Are migrants during the periconception period less likely to be supplementing with folic acid: An Australian cohort study.

BACKGROUND: Folic acid (FA) supplementation before and in early pregnancy is known to improve outcomes such as reducing neural tube defects; however, little is known about groups in Australia at risk of low FA use. AIM: To determine whether differences exist in FA supplementation rates between Australian-born women and migrant women, with a secondary aim of examining the sociodemographic characteristics of women who are not supplementing with FA in early pregnancy. METHODS: A retrospective cohort study from January 2018-July 2022 in a high-migrant population in Western Sydney, Australia. Multivariate logistic regression analysis was conducted adjusting for confounders including place of birth, age, ethnicity, parity, history of diabetes, and type of conception. FINDINGS: There were 48,045 women who met inclusion criteria; 65% of whom were migrants. We identified that 39.4% of the study population did not report FA supplementation by early pregnancy. Women who were migrants were more likely to report FA usage than those born in Australia (aOR 1.24; 95%CI 1.17-1.31). Women least likely to report use of FA were women < 20 years of age (aOR 0.54; 95%CI 0.44-0.67) and multiparous women (aOR 0.84; 95%CI 0.82-0.86). Women with type 1 or type 2 diabetes were more likely to report FA use (aOR 1.66; 95%CI 1.11-2.48, aOR 1.30; 95%CI 1.05-1.61). CONCLUSION: A significant proportion of the population did not report FA supplementation before or during early pregnancy. To increase uptake of FA supplementation, clinicians and public health messaging should target at-risk groups.

Relevance and Feasibility of Group Traumatic Episode Protocol Delivered to Migrants: A Pilot Field Study.

INTRODUCTION: Post-Traumatic Stress Disorder (PTSD) and Major Depressive Disorder (MDD) are commonly observed in migrants. Although Eye Movement Desensitization and Reprocessing (EMDR) can be helpful to treat these diseases, it remains difficult to propose EMDR as an individual intervention in help-seeking migrants. Group EMDR, like Group Traumatic Episode Protocol (G-TEP), which was built around the 8 phases of the original EMDR protocol, could offer an effective treatment to a large number of people. It may also be more resource-efficient to provide psychiatric care to migrants. METHODS: In this open-label trial, the feasibility and the effectiveness of a 6-session G-TEP intervention was investigated in a group of 10 migrants. RESULTS: The intervention was well tolerated by participants. The final attrition rate was 10%. After the intervention, there was a 28.2% significant decrease in PTSD and complex PTSD symptoms, as measured by the International Trauma Questionnaires (total_ITQ) scores (p = 0.013) and a trend towards a significant decrease in MDD symptoms, as measured with the Patient Health Questionnaire (PHQ-9) (p = 0.057). CONCLUSIONS: G-TEP may be effective in decreasing PTSD symptoms in migrants. The accessibility, low-cost, and very structured features of G-TEP may make its implementation sustainable in the field of psychiatric care for migrants.

Holistic approach supporting mental wellbeing of people in enforced quarantine in South Australia during the COVID-19 pandemic.

OBJECTIVES: To report the experience of quarantine for international arrivals to South Australia requiring quarantine in a medi-hotel setting during the COVID-19 pandemic and to describe the range of evidence-based support services to mitigate the mental health impacts of quarantine. METHODS: A range of services targeted at physical and mental wellbeing were provided. Data from 533 adult respondents out of 721 passengers were included. The Kessler 10 was used to measure psychological distress at two time points. RESULTS: About 7.1% of respondents reported psychological distress at time one, reduced to 2.4% at time two. There was no significant difference in psychological distress by gender at either time point. The mean K10 score at time one was 13.6 (standard deviation=5.2) and the mean score at time two was 11.5 (standard deviation=3.1), with a significant reduction in mean scores (p<0.001) between the two time points. CONCLUSIONS: The level of psychological stress in repatriated Australians was low at arrival and improved further at the time of release from quarantine. Implications for public health: A collaborative multi-sector approach to provide support services for individuals in quarantine can mitigate risks to mental wellbeing.

Taking stock of vaccine hesitancy among migrants: a scoping review protocol.

