Perspectives of Afghan refugee mothers on the experience of caring for a child with cancer: a qualitative analysis.

BACKGROUND: Cancer in children causes many challenges for the family. When a refugee family experiences it, its impacts may be different and more specific considerations for care may be needed. AIMS: This study aimed to explore the experiences of Afghan mothers living in the Islamic Republic of Iran who had a child with cancer. METHODS: This was a qualitative study, conducted in 2017, of Afghan refugee women with children diagnosed with cancer and referred to a cancer referral hospital in Tehran; they were selected through purposive sampling. Face-to-face, semi-structured and in-depth interviews were conducted for data collection until data saturation was reached. Conventional content analysis was done. MAXQDA 10 was used for organizing the data. RESULTS: Nine Afghan mothers were interviewed. They were aged 24-44 years and the children were aged 2-9 years. A primary theme called "passive acceptor" was found with five subthemes: chronic suffering, health issues, lack of skills, maladaptive coping and enthusiasm. The mothers were struggling to cope with the challenges of caring for a child with cancer both financially, physically and emotionally. CONCLUSION: In spite of many issues in common with similar groups in other countries, Afghan mothers appear to need to greater assistance when it comes to seeking help and understanding for the care for their child with cancer, possibly because of cultural barriers to self-empowerment. Tailored care plans are recommended for Afghan refugee mothers in the Islamic Republic of Iran.

Tuberculosis screening of asylum seekers in Finland, 2015-2016.

BACKGROUND: In Finland, asylum seekers from countries with high tuberculosis (TB) incidence (> 50/100,000 population/year) and those coming from a refugee camp or conflict area are eligible for TB screening. The aim of this study was to characterise the TB cases diagnosed during screening and estimate the yield of TB screening at the reception centres among asylum seekers, who arrived in Finland during 2015-2016. METHODS: Voluntary screening conducted at reception centres included an interview and a chest X-ray. Data on TB screening and health status of asylum seekers was obtained from the reception centres' national health register (HRS). To identify confirmed TB cases, the National Infectious Disease Register (NIDR) data of foreign-born cases during 2015-2016 were linked with HRS data. TB screening yield was defined as the percentage of TB cases identified among screened asylum seekers, stratified by country of origin. RESULTS: During 2015-2016, a total of 38,134 asylum applications were received (57% were from Iraq, 16% from Afghanistan and 6% from Somalia) and 25,048 chest x-rays were performed. A total of 96 TB cases were reported to the NIDR among asylum seekers in 2015-2016; 94 (98%) of them had been screened. Screening identified 48 (50%) cases: 83% were male, 56% aged 18-34 years, 42% from Somalia, 27% from Afghanistan and 13% from Iraq. Furthermore, 92% had pulmonary TB, 61% were culture-confirmed and 44% asymptomatic. TB screening yield was 0.19% (48/25048) (95%CI, 0.14-0.25%) and it varied between 0 and 0.83% stratified by country of origin. Number needed to screen was 522. CONCLUSIONS: TB screening yield was higher as compared with data reported from other European countries conducting active screening among asylum seekers. Half of the TB cases among asylum seekers were first suspected in screening; 44% were asymptomatic. TB yield varied widely between asylum seekers from different geographic areas.

Knowledge, attitudes and practices of South Asian immigrants in developed countries regarding oral cancer: an integrative review.

BACKGROUND: Oral cancer is a growing problem worldwide, with high incidence rates in South Asian countries. With increasing numbers of South Asian immigrants in developed countries, a possible rise in oral cancer cases is expected given the high prevalence in their source countries and the continued oral cancer risk behaviours of immigrants. The aim of this review is to synthesise existing evidence regarding knowledge, attitudes and practices of South Asian immigrants in developed countries regarding oral cancer. METHODS: Five electronic databases were systematically searched to identify original, English language articles focussing on oral cancer risk knowledge, attitudes and practices of South Asian immigrants in developed countries. All studies that met the following inclusion criteria were included: conducted among South Asian immigrants in developed countries; explored at least one study outcome (knowledge or attitudes or practices); used either qualitative, quantitative or mixed methods. No restrictions were placed on the publication date, quality and setting of the study. RESULTS: A total of 16 studies involving 4772 participants were reviewed. These studies were mainly conducted in the USA, UK, Italy and New Zealand between 1994 and 2018. Findings were categorised into themes of oral cancer knowledge, attitudes and practices. General lack of oral cancer risk knowledge (43-76%) among participants was reported. More than 50% people were found engaging in one or more oral cancer risk practices like smoking, betel quid/pan/gutka chewing. Some of the participants perceived betel quid/pan/gutka chewing habit good for their health (12-43.6%). CONCLUSION: This review has shown that oral cancer risk practices are prevalent among South Asian immigrants who possess limited knowledge and unfavourable attitude in this area. Culturally appropriate targeted interventions and strategies are needed to raise oral cancer awareness among South Asian communities in developed countries.

