Obstetric Outcomes of Eritrean Immigrants in Switzerland: A Comparative Study.

Objectives: This study aims to compare obstetric outcomes between Eritrean and Swiss women in Switzerland, focusing on instrumental or surgical interventions and analgesia use. Methods: The study included data from 45,412 Swiss and 1,132 Eritrean women who gave birth in Swiss hospitals (2019-2022). Mixed-effects logistic regression was used to assess the effect of nationality on mode of delivery and analgesia use and multinomial mixed-effects logistic regression to assess the effect of nationality on mode of delivery in women intended for spontaneous vaginal delivery. Results: Compared with Swiss, Eritrean women had a lower rate of primary C-section (Adj. OR 0.73, 95% CI [0.60, 0.89]) but a higher risk of initially planned vaginal deliveries ending in emergency C-section (RRR 1.31, 95% CI [1.05, 1.63]). Eritrean women were less likely to receive epidural analgesia (Adj. OR 0.53, 95% CI [0.45, 0.62]) and more likely to not receive any analgesia (Adj. OR 1.73, 95% CI [1.52, 1.96]). Conclusion: This study reveals disparities in obstetric care, notably in higher emergency C-section rates and lower analgesia use among Eritrean women. For promoting equitable healthcare practices deeper understanding of obstetrics decision-making is needed.

Navigating challenges: a socioecological analysis of sexual and reproductive health barriers among Eritrean refugee women in Ethiopia, using a key informant approach.

OBJECTIVES: The study aimed to explore the experiences and perceptions of healthcare providers (HCPs) regarding the sexual and reproductive health (SRH) challenges of Eritrean refugee women in Ethiopia. DESIGN: A qualitative exploratory design with the key informant approach. SETTING AND PARTICIPANTS: The study was conducted in the Afar regional state, North East, Ethiopia. The study participants were HCP responsible for providing SRH care for refugee women. RESULTS: Eritrean refugee women have worse health outcomes than the host population. The SRH needs were found to be hindered at multiple layers of socioecological model (SEM). High turnover and shortage of HCP, restrictive laws, language issues, cultural inconsistencies and gender inequalities were among the main barriers reported. Complex multistructural factors are needed to improve SRH needs of Eritrean refugee women. CONCLUSIONS: A complex set of issues spanning individual needs, social norms, community resources, healthcare limitations and structural mismatches create significant barriers to fulfilling the SRH needs of Eritrean refugee women in Ethiopia. Factors like limited awareness, cultural taboos, lack of safe spaces, inadequate healthcare facilities and restrictive policies all contribute to the severe limitations on SRH services available in refugee settings. The overlap in findings underscores the importance of developing multilevel interventions that are culturally sensitive to the needs of refugee women across all SEM levels. A bilateral collaboration between Refugees and Returnees Service (RRS) structures and the Asayta district healthcare system is critically important.

Feasibility and acceptability of Problem Management Plus with Emotional Processing (PM+EP) for refugee youth living in the Netherlands: study protocol.

Background: Refugee youth experience hardships associated with exposure to trauma in their homelands and during and after displacement, which results in higher rates of common mental disorders. The World Health Organization (WHO) developed Problem Management Plus (PM+), a non-specialist-delivered brief psychological intervention, for individuals who have faced adversity. PM+ comprises problem-solving, stress management, behavioural activation and strengthening social support. However, it does not include an emotional processing component, which is indicated in trauma-exposed populations. Objective: This pilot randomized controlled trial (RCT) aims to evaluate the feasibility and acceptability of PM+, adapted to Syrian, Eritrean and Iraqi refugee youth residing in the Netherlands, with and without a newly developed Emotional Processing (EP) Module. Methods: Refugee youth (N = 90) between 16 and 25 years of age will be randomized into PM+ with care-as-usual (CAU), (n = 30), PM+ with Emotional Processing (PM+EP) with CAU (n = 30) or CAU only (n = 30). Inclusion criteria are self-reported psychological distress (Kessler Psychological Distress Scale; K10 > 15) and impaired daily functioning (WHO Disability Assessment Schedule; WHODAS 2.0 > 16). Participants will be assessed at baseline, one-week post-intervention and three-month follow-up. The main outcome is the feasibility and acceptability of the adapted PM+ and PM+EP. The secondary outcomes are self-reported psychological distress, functional impairment, post-traumatic stress disorder (PTSD) symptom severity and diagnosis, social support, and self-identified problems. The pilot RCT will be succeeded by a process evaluation including trial participants, participants' significant others, helpers, and mental health professionals (n = 20) to evaluate their experiences with the PM+ and PM+EP programmes. Results and Conclusion: This is the first study that evaluates the feasibility of PM+ for this age range with an emotional processing module integrated. The results may inform larger RCTs and implementation of PM+ interventions among refugee youth. Trial Registration: Registered to Dutch Trial Registry, NL8750, on 3 July 2020. Medical Ethical Committee of the Amsterdam University Medical Centre, location Vrije Universiteit Medical Centre, Protocol ID: 2020.224, 1 July 2020.