INTRODUCTION: At the 72nd World Health Assembly of May 2019, WHO member states prioritised a global action plan to promote migrant and refugee health. Five months earlier, WHO had declared vaccine hesitancy-the reluctance to vaccinate despite the availability of vaccination services-as one of the top 10 threats to global health. Although vaccination is often a requirement for immigration, repeated outbreaks of vaccine-preventable diseases within certain immigrant communities in some host nations suggest that vaccine hesitancy could be a factor in their susceptibility to vaccine-preventable diseases. Studies of the prevalence and determinants of vaccine hesitancy among migrants globally seem to be lacking. This scoping review will (1) identify articles on vaccine hesitancy among migrants; (2) examine the extent and nature of the extant evidence; and (3) determine the value of undertaking a full systematic review. METHODS AND ANALYSIS: The framework for the scoping review proposed by the Joanna Briggs Institute will be used. The reporting will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. Studies published in English or French between January 1999 and December 2019 will be drawn from most or all of the following multidisciplinary databases: Africa-Wide Information, Allied and Complementary Medicine, Cochrane Library, Cumulative Index of Nursing and Allied Health Literature, Embase, Index Medicus for the Eastern Mediterranean Region, International Bibliography of Social Sciences, Literature in the Health Sciences in Latin America and the Caribbean, Medline, Proquest Theses/Dissertations, PsycInfo and Web of Science. The search will include an extensive list of keywords to capture multiple dimensions of confidence and hesitancy vis-à-vis vaccines among migrants. Findings will be reported through summary narratives, tables, flowcharts and evidence maps. ETHICS AND DISSEMINATION: This review is exempted from ethical approval and will be published in a peer-reviewed open-access journal to ensure wide dissemination.

Current status of the intercultural opening at hospitals and rehabilitation centres for psychosomatic medicine and psychotherapy in Bavaria.

Objectives: Intercultural opening of the health care system is supposed to optimize health services for migrants. It is part of the National Integration Plan and promoted by medical societies in Germany. This study examines its state of implementation at hospitals and rehabilitation centres for psychosomatic medicine and psychotherapy in Bavaria. Methods: A written survey was conducted using a modified version of the questionnaire for the implementation of intercultural opening in the mental health care system IKÖ-P (Penka et al. 2012a). Results: Altogether 18 institutions responded. Migrants were underrepresented among patients and employees excluding physicians. Specialized psychotherapeutic interventions for migrants were rarely available, but frequently used when offered. Conclusions: Intercultural opening was poorly implemented in a structural level. Due to the low response-rate of 21.7 % the survey is not representative. Participation of institutions interested in intercultural opening could have led to biased results. To provide adequate psychosomatic medical care for migrants, intercultural opening should be further developed.

[The perspective of migrants on access to health care in the context of austerity policies in Andalusia (Spain)]. / La perspectiva de personas migrantes sobre el acceso a la atención sanitaria en el contexto de políticas de austeridad en Andalucía.

OBJECTIVE: To conduct an assessment of migrant people regarding their access to the health system following entry into force of Royal Decree-Law 16/2012 along with the impact of economic cuts on such access. METHOD: Qualitative phenomenological study with semi-structured interviews, conducted in Andalusia (Spain), in two phases (2009-2010 and 2012-2013), with 36 participants. The sample was segmented by length of stay, nationality and area of residence. The nationalities of origin are Bolivia, Morocco and Romania. RESULTS: Elements facilitating access in both periods: regular administrative situation, possession of Individual Health Card, knowledge of the language, social networks and information. The results show differences in access to health care for migrants before and after the enforcement of the RDL 16/2012, within austerity policies. In the second period, access barriers such as waiting times or incompatibility of schedules are aggravated and the socio-economic and administrative conditions of participants worsen. CONCLUSIONS: The design of policies, economic and regulatory health care, should take into account barriers and facilitators of access as fundamental main points of health protection for migrants and, therefore, for the general population.

Utilization of healthcare services among Chinese migrants in Kenya: a qualitative study.

