Feasibility and Acceptability of Implementing a Culturally Adapted Cooking Curriculum for Burundian and Congolese Refugee Families.

Pika Pamoja (Cook Together) is an eight-session cooking curriculum for Burundian and Congolese refugee families, culturally adapted from the evidence-based iCook 4-H curriculum to address dietary acculturation barriers to and facilitators of food security. The goal of this study was to determine the feasibility and acceptability of implementing Pika Pamoja. Researchers and a multilingual community aid implemented Pika Pamoja in a pre-post pilot intervention with randomized control (n = 5)/treatment (n = 5) dyads (youth/mother). Feasibility (recruitment/retention, implementation, fidelity testing, and assessment procedures) and acceptability (process and program evaluations) measures were collected. All 10 dyads (control and treatment) were retained throughout the study. All fidelity measures were 91% or above. The final youth assessment instrument included scales for cooking skills (α = 0.93), cooking self-efficacy (α = 0.90), openness to new foods (α = 0.81), and eating (α = 0.68), playing (α = 0.90), and setting healthful goals (α = 0.88) together as a family. The final adult instrument included scales for cooking, eating, and playing together (α = 0.68), kitchen proficiency (α = 0.89), and food security (α = 0.79). Participant feedback was uniformly positive. Based on these results, Pika Pamoja was feasible to implement and was accepted by the priority population. Larger scale studies to measure the effectiveness of Pika Pamoja to increase food security among refugee families are needed.

Barriers and Facilitators to Food Security among Adult Burundian and Congolese Refugee Females Resettled in the US.

Sub-Saharan African refugees in the US have reported food security rates seven times below the national average. Dietary acculturation issues may be a contributing factor. Criterion-specific sample (n = 18) was recruited using network then snowball sampling methods. Semi-structured interviews were facilitated with the aid of a culturally and linguistically appropriate interpreter. An iterative, two cycle coding analytic process was completed within NVivo 11 by two coders who sought inter-rater reliability. Codes were organized into hierarchical maps and coding matrices for direct content analysis, and pattern and theme detection. Saturation was achieved and validated with an additional two interviews. Participants were primarily Burundian (67% vs. 33% Congolese), married (72%), held no high school degree (72%), unemployed (56%) and reported limited English proficiency (72%). Barriers and facilitators to food security across all levels of the Socio-Ecological Model (SEM) were noted. Emerging themes included difficulty with language, cooking, and shopping; transportation; social network support; orientation services; reliance on nutrition assistance programs; limited culturally relevant food and land access; and program policy miscomprehension. The complex relationship between dietary acculturation barriers and facilitators at various SEM levels demonstrates the need for a multi-level intervention to improve food security among refugees.

'Excuse me, do any of you ladies speak English?' Perspectives of refugee women living in South Australia: barriers to accessing primary health care and achieving the Quality Use of Medicines.

Reforms to the Australian health system aim to ensure that services are accessible, clinically and culturally appropriate, timely and affordable. During the reform consultation process there were urgent calls from stakeholders to specifically consider the health needs of the thousands of refugees who settle here each year, but little is known about what is needed from the refugee perspective. Access to health services is a basic requirement of achieving the quality use of medicines, as outlined in Australia's National Medicines Policy. This study aimed to identify the barriers to accessing primary health care services and explore medicine-related issues as experienced by refugee women in South Australia. Thirty-six women participated in focus groups with accredited and community interpreters and participants were from Sudan, Burundi, Congo, Burma, Afghanistan and Bhutan who spoke English (as a second language), Chin, Matu, Dari and Nepali. The main barrier to accessing primary health care and understanding GPs and pharmacists was not being able to speak or comprehend English. Interpreter services were used inconsistently or not at all. To implement the health reforms and achieve the quality use of medicines, refugees, support organisations, GPs, pharmacists and their staff require education, training and support.

Prevalence of chronic kidney disease among people living with HIV/AIDS in Burundi: a cross-sectional study.