Antecedentes: Los jóvenes refugiados experimentan dificultades relacionadas con la exposición al trauma en sus países de origen, tanto durante como después del desplazamiento. Esto resulta en tasas más elevadas de trastornos mentales comunes. La Organización Mundial de la Salud (OMS) desarrolló el programa Enfrentando Problemas Plus (EP+), una intervención psicológica breve brindada por personal no especializado para individuos que han sido expuestos a la adversidad. EP+ abarca la resolución de problemas, el manejo del estrés, la activación conductual y el fortalecimiento del soporte social. Sin embargo, no incluye un componente de procesamiento emocional, el cual es indicado en poblaciones expuestas al trauma.Objetivo: Este piloto de un ensayo clínico controlado y aleatorizado (ECA) tiene como objetivo evaluar la viabilidad y la aceptabilidad de EP+ adaptado para jóvenes refugiados sirios, eritreos e iraquíes que residen en los Países Bajos, con y sin un módulo de Procesamiento Emocional (PE) recientemente desarrollado.Métodos: Se aleatorizará a un grupo de refugiados jóvenes (N= 90) de entre 16 a 25 años a un grupo EP+ con atención habitual (AH), (n= 30), a un grupo EP+ con Procesamiento Emocional (EP+PE) con AH (n= 30), o un grupo de solamente AH (n= 30). Los criterios de inclusión son el completar los cuestionarios de autoreporte de malestar psicológico (Escala de Malestar Psicológico de Kessler; K10 >15) y de deterioro del funcionamiento diario (Cuestionario de Evaluación de la Discapacidad de la OMS; WHODAS 2.0 >16). Los participantes serán evaluados al inicio del estudio, una semana después de la intervención y a los 3 meses del seguimiento. El resultado principal es la viabilidad y aceptabilidad del programa EP+ adaptado y del EP+PE. Los resultados secundarios son el autoreporte de malestar psicológico, la discapacidad funcional, los síntomas de severidad y diagnóstico del trastorno de estrés postraumático (TEPT), el soporte social y los problemas autoidentificados. Luego de concluido el piloto del ECA, se procederá a una evaluación del proceso que incluirá a los participantes del ensayo, a las personas significativas de los participantes, a los colaboradores y a los profesionales de la salud mental (n=20) para evaluar sus experiencias con los programas EP+ y EP+PE.Resultados y conclusiones: Este es el primer estudio que evalúa la viabilidad de EP+ para este grupo de edad y con un módulo integrado de procesamiento emocional. Los resultados pueden brindar información al elaborar ECAs más grandes y a la implementación de intervenciones de EP+ entre jóvenes refugiados.

Haplotype data and forensic evaluation of 23 Y-STR and 12 X-STR loci in eight ethnic groups from Eritrea.

Eritrea is a multi-ethnic country of over 3 million of people consisting of different ethnic groups, having each its own language and cultural tradition. Due to the lack of population genetic data for markers of forensic interest, in this study, we analyzed the genetic polymorphisms of 23 Y-chromosome STR loci and of 12 X-chromosome STR loci in a sample of 255 unrelated individuals from 8 Eritrean ethnic groups, with the aim to generate a reference haplotype database for anthropological and forensic applications. X- and Y-chromosomes markers may indeed offer information especially in personal identification and kinship testing, when relying on the availability of large local population data to derive sufficiently accurate frequency estimates. The population genetic analyses in the Eritrean sample for both the two set of Y- and X-STR markers showed high power of discrimination both at country-based and population levels. Comparison population results highlight the importance of considering the ethnic composition within the analyzed country and the necessity of increasing available data especially when referring to heterogeneous populations such as the African ones.