Health of Special Immigrant Visa holders from Iraq and Afghanistan after arrival into the United States using Domestic Medical Examination data, 2014-2016: A cross-sectional analysis.

BACKGROUND: Since 2008, the United States has issued between 2,000 and 19,000 Special Immigrant Visas (SIV) annually, with the majority issued to applicants from Iraq and Afghanistan. SIV holders (SIVH) are applicants who were employed by, or on behalf of, the US government or the US military. There is limited information about health conditions in SIV populations to help guide US clinicians caring for SIVH. Thus, we sought to describe health characteristics of recently arrived SIVH from Iraq and Afghanistan who were seen for domestic medical examinations. METHODS AND FINDINGS: This cross-sectional analysis included data from Iraqi and Afghan SIVH who received a domestic medical examination from January 2014 to December 2016. Data were gathered from state refugee health programs in seven states (California, Colorado, Illinois, Kentucky, Minnesota, New York, and Texas), one county, and one academic medical center and included 6,124 adults and 4,814 children. Data were collected for communicable diseases commonly screened for during the exam, including tuberculosis (TB), hepatitis B, hepatitis C, malaria, strongyloidiasis, schistosomiasis, other intestinal parasites, syphilis, gonorrhea, chlamydia, and human immunodeficiency virus, as well as elevated blood lead levels (EBLL). We investigated the frequency and proportion of diseases and whether there were any differences in selected disease prevalence in SIVH from Iraq compared to SIVH from Afghanistan. A majority of SIV adults were male (Iraqi 54.0%, Afghan 58.6%) and aged 18-44 (Iraqi 86.0%, Afghan 97.7%). More SIV children were male (Iraqi 56.2%, Afghan 52.2%) and aged 6-17 (Iraqi 50.2%, Afghan 40.7%). The average age of adults was 29.7 years, and the average age for children was 5.6 years. Among SIV adults, 14.4% were diagnosed with latent tuberculosis infection (LTBI), 63.5% were susceptible to hepatitis B virus (HBV) infection, and 31.0% had at least one intestinal parasite. Afghan adults were more likely to have LTBI (prevalence ratio [PR]: 2.0; 95% confidence interval [CI] 1.5-2.7) and to be infected with HBV (PR: 4.6; 95% CI 3.6-6.0) than Iraqi adults. Among SIV children, 26.7% were susceptible to HBV infection, 22.1% had at least one intestinal parasite, and 50.1% had EBLL (≥5 mcg/dL). Afghan children were more likely to have a pathogenic intestinal parasite (PR: 2.7; 95% CI 2.4-3.2) and EBLL (PR: 2.0; 95% CI 1.5-2.5) than Iraqi children. Limitations of the analysis included lack of uniform health screening data collection across all nine sites and possible misclassification by clinicians of Iraqi and Afghan SIVH as Iraqi and Afghan refugees, respectively. CONCLUSION: In this analysis, we observed that 14% of SIV adults had LTBI, 27% of SIVH had at least one intestinal parasite, and about half of SIV children had EBLL. Most adults were susceptible to HBV. In general, prevalence of infection was higher for most conditions among Afghan SIVH compared to Iraqi SIVH. The Centers for Disease Control and Prevention (CDC) Guidelines for the US Domestic Medical Examination for Newly Arriving Refugees can assist state public health departments and clinicians in the care of SIVH during the domestic medical examination. Future analyses can explore other aspects of health among resettled SIV populations, including noncommunicable diseases and vaccination coverage.

Cystic echinococcosis in unaccompanied minor refugees from Afghanistan and the Middle East to Germany, July 2016 through June 2017.

Cystic echinococcosis (CE) is not covered by current refugee screening protocols. After we had detected CE among several refugees attending our clinic from Afghanistan and the Middle East, serological examinations for CE were performed for apparently healthy unaccompanied minor refugees from these regions.