BACKGROUND: Since little is known about chronic kidney disease (CKD) among people living with HIV/AIDS (PLWHA) in Sub-Saharan Africa, the prevalence and nature of CKD were assessed in Burundi through a multicenter cross-sectional study. METHODS: Patients underwent assessments at baseline and 3 months later. Glomerular Filtration Rate (GFR) was estimated using abbreviated 4-variable Modification of Diet in Renal Diseases (MDRD) and Cockroft-Gault estimation methods. Patients were classified at month 3 into various CKD stages using the National Kidney Foundation (NKF) definition, which combines GFR and urinary abnormalities. Risk factors for presence of proteinuria (PRO) and aseptic leukocyturia (LEU) were further analyzed using multiple logistic regression. RESULTS: Median age of the patients in the study (N = 300) was 40 years, 70.3% were female and 71.7% were on highly active antiretroviral therapy. Using the MDRD method, CKD prevalence in patients was 45.7%, 30.2% of whom being classified as stage 1 according to the NKF classification, 13.5% as stage 2 and 2% as stage 3. No patient was classified as stage 4 or 5. Among CKD patients with urinary abnormality, PRO accounted for 6.1% and LEU for 18.4%. Significant associations were found between LEU and non-steroidal anti-inflammatory drug (NSAID) use, previous history of tuberculosis, low body mass index and female gender and between PRO and high viral load. CONCLUSION: Our study, using a very sensitive definition for CKD evaluation, suggests a potentially high prevalence of CKD among PLWHA in Burundi. Patients should be regularly monitored and preventative measures implemented, such as monitoring NSAID use and adjustment of drug dosages according to body weight. Urine dipsticks could be used as a screening tool to detect patients at risk of renal impairment.

Access to dental care in two long-term refugee camps in western Tanzania; programme development and assessment.

OBJECTIVE: To analyse the demographics surrounding and the sustainability of a course in Emergency Dental Care and Health Promotion developed and taught by a team of dentists from the United States to refugee camp health-care workers in two long-term refugee camps in Western Tanzania. METHODS: Refugee camp dental patient log books from Mtabila and Nyarugusu camps Kigoma, Tanzania were analysed and demographic data collected on each patient visit from the programme inception in November 2007 until August 2009. Data collection included information relevant to 1961 patient visits. Data were entered into SPSS Statistics 17.0 using the Freq application. OUTCOMES: Patient visit data included demographics involving both the resident camp populations and the surrounding communities. The distribution of patients treated by nationality was: 58% Burundian (Mtabila), 14% Congolese (Nyarugusu), and 28% Tanzanian citizens residing near both camps. Extractions accounted for 95.5% of procedures performed. Recorded incidences of post-operative complications were 1> % of patient visits. Patient visits were steady over time and a referral system was implemented for complex cases. Health promotion sessions were held in both camps. CONCLUSION: This dental programme has been self-sustaining and is providing some access to care where none existed previously. Programmes such as this may be one solution to the access to dental care problem in long-term refugee camps.

Secondary migration and relocation among African refugee families in the United States.

The purpose of this study was to understand the secondary migration and relocation of African refugees resettled in the United States. Secondary migration refers to moves out of state, while relocation refers to moves within state. Of 73 recently resettled refugee families from Burundi and Liberia followed for 1 year through ethnographic interviews and observations, 13 instances of secondary migration and 9 instances of relocation were identified. A family ecodevelopmental framework was applied to address: Who moved again, why, and with what consequences? How did moving again impact family risk and protective factors? How might policies, researchers, and practitioners better manage refugees moving again? Findings indicated that families undertook secondary migration principally for employment, affordable housing, family reunification, and to feel more at home. Families relocated primarily for affordable housing. Parents reported that secondary migration and relocation enhanced family stability. Youth reported disruption to both schooling and attachments with peers and community. In conclusion, secondary migration and relocation were family efforts to enhance family and community protective resources and to mitigate shortcomings in resettlement conditions. Policymakers could provide newly resettled refugees jobs, better housing and family reunification. Practitioners could devise ways to better engage and support those families who consider moving.

Malaria in refugees from Tanzania--King County, Washington, 2007.