Type 1 diabetes outcomes of children born in Israel of Eritrean asylum seekers.

AIMS: Disparities in health outcomes in pediatric type 1 diabetes (T1D) based on race/ethnicity and socioeconomic position (SEP) have been reported. We compared T1D characteristics between Eritrean status-less children living in Israel and native-born Israeli children. METHODS: This observational study compared 7 Eritrean and 28 Israeli children (< 8 years old at T1D diagnosis) who were diagnosed in a single diabetes center during 2015-2019. Sociodemographic and diabetes-related data from diagnosis until the last clinic visit were retrieved from their medical files. RESULTS: At diagnosis, the mean age was 4.8 ± 2.2 years, 17 (48.6%) had diabetic ketoacidosis with a mean HbA1c level of 10.5 ± 2.1% (91.3 mmol/mol) and 29 (82.9%) had ≥ 2 pancreatic autoantibodies. The mean T1D duration of follow-up was 2.7 ± 1.4 years. Overall glycemic control during follow-up (> 6 months from diagnosis, mean number of samples 10.6 ± 5.2) was good, with mean, best, and peak HbA1c levels of 7.4 ± 0.8% (57.4 mmol/mol), 6.7 ± 0.7% (49.7 mmol/mol), and 8.1 ± 1.1% (65 mmol/mol), respectively. Thirty-two children (91.4%) used continuous glucose monitoring devices (CGMs), and the mean time from diagnosis to CGM initiation was 10.8 ± 14.1 months. CGM metrics: time CGM active: 95.4 ± 3.8%, mean glucose level: 170.0 ± 27.0 mg/dl (9.4 mmol/L), time-in-range: 56.4 ± 14.7%, time-below-range: 5.5 ± 5.7%, and time-above-range: 38.6 ± 16.1%. Diabetes-related parameters at diagnosis and during follow-up were similar between groups. Eritrean children had significantly lower SEPs (P < 0.001) and parental education levels (P < 0.001). Correlations between SEP and diabetes parameters and SEP and growth parameters were not significant. CONCLUSIONS: Eritrean status-less children in Israel achieved glycemic targets similar to those of Israeli children, perhaps reflecting uniformity in the standard of care and CGM usage.

Knowledge, attitudes, beliefs, and stigma related to latent tuberculosis infection: a qualitative study among Eritreans in the Netherlands.

BACKGROUND: Tailored and culturally appropriate latent tuberculosis (TB) infection screening and treatment programs, including interventions against TB stigma, are needed to reduce TB incidence in low TB incidence countries. However, we lack insights in stigma related to latent TB infection (LTBI) among target groups, such as asylum seekers and refugees. We therefore studied knowledge, attitudes, beliefs, and stigma associated with LTBI among Eritrean asylum seekers and refugees in the Netherlands. METHODS: We used convenience sampling to interview adult Eritrean asylum seekers and refugees: 26 semi-structured group interviews following TB and LTBI related health education and LTBI screening, and 31 semi-structured individual interviews with Eritreans during or after completion of LTBI treatment (November 2016-May 2018). We used a thematic analysis to identify, analyse and report patterns in the data. RESULTS: Despite TB/LTBI education, misconceptions embedded in cultural beliefs about TB transmission and prevention persisted. Fear of getting infected with TB was the cause of reported enacted (isolation and gossip) and anticipated (concealment of treatment and self-isolation) stigma by participants on LTBI treatment. CONCLUSION: The inability to differentiate LTBI from TB disease and consequent fear of getting infected by persons with LTBI led to enacted and anticipated stigma comparable to stigma related to TB disease among Eritreans. Additional to continuous culturally sensitive education activities, TB prevention programs should implement evidence-based interventions reducing stigma at all phases in the LTBI screening and treatment cascade.