BACKGROUND: The number of Chinese migrants in Sub-Saharan Africa (SSA) is increasing, which is part of the south-south migration. The healthcare seeking challenges for Chinese migrants in Africa are different from local people and other global migrants. The aim of this study is to explore utilization of local health services and barriers to health services access among Chinese migrants in Kenya. METHODS: Thirteen in-depth interviews (IDIs) and six focus group discussions (FGDs) were conducted among Chinese migrants (n = 32) and healthcare-related stakeholders (n = 3) in Nairobi and Kisumu, Kenya. Data was collected, transcribed, translated, and analyzed for themes. RESULTS: Chinese migrants in Kenya preferred self-treatment by taking medicines from China. When ailments did not improve, they then sought care at clinics providing Traditional Chinese Medicine (TCM) or received treatment at Kenyan private healthcare facilities. Returning to China for care was also an option depending on the perceived severity of disease. The main supply-side barriers to local healthcare utilization by Chinese migrants were language and lack of health insurance. The main demand-side barriers included ignorance of available healthcare services and distrust of local medical care. CONCLUSIONS: Providing information on quality healthcare services in Kenya, which includes Chinese language translation assistance, may improve utilization of local healthcare facilities by Chinese migrants in the country.

"Living like I am in Thailand": stress and coping strategies among Thai migrant masseuses in Oslo, Norway.

BACKGROUND: Migrants experience stress before, during and after migrating to a new country, all of which influences their mental wellbeing. In Norway, migration from Thailand is highly gendered as most Thai migrants are women who migrate to live with their Norwegian spouse. Massage shops, often owned by Thai entrepreneurs, are a locale where women use their cultural knowledge to bridge into the local economy. There is little knowledge about Thai migrant masseuses' experience of stress in daily life and associated coping strategies. The objective of this inquiry was to examine stressors and coping strategies among Thai migrant masseuses in Oslo, Norway. METHODS: We conducted in-depth interviews with 14 Thai migrants who were working as masseuses in Oslo, Norway. We asked participants about their health, experiences of stress, and coping strategies and subsequently analyzed the data using thematic analysis. RESULTS: Stress in participants' lives related to settling in, loneliness, finances and spousal relationships. Of these, relationship conflict was the largest source of stress. Women largely embraced self-coping strategies and utilized Thai cultural practices and Buddhist cognitive thinking. Once relationship conflict became untenable, participants fought to change their situation. Limited fluency in Norwegian, Thai stigma about mental health and limited knowledge of the Norwegian health system were barriers to seeking healthcare. CONCLUSIONS: Migrants in our study often adopted "Thainess", the use of Thai cultural practices and Buddhist cognitive thinking, as a strategy for coping with stress. Preferences for self-coping, mental health stigma, and linguistic competency are important considerations when designing mental wellbeing interventions for Thai women. Use of an interpreter or systems navigator can help overcome language barriers. Clinicians can take detailed case histories to better understand Thai patients' stress, coping strategies and wellbeing. Health policy makers could consider network approaches, including using Thai health systems navigators to bridge the health system and Thai communities.

Relaxation in the Chinese Hukou System: Effects on Psychosocial Wellbeing of Children Affected by Migration.

The hukou household registration system in China is being relaxed in small and medium-sized cities, which makes it easier for migrant worker parents to take their children with them to cities for work. The aim of this study was determine the potential impact on psychological well-being of this change for children by migration and hukou status. We conducted a cross-sectional survey using the Chinese version of the Strengths and Difficulties Questionnaire (SDQ) in urban and migrant schools in the capital, Hangzhou, and in schools in two rural counties of Zhejiang Province. Completed questionnaires were obtained from 2965 children, aged 10 to 15: 867 urban children with urban hukou, 625 migrant children with rural hukou, 695 rural children with rural hukou living with parents, and 778 left behind children. The crude SDQ scores showed that children directly affected by migration (migrant children and left behind children) were most at risk of psychological problems; urban and rural children living with their parents in their accustomed environment were least vulnerable. After adjustment for confounders, migrant children were the most vulnerable to psychological problems. Given that migration with children is on the increase, efforts should be made to improve conditions in urban areas for these children, and especially to ensure access to urban public schools.

