatality rates were ARI (31.3%), HIV/AIDS (30.0%) and cardiac failure (29.3%) respectively. Nearly half of the children (48.6%), H/A -2SD were stunted, over a third (36.7%), W/A -2SD were underweight and (8.5%), W/H -2SD wasted. CONCLUSION: Communicable diseases are the predominant causes of morbidity and mortality during the emergency phase of encampment. Timely and effective management of communicable diseases including malnutrition and trauma are crucial to avoid high mortality amongst refugees, coupled with the provision of essential requirements and services such as water, sanitation, food, shelter and immunisation.

Adolescent↗
PubMed1999

Health status of and intervention for U.S.-bound Kosovar refugees--Fort Dix, New Jersey, May-July 1999.

In March 1999, as a result of armed conflict in the Kosovo province of the Federal Republic of Yugoslavia, approximately 860,000 ethnic Albanians sought refuge in neighboring Albania, the Former Yugoslav Republic of Macedonia (FYROM), the Republic of Montenegro--Federal Republic of Yugoslavia, and Bosnia-Herzegovina. As a result of massive refugee movement into FYROM, many nations, including the United States, accepted refugees for resettlement. Refugee processing centers were established in FYROM and the United States. In the United States, the Migration Health Assessment (MHA) of refugees was undertaken at Fort Dix, New Jersey (i.e., Operation Provide Refuge), in collaboration with the Office of Emergency Preparedness (OEP), Public Health Service, under the direction of the Office of Refugee Resettlement, U.S. Department of Health and Human Services. Assessments in Skopje, FYROM, were conducted by the International Organization for Migration. This report summarizes the results of collaboration between OEP and CDC to provide preventive health programs for 4045 Kosovar refugees at Fort Dix during a 10-week period, which found that the refugees were in good health and underscores the need for a tailored intervention program targeted at the health conditions of the specific population.

Emigration and Immigration↗
PubMed1987

The Fresno County Refugee Health Volunteer Project: a case study in cross-cultural health care delivery.

Beginning in 1979, Fresno County received a 2nd dramatic influx of Southeast Asian refugees. There are now approximately 20,000 of these refugees, including the largest population of Hmong in the US. This community includes about 2000 Cambodian, 14,000 Hmong, and 4000 Lowland Lao. Altogether, Southeast Asian refugees comprise nearly 10% of the population of Fresno. These demographics provide the backdrop for significant problems in health care service delivery. Some barriers include: 1) stress, loss, dislocation, poverty, illness, and unemployment that are part of the refugee experience; 2) language differences; 3) cultural isolation; and 4) cultural beliefs and practices whose spiritual, wholistic, and natural forms of care often run contrary to the West's scientific, specialized, and technological treatment modalities. The Health Department began to recognize some difficulties related to health services for refugees and developed a strategy to combat these. This strategy was named the Refugee Health Volunteer Project and its goal was to enable individuals, families, and community groups to better meet their own health care needs. Goals were to be met by 1st creating a community-based health promotion network to 1) identify health needs, 2) communicate health information, 3) train community health volunteers, and 4) build a greater capacity for self-care that would last beyond the end of the program. The program's goal would also be met by overcoming the access problems with the service system by 1) communicating community-identified needs, 2) identifying specific barriers in the service system, 3) initiating broad participation among service providers in designing more accessible approaches to service delivery, and 4) improving coordination between service providers. Significant progress has been made in a very short time. The Project demonstrates that a fairly common, bureaucratic organization can be responsive to extremely unique community needs. The project is demonstrating the effectiveness of a network approach as a model for service delivery to ethnic communities experiencing language and cultural barriers to health care. The project staff have served as a catalyst for initiatives which are creating ways in which the broader health delivery system can be more accessible to refugee clients. What is emerging is an approach to health empowerment that builds on the strengths, skills, knowledge, and experience of community people and those organizations which support their efforts.

Americas↗