Pregnancy outcomes in asylum seekers in the North of the Netherlands: a retrospective documentary analysis.

BACKGROUND: With more than 20,000 asylum seekers arriving every year, healthcare for this population has become an important issue. Pregnant asylum seekers seem to be at risk of poor pregnancy outcomes. This study aimed to assess the difference in pregnancy outcomes between asylum seekers and the local Dutch population and to identify potential substandard factors of care. METHODS: Using a retrospective study design we compared pregnancy outcomes of asylum-seeking and Dutch women who gave birth in a northern region of the Netherlands between January 2012 and December 2016. The following data were compared: perinatal mortality, maternal mortality, gestational age at delivery, preterm delivery, birth weight, small for gestational age children, APGAR score, intrauterine foetal death, mode of delivery and the need for pain medication. Cases of perinatal mortality in asylum seekers were reviewed for potential substandard factors. RESULTS: A total of 344 Asylum-seeking women and 2323 Dutch women were included. Asylum seekers had a higher rate of perinatal mortality (3.2% vs. 0.6%, p = 0.000) including a higher rate of intrauterine foetal death (2.3% vs. 0.2%, p = 0.000), higher gestational age at birth (39 + 4 vs. 38 + 6 weeks, p = 0.000), labour was less often induced (36.9 vs. 43.8, p = 0.016), postnatal hospitalization was longer (2.24 vs. 1.72 days p = 0.006) and they received more opioid analgesics (27.3% vs. 22%, p = 0.029). Babies born from asylum-seeking women had lower birth weights (3265 vs. 3385 g, p = 0.000) and were more often small for gestational age (13.9% vs. 8.4%, p = 0.002). Multivariate analysis showed that the increased risk of perinatal mortality in asylum-seeking women was independent of parity, birth weight and gestational age at birth. Review of the perinatal mortality cases in asylum seekers revealed possible substandard factors, such as late initiation of antenatal care, missed appointments because of transportation problems, not recognising alarm symptoms, not knowing who to contact and transfer to other locations during pregnancy. CONCLUSION: Pregnant asylum seekers have an increased risk of adverse pregnancy outcomes. More research is needed to identify which specific risk factors are involved in poor perinatal outcomes in asylum seekers and to identify strategies to improve perinatal care for this group of vulnerable women.

Strategies to reach and motivate migrant communities at high risk for TB to participate in a latent tuberculosis infection screening program: a community-engaged, mixed methods study among Eritreans.

BACKGROUND: In the Netherlands, migrant populations with a high tuberculosis (TB) incidence are an important target group for TB prevention. However, there is a lack of insight in effective community-engaged strategies to reach and motivate these migrants to participate in latent TB infection (LTBI) screening and treatment programs. METHODS: In cocreation with Eritrean key figures and TB staff, we designed and executed six strategies to reach and motivate Eritrean communities to participate in LTBI programs, in five regions in the Netherlands. We registered participation in LTBI education and screening, and LTBI treatment uptake and completion. We used semi-structured group and individual interviews with Eritrean participants, key figures, and TB staff to identify facilitators and barriers. RESULTS: Uptake of LTBI education (13-75%) and consequent screening (10-124%) varied between strategies. LTBI screening uptake > 100% resulted from educated participants motivating others to participate in screening. Two strategies, using face-to-face promotion and targeting smaller groups, were the most successful. The program resulted in high LTBI treatment initiation and completion (both 97%). Reported program barriers included: competing priorities in the target group, perceived good health, poor risk perception, and scepticism towards the program purpose. TB staff perceived the program as useful but demanding in terms of human resources. CONCLUSIONS: Eritrean migrant communities can be successfully reached and motivated for LTBI screening and treatment programs, when sufficient (human) resources are in place and community members, well-connected to and trusted by the community, are engaged in the design and execution of the program.

What are the experiences of education for unaccompanied asylum-seeking minors in the UK?