Nomads' perceptions of quality, accessibility, and affordability of health services as determinants of using skilled birth attendants in Gossi, Mali.

AIM: More than half of all maternal deaths worldwide occur in sub-Saharan Africa (SSA). For nomadic pastoralists (30 to 60 million) in SSA, the risk of maternal death is very high because of the low proportion of assisted deliveries in the areas where they live. The objective of this research was to understand the determinants of using skilled birth attendants in relation to the perceptions of quality, geographic accessibility, and financial affordability of health services by nomadic women. METHODS: We used a qualitative research design, inspired by ethnography. Research was conducted in the commune of Gossi (Mali), where 90% of the population is nomadic. The study population consisted of 26 nomadic women living in their camps. Saturation and diversification guided sampling. Semi-structured individual interviews and non-participant observation enabled concomitant data collection. Thematic content analysis was performed using QDA Miner software. RESULTS: Our results show that only 10 women used assisted childbirth for their last delivery. These women thought that health workers were competent and well trained, and they liked the fact that these workers were recruited locally. Similarly, these 10 women deemed the health workers' attitude acceptable and appreciated their availability. In contrast, the majority of participants (16 women) were prevented or discouraged from using skill birth attendants. Some of them did not use them because they were afraid of being undressed, of giving birth on a table, and especially of male staff. They also said that they did not have access to information about health services. In addition, respondents considered health services very difficult to access due to distances, unavailable means of transportation, and costs perceived as being expensive. CONCLUSION: Our results identify several determinants of the use or non-use of skilled birth attendants by nomadic women in relation to the context and way of life. In addition, our findings call for future research to better understand these determinants and to deepen, refine, and test emerging strategies that seem potentially hopeful with respect to facilitating the use of skilled birth attendance in SSA.

La Maison Bleue: Strengthening resilience among migrant mothers living in Montreal, Canada.

INTRODUCTION: La Maison Bleue is a community-based perinatal health and social centre in Montreal that provides services during pregnancy up to age five to families living in vulnerable contexts. The study aimed to describe: 1) the challenges and protective factors that affect the well-being of migrant families receiving care at La Maison Bleue; and 2) how La Maison Bleue strengthens resilience among these families. METHODS: We conducted a focused ethnography. Immigrants, refugees, asylum seekers and undocumented migrants were invited to participate. We collected data from November to December 2017 via semi-structured interviews and participant observation during group activities at La Maison Bleue. Data were thematically analysed. RESULTS: Twenty-four mothers participated (9 interviewed, 17 observed). Challenges to well-being included family separation, isolation, loss of support, the immigration process, an unfamiliar culture and environment, and language barriers. Key protective factors were women's intrinsic drive to overcome difficulties, their positive outlook and ability to find meaning in their adversity, their faith, culture and traditions, and supportive relationships, both locally and transnationally. La Maison Bleue strengthened resilience by providing a safe space, offering holistic care that responded to both medical and psychosocial needs, and empowering women to achieve their full potential towards better health for themselves and their families. CONCLUSION: Migrant mothers have many strengths and centres like La Maison Bleue can offer a safe space and be an empowering community resource to assist mothers in overcoming the multiple challenges that they face while resettling and raising their young children in a new country.

Illness representations and coping practices for self-managing hypertension among sub-Saharan Africans: A comparative study among Ghanaian migrants and non-migrant Ghanaians.

OBJECTIVE: Hypertension (HTN) control is a major obstacle among sub-Saharan African populations partly due to poor self-management. We explored and compared how persons' social and physical context shapes their illness representations regarding HTN and the coping strategies they develop and adapt to mitigate challenges in self-managing HTN. METHODS: A cross sectional multisite qualitative study using semi-structured interviews among 55 Ghanaians with HTN living in The Netherlands and urban and rural Ghana. A thematic approach was used in data analysis. RESULTS: Family HTN history, personal experiences with HTN and outcomes of using biomedical and traditional treatments shaped participants' illness representations and coping strategies. Migrants and urban non-migrants modified medication schedules and integrated taking medication into daily routine activities to cope with experienced side effects of taking antihypertensive medication while rural non-migrants used traditional remedies and medicines to mitigate experienced medication side effects and/or in search for a cure for HTN. CONCLUSION: Contextual factors within participants' social and physical environments shape their illness representations and coping strategies for HTN though interactive phrases. PRACTICE IMPLICATIONS: Health professionals should harness the relationships within peoples' social and physical environments, encourage implementation of family-wide behavioural changes and involve family and communities in HTN treatment to enhance patients' self-management of HTN.