High rates of meticillin-resistant Staphylococcus aureus among asylum seekers and refugees admitted to Helsinki University Hospital, 2010 to 2017.

IntroductionAntimicrobial resistance is increasing rapidly in countries with low hygiene levels and poorly controlled antimicrobial use. The spread of resistant bacteria poses a threat to healthcare worldwide. Refugees and migrants from high-prevalence countries may add to a rise in multidrug-resistant (MDR) bacteria in low-prevalence countries. However, respective data are scarce.MethodsWe retrospectively collected microbiological and clinical data from asylum seekers and refugees treated at Helsinki University Hospital between January 2010 and August 2017.ResultsOf 447 asylum seekers and refugees (Iraq: 46.5%; Afghanistan: 10.3%; Syria: 9.6%, Somalia: 6.9%); 45.0% were colonised by MDR bacteria: 32.9% had extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE), 21.3% meticillin-resistant Staphylococcus aureus (MRSA), 0.7% carbapenemase-producing Enterobacteriaceae (CPE), 0.4% multiresistant Pseudomonas aeruginosa (MRPA), 0.4% multiresistant Acinetobacter baumannii (MRAB); no vancomycin-resistant Enterococcus (VRE) were found. Two or more MDR bacteria strains were recorded for 12.5% of patients. Multivariable analysis revealed geographical region and prior surgery outside Nordic countries as risk factors of MRSA colonisation. Young age (< 6 years old), short time from arrival to first sample, and prior hospitalisation outside Nordic countries were risk factors of ESBL-PE colonisation.ConclusionWe found MDR bacterial colonisation to be common among asylum seekers and refugees arriving from current conflict zones. In particular we found a high prevalence of MRSA. Refugees and migrants should, therefore, be included among risk populations requiring MDR screening and infection control measures at hospitals.

The Feasibility of Venovenous ECMO at Role-2 Facilities in Austere Military Environments.

INTRODUCTION: Venovenous extracorporeal membrane oxygenation (VV-ECMO) has been gaining use to bridge the recovery from acute respiratory distress syndrome (ARDS) refractory to conventional treatment. However, these interventions are often limited to higher echelons of military care. We present a case of lung salvage from severe ARDS in an Afghani soldier with VV-ECMO at a Role-2 (R2) facility in an austere military environment in Afghanistan. CASE: A 25-year-old Afghani soldier presented to an R2 facility with blast lung injury and multiple penetrating injuries following an explosion. The patient underwent immediate damage control laparotomy. The abdomen was left open for subsequent washouts and ongoing resuscitation. Due to his ineligibility for evacuation and worsening ARDS, despite 5 d of conventional ventilation strategies, he was started on VV-ECMO. The patient had immediate improvements in oxygenation, which continued for 10 d. Moreover, he underwent three transportations to the operating room without accidental decannulation or disruption of the VV-ECMO device. Despite significant improvements, the patient expired on postoperative day 15, due to an overwhelming intra-abdominal sepsis. CONCLUSION: As future advancements are sought, VV-ECMO may become a consideration for casualties with severe ARDS at the point of injury and at lower echelons of military care.

Barriers to Accessing Testing and Treatment for Chronic Hepatitis B in Afghan, Rohingyan, and South Sudanese Populations in Australia.

The burden of chronic Hepatitis B (CHB) infection and associated complications such as hepatocellular carcinoma is growing significantly in Australia due to increased migration from countries with a high prevalence of CHB. Significant barriers to screening and engagement with healthcare persist due to stigma and perceptions associated with CHB within these communities. Our study was a pilot intervention aimed at engaging Afghan, Rohingyan, and Sudanese populations into CHB care through an initial needs assessment. Twenty six patients from Afghan, Rohingyan, and Sudanese communities, identified in the Monash Health CHB database, participated in a combination of survey questionnaires and semi-structured interviews. Language and cultural barriers, lack of HBV knowledge, housing and family reunification priorities associated with new settlement, as well as previous experiences of healthcare engagement were all identified as obstacles to accessing CHB care. Healthcare and health promotion workers should be sensitive to the additional health barriers associated with seeking asylum, as these barriers can take priority over the often asymptomatic and chronic nature of CHB. Communities with high prevalence of CHB require culturally relevant education tools delivered at a community level in order to improve their knowledge.