BACKGROUND: The number of refugees worldwide has increased in recent years, and with this, there has been an increase in the numbers of unaccompanied asylum-seeking minors (UASMs) in the UK. Refugees have been found to experience notable difficulties upon resettlement, and there is evidence to suggest that education can provide a supportive role for young refugees. Although there has been research that has found that UASMs value education, there has been less research that has directly looked at the experiences of education for UASMs. METHODS: In the present study, six UASMs were interviewed and interpretative phenomenological analysis (IPA) was used as a methodology to analyse the data. RESULTS: Five themes were identified: education facilitating socializing; education and English proficiency leading to a better life in the UK; the impact of transitions; the impact of external stressors; and a desire for additional resources to learn at one's own pace. CONCLUSIONS: Participants within the present research expressed a strong desire for additional resources that would allow them to learn at their own pace. They also emphasized how transitions between different settings and external stressors had an impact on their experiences of education. The links between coping strategies and the participant's asylum status are also discussed with reference to relevant research in the field.

Barriers to contraceptive careseeking: the experience of Eritrean asylum-seeking women in Israel.

Objectives: In recent years, there has been a mass migration of Eritreans (many seeking political asylum) into Israel after precarious irregular movement across international borders. This study qualitatively explores the structural barriers to family planning (i.e. contraceptive services) for Eritrean women in Israel that are rooted in their temporary legal status and the patchwork of family planning services.Design/Methods: From December 2012 to September 2013, we interviewed 25 key informants (NGO workers, researchers, Eritrean community activists, International NGO representatives and Ministry of Health officials) and 12 Eritrean asylum seekers. We also conducted 8 focus groups with Eritrean asylum seekers. Data were analyzed using both inductive and deductive coding.Results: We identified 7 main barriers to accessing family planning services: (1) distance to health facilities; (2) limited healthcare resources; (3) fragmentation of the healthcare system; (4) cost of contraceptive services; (5) low standard of care in private clinics; (6) discrimination; and (7) language barriers.Conclusion: The political, economic and social marginalization of Eritrean asylum-seeking women in Israel creates structural barriers to family planning services. Their marginalization complicates providers' efforts (NGO and governmental) to provide them with comprehensive healthcare, and hinders their ability to control their sexual and reproductive health. Failure to act on this evidence may perpetuate the pattern of unwanted pregnancies and social and economic disparities in this population.

The prevalence of iron deficiency anemia among African asylum seeking children residing in Tel Aviv.

BACKGROUND: It has been the impression of pediatricians at the Terem Clinic for African asylum seekers in Tel Aviv that they encounter large numbers of anemic children. The objectives of this study were 1) to quantify the prevalence of anemia among African African asylum seeking children treated in the Terem Clinic for refugees in Tel Aviv; 2) to compare it to the rates among Jewish Israeli children; 3) and to correlate it with their nutritional iron intake. Overall, this effort aims at informing changes in policies and practices that will ensure healthy development of African asylum seeking children in Israel. METHODS: The prevalence of anemia was calculated for all toddlers and children under the age of twelve years visiting the refugee clinic and compared to the recently reported rates of anemia among urban Jewish Israeli children of similar ages; Nutritional iron intake was calculated in a subgroup by a food frequency questionnaire translated to Amharic and Tigrinya. RESULTS: Mean age of the children (SD) was 2.96 yr. (SD 2.77) and mean hemoglobin 10.88 g/dl (1.47). Out of 386 eligible children, 131(34%) were anemic, fourfold more prevalent than reported among 263 Jewish toddlers and young children of the same age group [(11%), OR 4.15(95% ci 2.67-6.43)]. In a subgroup (n = 26) investigated for amount of daily iron intake, 46.2% did not receive the recommended daily allowance for their age. Nine of them had received iron supplements. CONCLUSIONS: Low hemoglobin levels are four-fold more prevalent among the African asylum seeking children. The dietary data suggest iron deficiency as a major cause, although other etiologies need to be ruled out. Because of the adverse long term impact of early anemia on child development, new policies need to be developed to ensure that refugee children develop in a healthy manner. These should include routine mandatory supplements of iron for all refugee children, in parallel to developing an educational program for parents how to achieve iron-sufficient diets for their children. Further research is needed to guide public health action for these children.

[Barriers and facilitators to access to healthcare among asylum seekers from Eritrea and Afghanistan in the canton of Vaud, Switzerland]. / Facilitateurs et barrières pour l'accès aux soins chez les requérants d'asile du canton de Vaud en Suisse et recommandations.