Adapting the 2015 Mother-Baby Friendly Birth Facility Guidelines for Semi-nomadic Pastoralist Communities in Laikipia and Samburu Counties of Kenya.

Purpose To adapt the 2015 International Federation of Gynecologists and Obstetricians (FIGO), International Confederation of Midwives (ICM), White Ribbon Alliance (WRA), International Pediatric Association (IPA), and WHO auspiced Guidelines on Mother-Baby Friendly Facilities to a particular sub-population; seminomadic pastoralist communities of Laikipia and Samburu Counties, Kenya. We anticipate an increased utilization of childbirth services by improving their acceptability. Description We drafted a Pastoralist Friendly Birthing Facility Checklist based on the FIGO/ICM/WRA/IPA/WHO guidelines and previous research in this context. We employed mixed methods to finalise the adaptation: a workshop with 27 local stakeholders; interviews with ten health planners and skilled birth attendants (SBAs); and ten focus group discussions (FGDs) with health committee members, community health workers, mothers and traditional birth attendants (TBAs). A facility audit of dispensaries across five group ranches was also undertaken. Assessment The final Checklist was divided into: characteristics of care and the environment; care during labour and birth; post-partum care; and community staff relationships. It was endorsed by the Ministries of Health in the relevant counties, and by women, SBAs and TBAs. No facility currently satisfies all the criteria specified in the Checklist. Conclusion The FIGO/ICM/WRA/IPA/WHO Guidelines were successfully adapted and can be used to ensure health facilities meet the needs of pastoralist women.

Migrant patients living with HIV/AIDS in Japan: Review of factors associated with high dropout rate in a leading medical institution in Japan.

The present study aimed to identify factors associated with retention in HIV/AIDS care among migrant patients who visited the outpatient clinic of the AIDS Clinical Center, National Center for Global Health and Medicine in Tokyo, Japan. We reviewed the records of 551 selected (78 non-Japanese and 473 Japanese) patients who started visiting our clinic between 2011 and 2014. A total of 390 patients (70.8%: 38 non-Japanese and 352 Japanese) continued their visits during the study: from the date of their first visit to the end of 2015. The difference in retention rate was not significant (Incidence Rate Ratio (IRR) = 0.89, p = 0.27), but the loss-to-follow-up cases were considerably high among non-Japanese patients (n = 13, Incidence rate (IR) = 24.6 per 100,000 person-days, IRR = 3.65, p<0.01 after adjusting for time since diagnosis). The results showed, nevertheless, that there was no apparent association between retention and factors peculiar to non-Japanese. Twelve out of thirteen lost-to-follow-up non-Japanese patients held legal status to reside in Japan and were eligible for public health services. Nine had limited fluency in Japanese language, and six used alternative verbal communication. Further studies are needed to identify the factors responsible for the high dropout rate and to improve the care of migrant patients living with HIV/AIDS.

Medicinal foods and beverages among Maasai agro-pastoralists in northern Tanzania.