Recent immigrants and refugees constitute a substantial proportion of malaria cases in the United States, accounting for nearly one in 10 imported malaria cases involving persons with known resident status in 2006. This report describes three cases of Plasmodium falciparum malaria and two cases of Plasmodium ovale malaria that occurred during June 27-October 15, 2007 in King County, Washington. The infections were diagnosed in Burundian refugees who had recently arrived in the United States from two refugee camps in Tanzania. Since 2005, CDC has recommended presumptive malaria treatment with artemisinin-based combination therapy (ACT) (e.g., artemether-lumefantrine) for refugees from sub-Saharan Africa before their departure for the United States (2). Rising levels of resistance to the previous mainstays of treatment, chloroquine and sulfadoxine-pyrimethamine, prompted CDC to make this recommendation. Implementation has been delayed in some countries, including Tanzania, where predeparture administration of presumptive ACT for refugees started in July 2007. The cases in this report highlight the need for health-care providers who care for recently arrived Burundian and other refugee populations to be vigilant for malaria, even among refugees previously treated for the disease.

Trust-based altruism facing new contexts: The Vyegwa-Gika pygmies from Burundi.

The community of Pygmies settled in Vyegwa-Gika provides an exceptional case study to test the role of trust in the evolution of altruism. The Vyegwa-Gika Pygmies were forced to migrate from rainforests to the savanna, changing quickly their environment, culture, and socio-economic situation. Despite the high level of poverty they suffer in this new settlement, we found evidence of strong altruistic attitudes toward trustees when playing an economic game. In addition, Vyegwa-Gika Pygmies keep small personal trust networks despite the fact they share frequent social interactions within the community. These results indicate the great effectiveness of personal trust in fostering altruism, even if the circumstances make it difficult to establish such kind of affective bonds. A theory of the evolution of altruism should therefore also account for the evolution of psychology of trust, as a key element in the process.

Local terms and understandings of mental health problems in Burundi.

A pilot study and two intensive studies were conducted to document the local vocabularies used by Burundians to describe mental health problems and their understandings about the causes. The pilot study-in which 14 different large groups of community members awaiting appointments at a village health clinic were engaged in open-ended discussions of the local terminology and causal beliefs about mental health problems-suggested three key syndromes: akabonge (a set of depression-like symptoms), guhahamuka (a set of trauma-related symptoms), and ibisigo (a set of psychosis-like symptoms). In Study 1 ( N = 542), individual interviews or surveys presented participants with the names of these syndromes and asked what they considered to be the symptoms and causes of them. Study 2 ( N = 143) cross-validated these terms with a different sample (also in individual interviews/surveys), by presenting the symptom clusters and asking what each would be called and about their causes. Findings of both studies validated this set of terms and yielded a rich body of data about causal beliefs. The influence of education level and gender on familiarity with these terms was also assessed. Implications for the development of mental health services and directions for future research are discussed.

Knowledge, attitude and practice of hygiene and sanitation in a Burundian refugee camp: implications for control of a Salmonella typhi outbreak.

INTRODUCTION: A Salmonella typhi outbreak was reported in a Burundian refugee camp in Rwanda in October 2015. Transmission persisted despite increased hygiene promotion activities and hand-washing facilities instituted to prevent and control the outbreak. A knowledge, attitude and practice (KAP) study was carried out to assess the effectiveness of ongoing typhoid fever preventive interventions. METHODS: A cross-sectional survey was conducted in Mahama Refugee Camp of Kirehe District, Rwanda from January to February 2016. Data were obtained through administration of a structured KAP questionnaire. Descriptive, bivariate and multivariate analysis was performed using STATA software. RESULTS: A total of 671 respondents comprising 264 (39.3%) males and 407 (60.7%) females were enrolled in the study. A comparison of hand washing practices before and after institution of prevention and control measures showed a 37% increase in the proportion of respondents who washed their hands before eating and after using the toilet (p < 0.001). About 52.8% of participants reported having heard about typhoid fever, however 25.9% had received health education. Only 34.6% and 38.6% of the respondents respectively knew how typhoid fever spreads and is prevented. Most respondents (98.2%) used pit latrines for disposal of feces. Long duration of stay in the camp, age over 35 years and being unemployed were statistically associated with poor hand washing practices. CONCLUSION: The findings of this study underline the need for bolstering up health education and hygiene promotion activities in Mahama and other refugee camp settings.