Introduction : In the context of an upsurge in the number of asylum seekers arriving in Switzerland in 2015, caregivers encountered new issues.Background : We lack local studies that simultaneously analyze asylum seekers' experiences of the healthcare system and the perceptions of health professionals in contact with asylum seekers.Objectives : To assess the health problems of this population in order to gain a better understanding of their specific needs and to implement best practice interventions in order to improve access to care and efficiency of care.Methods : A qualitative study with twenty interviews, either one-to-one or in groups, with Eritrean and Afghan ASs, and three focus groups with registered nurses, interpreters, and emergency department professionals.Results : The main results concern access to healthcare in the country of origin, expectations about the living conditions in Switzerland, the effects of migration on health, cultural beliefs on physical health and psychiatry, visits to the emergency department, reasons for missed appointments, and peer support.Discussion : Information, trust, and time are the main issues identified to optimize access to care.Conclusion : Our results allow for a better understanding of specific needs and health interventions for Afghan and Eritrean ASs. Recommendations for practice were issued.

Prevalence of post-traumatic stress disorder, depression and somatisation in recently arrived refugees in Germany: an epidemiological study.

AIMS: Despite recent worldwide migratory movements, there are only a few studies available that report robust epidemiological data on the mental health in recent refugee populations. In the present study, post-traumatic stress disorder (PTSD), depression and somatisation were assessed using an epidemiological approach in refugees who have recently arrived in Germany from different countries. METHODS: The study was conducted in a reception facility for asylum-seekers in Leipzig, Germany. A total of 1316 adult individuals arrived at the facility during the survey period (May 2017-June 2018), 569 of whom took part in the study (N = 67 pilot study and N = 502 study sample; response rate 43.2%). The questionnaire (11 different languages) included sociodemographic and flight-related questions as well as standardised instruments for assessing PTSD (PCL-5), depression (PHQ-9) and somatisation (SSS-8). Unweighted and weighted prevalence rates of PTSD, depression and somatisation were presented stratified by sex and age groups. RESULTS: According to established cut-off scores, 49.7% of the respondents screened positive for at least one of the mental disorders investigated, with 31% suffering from somatisation, 21.7% from depression and 34.9% from PTSD; prevalence rates of major depression, other depressive syndromes and PTSD were calculated according to the DSM-5, which indicated rates of 10.3, 17.6 and 28.2%, respectively. CONCLUSIONS: The findings underline the dramatic mental health burden present among refugees and provide important information for health care planning. They also provide important information for health care systems and political authorities in receiving countries and strongly indicate the necessity of establishing early psychosocial support for refugees suffering from psychological distress.

Perinatal health of refugee and asylum-seeking women in Sweden 2014-17: a register-based cohort study.

BACKGROUND: An increasing number of migrants have fled armed conflict, persecution and deteriorating living conditions, many of whom have also endured risky migration journeys to reach Europe. Despite this, little is known about the perinatal health of migrant women who are particularly vulnerable, such as refugees, asylum-seekers, and undocumented migrants, and their access to perinatal care in the host country. METHODS: Using the Swedish Pregnancy Register, we analyzed indicators of perinatal health and health care usage in 31 897 migrant women from the top five refugee countries of origin between 2014 and 2017. We also compared them to native-born Swedish women. RESULTS: Compared to Swedish-born women, migrant women from Syria, Iraq, Somali, Eritrea and Afghanistan had higher risks of poor self-rated health, gestational diabetes, stillbirth and infants with low birthweight. Within the migrant population, asylum-seekers and undocumented migrants had a higher risk of poor maternal self-rated health than refugee women with residency, with an adjusted risk ratio (RR) of 1.84 and 95% confidence interval (95% CI) of 1.72-1.97. They also had a higher risk of preterm birth (RR 1.47, 95% CI 1.21-1.79), inadequate antenatal care (RR 2.56, 95% CI 2.27-2.89) and missed postpartum care visits (RR 1.15, 95% CI 1.10-1.22). CONCLUSION: Refugee, asylum-seeking and undocumented migrant women were vulnerable during pregnancy and childbirth. Living without residence permits negatively affected self-rated health, pregnancy and birth outcomes in asylum-seekers and undocumented migrants. Pregnant migrant women's special needs should be addressed by those involved in the asylum reception process and by health care providers.