Management of Soft-Tissue and Bone Defects in a Local Population: Plastic and Reconstructive Surgery in a Deployed Military Setting.

OBJECTIVE: Gunshot injuries, blast injuries, and major contusions can cause extensive extremity defects. In countries with damaged or destroyed infrastructure, local national patients with these injuries pose a challenge. Deployed medical facilities of the German Armed Forces provide medical care to these patients as part of their humanitarian activities. Reconstructive techniques, for example, microvascular free tissue transfer, can be used only to a limited extent in such settings, which require safe and simple (outpatient) procedures. The focus of treatment is not on cosmetic aspects but on rapidly restoring function. Low-resource settings require ethical and medical compromises. It is still a topic of the discussion which reconstructive surgical procedures could be performed in a deployment mission and which should be in the portfolio of the deployed surgeon. METHODS: We conducted a retrospective analysis of a sample of 550 patients who received definitive treatment from seven surgeons from a single German Armed Forces hospital during a total of 47 tours of duty (i.e., 94 months) with the International Security Assistance Force in Feyzabad, Kunduz, and Mazar-i-Sharif in Afghanistan. The deployed surgeons (authors) were given an Excel spreadsheet and were asked to enter details on the surgical procedures they had performed in the deployed setting on the basis of operative reports. RESULTS: Local and pedicled flaps were used in 73 cases to cover extensive soft-tissue defects and preserve the affected limbs. Improvised distraction osteogenesis was used in 18 patients to manage large bone defects. In 13 cases, bone defects were temporarily filled with a cement spacer (Masquelet technique). Fourteen patients required a combination of soft-tissue and bone reconstruction. CONCLUSIONS: Simple surgical reconstructive procedures are available that enable surgeons to preserve the shape and function of an injured limb with limited resources. This emphasizes the need either to make these techniques a mandatory part of training not only for surgeons who are deployed to combat zones and disaster areas but also for surgeons working for civilian relief organizations or to ensure that surgical teams are composed in such a way that these techniques are available.

Screening for infectious diseases among asylum seekers newly arrived in Germany in 2015: a systematic single-centre analysis.

OBJECTIVES: During the migrant crisis in 2015, Germany was the largest single recipient of new asylum seekers in Europe. The German asylum law requires a screening examination for certain infectious diseases in asylum seekers upon arrival. The aim of this work was to analyse the rate of certain infectious diseases among asylum seekers screened at a reception centre in Southern Germany. STUDY DESIGN: Retrospective medical record review. METHODS: Medical records of 2602 asylum seekers screened by a local public health authority in Germany in 2015 were systematically analysed. RESULTS: The majority of screened subjects came from Afghanistan and Syria. The mean age was 22.1 (±12.0) years. The majority of subjects were male (75.4%). Most individuals were of normal weight or overweight, more subjects were obese than underweight. A total of 78 (3.9%) individuals were infected with hepatitis B and eight (0.4%) with HIV. In 31 cases, chest radiographs suggested active tuberculosis (1.6%), which was confirmed in four cases (0.2%). The physical examination uncovered 44 (1.7%) cases of scabies, nine (0.3%) cases of lice, eight (0.3%) of upper respiratory tract infections, two (0.1%) of varicella and 13 (0.5%) of other skin infections. CONCLUSIONS: In the majority of subjects none of the screened infectious diseases were found. No evidence was found that the overall prevalence of certain infectious diseases screened for in the present analysis was considerably higher than in previous migration studies.

[Black smoke lung disease ­ a new disease in Sweden]. / Sotrökslunga är en ny sjukdom i Sverige - Exponering för rök från biomassa är orsaken.

Black smoke lung disease - a new disease in Sweden We describe two elderly female patients, immigrants to Sweden from Afghanistan, with intensive longtime exposure to smoke from biomass, and who presented with bronchial stenosis and severe bronchial obstruction. CT and X-ray showed bizarre perihilar infiltrates in the lungs. Bronchoscopy revealed black narrow bronchi with a middle lobe stenosis in one of the patients. These findings indicate the diagnosis bronchial anthracofibrosis (BAF). The here described findings are seen mainly in elderly never-smoking women from developing countries who have spent years cooking food in poorly ventilated kitchens. With increased immigration from these countries such cases will be seen in industrialized countries as well. Active tuberculosis must always be excluded but otherwise no more active investigations such as biopsies are warranted. We suggest that this disease should be termed ¼black smoke disease« to differentiate it from coal workers' pneumoconiosis, silicosis, and other classical occupational diseases which can have similar clinical and radiological pictures. This term is easily understood even by non-medical persons and illustratess both the etiology and the black bronchi.

