Pediatric Refugee Health and Patterns of Health Care Utilization in Durham, North Carolina.

BACKGROUND: This study explored the health needs, trends of health care utilization, and barriers to care of a diverse population of refugee children resettled in Durham County, North Carolina. METHODS: Researchers conducted a retrospective chart review of 327 pediatric (aged 0-21 years) refugee patients who received care at Lincoln Community Health Center from 2016 to 2018. RESULTS: Results describe a low prevalence of infectious diseases, such as human immunodeficiency virus (0%), hepatitis B (2%), and tuberculosis (5%), but a high prevalence of nutritional problems, such as growth stunting (17%), overweight (21%), Vitamin D insufficiency (79% of the 39 tested), and anemia (13%). Subspecialty care was frequently utilized, despite prolonged appointment delays and frequent missed visits. LIMITATIONS: Limitations of the study included a small sample size that only considered refugees in one geographic area and one primary care clinic, as well as variability in physician documentation. CONCLUSIONS: These findings highlight the need for tailored programs and processes, such as dedicated case management and improved screening practices, in order to facilitate integrated care and promote wellness among this vulnerable group of young refugees.

Developing a Digital Marketplace for Family Planning: Pilot Randomized Encouragement Trial.

BACKGROUND: Family planning is an effective tool for preventing death among women who do not want to become pregnant and has been shown to improve newborn health outcomes, advance women's empowerment, and bring socioeconomic benefits through reductions in fertility and population growth. Yet among the populations that would benefit the most from family planning, uptake remains too low. The emergence of digital health tools has created new opportunities to strengthen health systems and promote behavior change. In this study, women with an unmet need for family planning in Western Kenya were randomized to receive an encouragement to try an automated investigational digital health intervention that promoted the uptake of family planning. OBJECTIVE: The objectives of the pilot study were to explore the feasibility of a full-scale trial-in particular, the recruitment, encouragement, and follow-up data collection procedures-and to examine the preliminary effect of the intervention on contraception uptake. METHODS: This pilot study tested the procedures for a randomized encouragement trial. We recruited 112 women with an unmet need for family planning from local markets in Western Kenya, conducted an eligibility screening, and randomized half of the women to receive an encouragement to try the investigational intervention. Four months after encouraging the treatment group, we conducted a follow-up survey with enrolled participants via short message service (SMS) text message. RESULTS: The encouragement sent via SMS text messages to the treatment group led to differential rates of intervention uptake between the treatment and control groups; however, uptake by the treatment group was lower than anticipated (19/56, 33.9% vs 1/56, 1.8%, in the control group). Study attrition was also substantial. We obtained follow-up data from 44.6% (50/112) of enrolled participants. Among those in the treatment group who tried the intervention, the instrumental variables estimate of the local average treatment effect was an increase in the probability of contraceptive uptake of 41.0 percentage points (95% uncertainty interval -0.03 to 0.85). CONCLUSIONS: This randomized encouragement design and study protocol is feasible but requires modifications to the recruitment, encouragement, and follow-up data collection procedures. TRIAL REGISTRATION: ClinicalTrials.gov NCT03224390; https://clinicaltrials.gov/ct2/show/NCT03224390 (Archived by WebCite at http://www.webcitation.org/70yitdJu8).