1-year follow-up of the mental health and stress factors in asylum-seeking children and adolescents resettled in Germany.

BACKGROUND: Asylum-seeking children and adolescents (ASCs) who have resettled in Western countries show elevated rates of psychological distress, including Posttraumatic Stress Symptoms (PTSS), depression, and anxiety. Most longitudinal data suggest a relatively stable course of symptoms during the first years in exile. However, no longitudinal examination of the mental health of ASCs, who resettled in Europe in the wake of the 2015-17 European migrant crisis, has been conducted so far. METHODS: A prospective cohort study looked at 98 ASCs who resettled in southern Germany throughout 2015-17. They mainly came from Afghanistan, Syria, Eritrea, and Iraq. Baseline assessments were undertaken 22 months, on average, after resettlement, and follow-up assessments 1 year thereafter. Seventy-two ASCs could be secured for the follow-up. The measures included self-report questionnaires screening for PTSS, depression, anxiety, externalizing behavior, and post-migration factors that were administered in an interview-like setting. Results were analyzed using hierarchical multiple regression analysis. RESULTS: Participating ASCs reported on average eight potentially traumatic experiences and high levels of psychological distress at baseline that had significantly declined at follow-up. At follow-up, rates of clinically significant symptoms ranged from 9.7% (externalizing behavior) to 37.5% (PTSS). There was considerable individual variation in symptom change resulting in multiple mental health trajectories. ASCs whose asylum applications had been rejected presented significantly more symptoms than ASCs whose asylum applications had been accepted between assessments. Baseline psychopathology and asylum status predicted follow-up symptom severity. CONCLUSIONS: In contrast to earlier studies, the symptom severity in this sample of ASCs in Germany ameliorated between assessments. Decisions on the asylum applications of ASCs are thought to contribute to the course of symptoms. Since levels of psychological distress were still high, dissemination and implementation of appropriate treatments for ASCs is crucial.

Seroprotection rates of vaccine-preventable diseases among newly arrived Eritrean asylum seekers in Switzerland: a cross-sectional study.

BACKGROUND: According to 2016 World Health Organization and United Nations Children's Fund country estimates, Eritrea has overall high vaccination coverage with immunization rates for three doses of diphtheria/tetanus/pertussis and polio vaccine of 95%, for two doses measles vaccine of 85% and for three doses hepatitis B vaccine of 85%. If confirmed, this could imply that routine basic vaccination of newly arrived Eritreans could be safely omitted. METHODS: We used stored serum samples from two cross-sectional studies that screened newly arrived Eritrean refugees for infectious diseases. Consenting refugees aged 16 years and older who registered in one of three neighbouring cantons in northwestern Switzerland were enrolled between January 2016 and December 2017. Antibody titers against the following vaccine-preventable diseases were measured (applied thresholds for seroprotection in brackets): diphtheria (>0.1 IU/ml), tetanus (>0.1 IU/ml), measles (>150 mIU/ml), rubella (only for women, >11 IU/ml), varicella (>50 mIU/ml), hepatitis B [hepatitis B surface antigen (HBsAg) Index >0.9, Hepatitis B core antibody (anti-HBc) Index >0.9 and antibodies to HBsAg (anti-HBs) >10 IE/L]. Differences between sex and age groups (≤25 and >25 years) were measured by Fisher's exact test. RESULTS: We analysed samples of 133 study participants (20 women, 15%) with a median age of 25 years (range 16-61). Rates of seropositivity were as follows for women/men, respectively: diphtheria 57.9%/74.8% (difference non-significant), tetanus 94.8%/41.1% (P < 0.001), measles 73.7%/76.6% (non-significant), rubella in women 78.9%, varicella 89.5%/95.3% (non-significant), anti-HBc 15.8%/26.2% (non-significant) and anti-HBs 15.8%/17.8% (non-significant). CONCLUSION: Seroprevalence for vaccine-preventable infections did not meet levels required to confer herd immunity in any of the human-to-human transmissible diseases that were studied. In general, the strategy proposed by the Federal Office of Public Health to offer basic immunization to all newly arrived refugees, including newly arriving Eritrean refugees, is justified.