Management of breast cancer in an Asian man with post-traumatic stress disorder: a case report.

BACKGROUND: Migration to the UK has increased considerably, which is reflected in the diverse multicultural population which includes asylum seekers and economic migrants. Differences in ethnic and cultural values between the host and newcomer populations could impact on effective health care provision, especially in gender-biased conditions such as breast cancer. Breast cancer is rare in men and the diagnosis is often met with disbelief. This case report describes an unusual case of breast cancer in an Afghan man who is an asylum seeker of Asian ethnic origin. CASE PRESENTATION: A focused ethnographic case study and in-depth interview was used to gain qualitative data and insight into the personal experiences of a male Afghan asylum seeker, age unknown (estimated to be in his 30s), with post-traumatic stress disorder who was electively admitted into hospital for the investigation of a suspicious lump in his left breast, which was subsequently found to be breast cancer. He was extremely reluctant to accept a breast cancer diagnosis and initially would not consent to any treatment, preferring to seek further opinion. During consultation with various members of the breast team he continually declined to accept the diagnosis and felt there was an error in the investigative protocol. Through the involvement of a Muslim nurse, fluent in Urdu and knowledgeable of the Afghan culture and religious background, we learned about his experiences and feelings; he opened up to her about his experiences in Afghanistan, detailing his experiences of trauma as a result of war, and disclosing that he had been diagnosed as having post-traumatic stress disorder by his physician. He saw breast cancer as a "woman's disease" which deeply affected his feelings of masculinity and left him feeling vulnerable. CONCLUSIONS: While sensitivity is undoubtedly required when diagnosing gender-biased conditions such as breast cancer in men, our experience showed this is exacerbated in ethnic minority groups where language barriers often exist and awareness of cultural differences is required. Awareness of the possibility of post-traumatic stress disorder in migrant populations from conflict-torn areas is also recommended during consultation.

Prevalence of Giardia intestinalis and Hymenolepis nana in Afghan refugee population of Mianwali district, Pakistan.

BACKGROUND: Present study aimed to investigate prevalence of Giardia intestinalis and Hymenolepis nana in Afghan refugees visiting Central Health Unit (CHU), Kot Chandana (Mianwali, Northern Punjab) during two years period (February 2007 to December 2009). METHODS: A total of 687 stool samples were collected from different age groups of both genders. Samples were processed under sterile conditions after gross examination. Microscopic examination was done on same day along with eggs (H. nana), cyst and trophozoites (G. intestinalis) detection after staining. RESULTS: The prevalence of G. intestinalis was significantly higher (x2=59.54, p<0.001) than that of H. nana. Females were found more likely to be infected as compared to males (OR: 1.40, 95% CI=1.03-1.92). Prevalence of both parasites decreased with age and highest prevalence was observed in young individuals belonging to 1-15 years of age group (41.8% and 48.7% respectively for H. nana and G. intestinalis, p<0.001). Abdominal distress (OR: 1.13, 95%CI=0.83-1.53), vomiting (OR: 1.13, 95%CI=1.13-1.81) and rectal prolapse (OR: 4.26, 95%CI=1.38-13.16) were the gastro-intestinal clinical symptoms observed in G. intestinalis. Whereas, bloody diarrhea (OR: 1.56, 95%CI=1.00-2.43) and rectal prolapse (OR: 5.79, 95%CI=1.87-17.91) were associated with H. nana infections. CONCLUSIONS: Intestinal parasitic infections are common among Afghan refugees and serious preventive measures should be implemented to promote the safety and healthy lifestyle of these people.

Developing a culturally competent faith-based framework to promote breast cancer screening among Afghan immigrant women.

For the tens of thousands of Afghan immigrant women currently living in the USA, religious and cultural beliefs can act as a barrier to health care access. Islamic frameworks and men's gatekeeping roles often control women's decision-making power about their health care needs. Gatekeepers, however, can be reconceived as facilitators empowered to protect the well-being of the family, and positive messages within Islam can foster collaborative investment in women's health. Drawing upon a pilot study utilizing community-based participatory research involving the largest Afghan community in the USA, this paper documents the need for culturally sensitive faith-based education to promote breast cancer screening among this growing population.