Ageism in Belgium and Burundi: a comparative analysis.

BACKGROUND: Recent cross-cultural comparisons between Asian and Western cultures have shown that ageism arises more from the lack of availability of social and economic resources for older adults than from the culture itself. We tested this assumption by conducting a survey among people living in a least developed country compared with those living in a developed country. PARTICIPANTS AND METHODS: Twenty-seven Belgians living in Belgium, 29 Burundians living in Belgium, and 32 Burundians living in Burundi were included in this study. Their attitudes toward older adults were assessed using several self-reported measures. RESULTS: Statistical analyses confirmed that older people are more negatively perceived by Burundians living in Burundi than by Burundians and Belgians living in Belgium, whose attitudes did not differ from each other. CONCLUSION: Consistent with our hypothesis, our results suggest that the level of development of a country and more particularly the lack of government spending on older people (pension and health care systems) may contribute to their younger counterparts perceiving them more negatively.

Pediatric migration and hepatitis A risk in host population.

Hepatitis A virus (HAV) circulation in a given area is closely related to socioeconomic standards. Following the improvement of living conditions, HAV seroprevalence rates in the population have decreased steadily during the last decades in many Western European countries, including Italy, thereby leading to a shift of risk of disease towards older age groups. Since the severity of the disease closely parallels age, a higher incidence of symptomatic cases in adults is now reported in Europe and the United States, being travel-related to a large extent. Intrafamilial person-to-person spread is also an important source of infection and transmission from children to parents may occur due to the lack of immunity in the general population. In the last two decades, Italy has been the destination of an increasing number of migrants from developing countries, where HAV is highly endemic. Furthermore, international adoption programmes cause pediatric populations from HAV endemic countries to increase in low endemic areas, possibly leading to secondary cases in close contacts.7 The aim of this paper is to report the epidemic HAV outbreak which occurred among the voluntary nursing staff of a pediatric Rwandan refugee community hosted in a village of the Brescia Province, in northern Italy.

[An outbreak of Shigella dysenteriae type 1 dysentery in a refugee camp in Rwanda]. / Une épidémie de dysenterie à Shigella dysenteriae type 1 dans un camp de réfugiés au Rwanda.

As a consequence of the civil war that devastated Burundi in October 1993, more than 300,000 refugees settled in the neighboring country of Rwanda. We describe the outbreak of dysentery due to Shigella dysenteriae type 1 (Sd1) that developed in Nzangwa, a camp hosting some 20,000 Burundese refugees. Between November 17, 1993 and March 10, 1994, 6,122 cases of bloody diarrhea were notified by the health information system of the camp. The overall attack rate was 32.3%, and the fatality rate was 3.8%. Children under five years of age were the most affected group of the population. All dysentery cases were treated with nalidixic acid for 5 days. The compliance assessment showed that less than 50% of the ambulatory patients completed the 5-day regimen. From 35 stool samples obtained from the refugees, seven Sd1 strains were isolated, of which three were multi-resistant to nalidixic acid. These results confirmed the morbidity and mortality of Sd1 outbreaks in the displaced populations of Central Africa. We also emphasize the difficulties in implementing effective prevention measures and appropriate case management strategies in this environment. To improve the management of patients in large Sd1 outbreaks with limited resources, we devised a clinical classification of cases according to the risk of dying.

[Infection caused by the human immunodeficiency virus type 2 in the USSR]. / Infektsiia, vyzvannaia virusom immunodefitsita cheloveka tipa 2, v SSSR.

The serological study of 20 sera, showing atypical reaction with HIV-1 in the immunoblotting assay, for the presence of HIV-2 infection revealed some cases of this infection among Africans who had arrived to the USSR from Western Africa (5 cases) and Burundi (1 case); besides, in 1 case HIV-2 infection was detected in a Soviet female citizen having had many sexual partners among foreigners.