Validity of the Center for Epidemiologic Studies Depression Scale (CES-D) in Eritrean refugees living in Ethiopia.

BACKGROUND: Depression is among the top mental health problems with a major contribution to the global burden of disease. This study aimed at identifying the latent factor structure and construct validity of the Center for Epidemiologic Studies Depression (CES-D) Scale. PARTICIPANTS AND SETTING: A cross-sectional survey of 562 adults aged 18 years and above who were randomly selected from the Eritrean refugee community living in the Mai-Aini refugee camp, Ethiopia. MEASURES: The CES-D Scale, Primary Care PTSD (PC-PTSD) screener, premigration and postmigration living difficulties checklist, Oslo Social Support Scale (OSS-3), Sense of Coherence Scale (SoC-13), Coping Style Scale and fast alcohol screening test (FAST) were administered concurrently. Confirmatory factor analysis was employed to test prespecified factor structures of CES-D. RESULT: First-order two factors with second-order common factor structure of CES-D (correlated error terms) yielded the best fit to the data (Comparative Fit Index =0.975; root mean square error of approximation=0.040 [90% CI 0.032 to 0.047]). The 16 items defining depressive affect were internally consistent (Cronbach's α=0.932) and internal consistency of the 4 items defining positive affect was relatively weak (Cronbach's α=0.703). These two latent factors have a weaker standardised covariance estimate of 33% (24% for women and 40% for men), demonstrating evidence of discriminant validity. CES-D is significantly associated with measures of adversities, specifically, premigration living difficulties (r=0.545, p<0.001) and postmigration living difficulties (r=0.47, p<0.001), PC-PTSD (r=0.538, p<0.001), FAST (r=0.197, p<0.001) and emotion-oriented coping (r=0.096, p˂0.05) providing evidence of its convergent validity. It also demonstrated inverse association with measures of resilience factors, specifically, SoC-13 (r=-0.597, p<0.001) and OSS-3 (r=-0.319, p<0.001). The two correlated factors model of CES-D demonstrated configural, metric, scalar, error variance and structural covariance invariances (p>0.05) for both men and women. CONCLUSIONS: Unlike previous findings among Eritreans living in USA, second-order two factors structure of CES-D best fitted the data for Eritrean refugees living in Ethiopia; this implies that it is important to address culture for the assessment and intervention of depression.

Assessing the Knowledge, Attitudes, and Behaviors of Hookah Smoking among Ethiopian and Eritrean Americans.

The aims of this study were to estimate the prevalence of hookah smoking and describe its associated knowledge, attitudes, and behaviors among Ethiopian and Eritrean Americans. Approximately 400 participants completed an online survey on hookah tobacco use, perceptions of harm and social acceptability. Nearly 80% had tried hookah in their lifetime (ever users), and about 43% had smoked hookah in the past 30 days (current users). Hookah ever use was highest among people 24-29 years of age, but there were no significant differences by gender, education or employment. Ever users were less supportive of bans on hookah smoking in a bar or restaurant compared with never users, X2 (3, N = 396) = 57.56, p<.001. Additionally, ever users more often reported hookah smoking was less harmful than cigarette smoking compared with never users. Future research is needed to understand the predictors of hookah smoking in this subpopulation and inform interventions.

Violence en route: Eritrean women asylum-seekers experiences of sexual violence while migrating to Israel.

Migrating irregularly, without access to support, may increase female asylum-seekers' vulnerability to sexual violence. In this study, the authors applied a public health lens to explore the risk for sexual violence experienced by female asylum-seekers en route from Eritrea to Israel. The study team conducted 13 in-depth interviews and 8 focus groups with Eritreans in Israel between April and September of 2013. Participants in the study described their experiences occurring in three segments. The combination of irregular movement through dangerous, difficult and often isolated terrain, dependence on human smugglers, and vulnerability to traffickers led to the systematization and normalization of sexual violence en route. Such factors heighten vulnerability to sexual violence among these Eritrean women asylum-seekers, as well as others who find themselves in similar circumstances.