ETHNOPHARMACOLOGICAL RELEVANCE: Pastoralist Maasai populations of east Africa use several different wild plants as dietary and medicinal additives in beverages (soups and teas), yet little is known about how the plants used and the rationales for use compare and contrast across different Maasai beverages, including how gender specific dietary and health concerns structure patterns of intake. AIM OF THE STUDY: We investigated three Maasai beverages: almajani (tea or herbal infusion); motorí (traditional soup); and okiti (psychoactive herbal tea). In order to build knowledge about the cultural functions of these Maasai food-medicines and their incidence of use we also investigated use rationales and self-reported frequencies of use. We conclude by examining gender differences and the possible pharmacological antimicrobial activity of the most frequently used plants. MATERIALS AND METHODS: Research was conducted in 2015, with a population of semi-nomadic agropastoralist Maasai residing in northern Tanzania. Data were collected using key informant interviews, plant collections, n = 32 structured surveys, and n = 40 freelist interviews followed by a literature review to determine the known antimicrobial activity of the most used plants. RESULTS: We identified 20 plants that Maasai add to soup, 11 in tea, and 11 in the psychoactive tea, for a total of 24 herbal additives. Seven plant species were used in all three Maasai beverages, and these clustered with 10 common ailments. Based on self-reports, women use the beverages less frequently and in smaller amounts than men. There were also several gender differences in the plants that Maasai add to motorí and their associated use rationales. CONCLUSIONS: There are several intersections concerning the plant species used and their associated rationales for use in almajani, motori, and okiti. Moving outward, Maasai beverages and their additives increasingly involve gender specific concerns. Female use of food-medicines, relative to men, is structured by concerns over pregnancy, birth, and lactation. The frequent consumption of herbal additives, many of which contain antimicrobial compounds, potentially helps modulate infections, but could have other unintentional effects as well.

The midwife-woman relationship in a South Wales community: Experiences of midwives and migrant Pakistani women in early pregnancy.

BACKGROUND: In 2015, 27.5% of births in England and Wales were to mothers born outside of the UK. Compared to their White British peers, minority ethnic and migrant women are at a significantly higher risk of maternal and perinatal mortality, along with lower maternity care satisfaction. Existing literature highlights the importance of midwife-woman relationships in care satisfaction and pregnancy outcomes; however, little research has explored midwife-woman relationships for migrant and minority ethnic women in the UK. METHODS: A focused ethnography was conducted in South Wales, UK, including semi-structured interviews with 9 migrant Pakistani participants and 11 practising midwives, fieldwork in the local migrant Pakistani community and local maternity services, observations of antenatal appointments, and reviews of relevant media. Thematic data analysis was undertaken concurrently with data collection. FINDINGS: The midwife-woman relationship was important for participants' experiences of care. Numerous social and ecological factors influenced this relationship, including family relationships, culture and religion, differing health-care systems, authoritative knowledge and communication of information. Marked differences were seen between midwives and women in the perceived importance of these factors. CONCLUSIONS: Findings provide new theoretical insights into the complex factors contributing to the health-care expectations of pregnant migrant Pakistani women in the UK. These findings may be used to create meaningful dialogue between women and midwives, encourage women's involvement in decisions about their health care and facilitate future midwifery education and research. Conclusions are relevant to a broad international audience, as achieving better outcomes for migrant and ethnic minority communities is of global concern.

Asthma management experiences of Australians who are native Arabic speakers.

OBJECTIVE: The aim of this study was to explore the asthma management experiences of people with asthma within the Arabic-speaking community in Australia. METHODS: Semi-structured interviews guided by a schedule of questions were conducted with 25 Arabic-speaking women with asthma\carer of a child with asthma, recruited from medical practices and community centers in Melbourne, Australia. RESULTS: Twenty-five Arabic-speaking participants with asthma or caring for those with asthma were interviewed. Interviews lasted on average 25 minutes. Most participants or those they were caring for did not have well-controlled asthma. Thematic analyses of the interview transcripts highlighted five key emergent themes: stigma, health literacy, non-adherence, expectations, and coping styles. Findings indicated that many participants were not conversant about local information avenues or healthcare or facilities such as the Asthma Foundation or availability of Arabic translators during general practitioner (GP) consults. Many recent migrants were generally non-adherent with treatment; preferring to follow traditional folk medicine rather than consulting a GP or pharmacist. Some unrealistic expectations from doctors/treatment goals were expressed by a few participants. Some parents of children with asthma reported disappointment with the fact that their children did not grow out of asthma. CONCLUSION: Low health literacy and in particular knowledge about asthma, cultural beliefs, language, and migration-related issues may all be affecting the level of asthma control in the Arabic-speaking population in Australia. Measures to enhance asthma and health system literacy designed to be culturally concordant with the beliefs, expectations, and experiences of such populations may be key to improving asthma management.