AIDS in two African infants born in Belgium.

Two African infants born in Belgium, dying from the acquired immune deficiency syndrome are reported. The first patient was a premature baby girl born to healthy parents. However, her asymptomatic mother was found to have polyclonal hypergammaglobulinaemia, a reversed T-helper/T-suppressor ratio and a decreased lymphocyte response to mitogens. The second patient's mother was treated for pneumocystis carinii pneumonia during the fourth month of gestation and was subsequently diagnosed with AIDS. The rapid clinical evolution of the acquired immunodeficiency syndrome in infancy suggests that the incubation period is shorter than in adults.

Representing refugees: the role of elites in Burundi refugee society.

Among Burundi refugees in Tanzania, men who have a university education and know English or French are most likely to represent their concerns to officials, particularly those from UNHCR. Officials consequently learn about the perspectives of refugees from these men. Based upon findings from two years of field research in Tanzania, the history of relations between ethnic Hutu elites and the peasantry in Burundi is outlined and it is explained why education has assumed such pronounced significance in Burundi refugee society. The use of ethnicity as a political tool for elite refugees is also described. It is concluded that elite refugees may not, as is often claimed, represent the refugee majority.

An outbreak of measles in Tanzanian refugee camps.

From March 2000 to May 2001, four camps in Kibondo District, Tanzania, hosting refugees from Burundi reported 1062 cases of measles, a highly infectious and potentially lethal disease. Of 1062 case-patients, 225 (21%) were <9 months old, 286 (27%) were 9 months to 5 years, 324 (31%) were 6-15 years, and 227 (21%) were >/=16 years old. No deaths were reported. Although, in accordance with Sphere Project guidelines for humanitarian emergencies, camp policy was to vaccinate all new arrivals aged 6 months to 15 years against measles, 152 (72%) of 210 newly arrived refugees in this age group were unvaccinated; 143 (94%) of the 152 had lived in the camp >/=1 month before rash onset. This investigation supports Sphere Project recommendations for wide age group vaccination and suggests that in some circumstances vaccination of refugees >15 years old may be beneficial.

An evaluation of poor pregnancy outcomes among Burundian refugees in Tanzania.

CONTEXT: Little is known about pregnancy outcomes among the approximately 11 million refugees worldwide, 25% of whom are women of reproductive age. OBJECTIVE: To estimate incidence of and determine risk factors for poor pregnancy outcomes and to calculate the contribution of mortality from neonatal and maternal deaths to overall mortality in a refugee camp. DESIGN: Cross-sectional review of records and survey, conducted in February and March 1998. SETTING: Mtendeli refugee camp, Tanzania. PARTICIPANTS: For the overall assessment, 664 Burundi women who had a pregnancy outcome during a recent 5-month period (September 1, 1997-January 31, 1998) and their 679 infants; 538 women (81%) completed the survey. MAIN OUTCOME MEASURES: Incidence of fetal death (fetus born > or =500 g or > or =22 weeks' gestation with no signs of life), low birth weight (<2500 g), neonatal death (death <28 days of life), and maternal death (deaths during or within 42 days of pregnancy from any cause related to or aggravated by the pregnancy or its management). RESULTS: The fetal death rate was 45.6 per 1000 births, the neonatal mortality rate was 29.3 per 1000 live births, and 22.4% of all live births were low birth weight. Compared with women without poor pregnancy outcome, those with poor pregnancy outcome were more likely to report prior high socioeconomic status (adjusted odds ratio [OR], 1.6; 95% confidence interval [CI], 1.1-2.4), having a first or second pregnancy (OR, 2.2; 95% CI, 1.4-3.4), and having 3 or more episodes of malaria during pregnancy (OR, 2.0; 95% CI, 1.4-3.1). Neonatal and maternal deaths accounted for 16% of all deaths during the period studied. CONCLUSIONS: Poor pregnancy outcomes were common in this refugee setting, and neonatal and maternal deaths, 2 important components of reproductive health-related deaths, contributed substantially to overall mortality.